It’s a blizzard outside. Roads are treacherous, and the only sound louder than your own heart pounding is the warning broadcast over the radio advising you stay off the streets. At one point or another, many people in this situation have had thoughts about the possibility of getting into a deadly car accident. Eventually, most are able to push this thought out of their minds and get to their destinations as safely and anxiety-free as possible.
For someone with obsessive compulsive disorder, however, that same thought can’t be easily suppressed. The unwanted thoughts or images are experienced as disturbing or distressing; they aren't necessarily triggered by something tangible, such as a blizzard, but rather can occur regularly, particularly during times of stress.
“It's really distressing and painful, because over time and with repeated exposure OCD sufferers start to wonder if are true or mean something,” says Dr. Jessica Mitchell, supervising psychologist at Ontario County Mental Health. “And then they start to feel like a bad person because they're having these bad thoughts or images.”
According to the National Institute of Mental Health, OCD is a common, chronic and long-lasting disorder in which a person has uncontrollable thoughts and behaviors that they feel the urge or need to repeat.
When speaking with a client, Mitchell says she explains that OCD is similar to an anxiety disorder, but is characterized by the presence of either obsessions or compulsions. The obsessions are primarily persistent or reoccurring thoughts, images or urges that the person doesn’t desire. The compulsions are the behaviors or rituals in which the individual engages in an attempt to alleviate the stress caused by the obsession.
"People can have the obsessions, they can have the compulsions, or they can have both and still have OCD,” Mitchell says.
An obsession can be a concern about contracting a serious disease, and the person may feel that can be caused by touching a contaminated surface. This then triggers an excessive amount of anxiety and stress, and the way to suppress it — in their minds — could be by repeated hand washing. Often, though, the obsessions and compulsions become more serious than concerns about germs and repeated hand-washing.
"For some people the obsessions can actually be quite disturbing in terms of thoughts or images,” she says. “We all at some level have these thoughts or images or worries that creep into our minds, but for the most part, we're able to pretty easily push them out of our minds."
Mitchell explains that one of the ways she gauges whether a habit becomes a problem is if the obsession or the compulsion becomes excessively time consuming. If the ritual takes more than an hour, or if the obsession cannot be suppressed over the course of a day or several hours and is causing excessive stress or anxiety, then it is time to seek medical advice.
Causes and Treatment
The exact causes of OCD are unknown, but Mitchell says it tends to be hereditary — similar to anxiety and mental health disorders — and related to communication problems between the frontal lobes and other parts of the brain.
Typically, people start experiencing symptoms of OCD in their teen years, which then escalates as they get older and more stressors enter their life. Traumatic events at a young age can also increase a person’s vulnerability for developing OCD, Mitchell says.
For treatment options, Mitchell says there is strong evidence for cognitive behavioral therapy that focuses on changing the cognitive distortions linked to OCD, and for exposure and response prevention. The treatment works by exposing the person for a period of time, usually gradually starting with thos that cause moderate stress. It could be by having the person imagine not doing a certain ritual for a period of tiem until their anxiety lessens, then working up to not doing their ritual so they can see for themselves that their fears, or the consequences of their thoughts or of not dojng the ritual, are not true.
“A lot of times with anxiety and OCD, worries or fears are exaggerated or magnified, and our emotional experience gets confused with the probability of what things actually occur or 'if I think it, it must be true.' when we get our emotions confused with the probability of what things actually occur. I think with OCD, lot of attention and meaning is attached to the unwanted thoughts or images that can cause a lot of distress."
Mitchell says most people with OCD are aware that what they are thinking or doing is irrational, and that awareness can contribute to the distress.
"They often know what they're doing to suppress or offset their unwanted thoughts doesn't make sense, but that it seems to help in the moment," she says. “But this also maintains it.”
Medication is available as a treatment option for minimizing stress and anxiety. Mitchell says if OCD is left untreated, it can lead to severe depression and anxiety.
“Stress or sadness or even anxiety can wax and wane over time, but for those who don't get treatment for OCD it can become a chronic condition,” she says.
For persons with OCD, or for family and friends who may know someone with symptoms of the disorder, Mitchell urges them not to feel embarrassed, as OCD sufferers often do, and to seek help.
"What I've found with the patients who have OCD, in a lot of ways, they're completely mortified and embarrassed by some of the thoughts that they're having,” she says. “Imagine having to tell someone about those things and being afraid about what that means about them and the type of person they are. I think it is important that people are aware that it's not them — it's really the illness."