|
Doubts are more cruel than the worst of truths
Moliere
I
am not a mental health professional merely a sufferer of one of
the most debilitating of the category of mental illnesses
referred to as anxiety disorders. However in my personal opinion
obsessive-compulsive disorder OCD is far more than what is
referred to as an anxiety disorder and somehow the term
diminishes the all-consuming effects that this illness and other
anxiety disorders have upon the sufferer. Yes OCD most
certainly causes anxiety, and anxiety is unmistakably one of its
main symptoms. However OCD also causes depression, social
isolation, extreme fear, feelings of hopeless, a sense of
uselessness, profound regret for all the wasted years that it
consumes and eventually it may lead to a plethora of
psychosomatic disorders. At least that is my experience of this
very incapacitating illness. It is a psychological illness with
a biological/physical component rather than purely
psychological; research suggests that chemical activity in the
brain involving the neurotransmitter serotonin may be
responsible for OCD. Although I believe the manifestation that
it takes is purely psychological and is as unique as is each
individual and is dependant upon education, upbringing, culture
and eventually ones worldview. There are of course similarities
amongst individuals and these can be put into categories, such
as contamination OCD, religious/ scrupulosity OCD, checking OCD
and so on. But each presentation of OCD is unique to the
individual person, no two people present with exactly the same
obsessive behaviours and compulsions. Nonetheless people who
develop OCD are believed to be born with a genetic
predisposition to develop the disorder, it is only the form that
it takes that is effected by the circumstance of upbringing and
so on.
A
diagnosis is based on the presence of two main symptoms,
obsessions and compulsions. Although one may be present without
the other it is not usual. Other symptoms may be present as a
result of OCD such as depression and anxiety. Still other
disorders can exist comorbid with OCD, some of the most common
are: obsessive-compulsive spectrum disorders OCSDs (consisting
of Trichotillomania, Tourett’s syndrome, hypochondriasis,
depression, and body dysmorphic disorder BDD), attention deficit
disorder ADD and attention deficit hyperactive disorder ADHD
and, eating disorders such anorexia nervosa and bulimia and any
number of other anxiety disorders such as social phobia and
panic disorder.
Obsessions consist of unwanted intrusive and repetitive thoughts
and mental images, which consequently lead to compulsions
usually to mitigate the effect of the obsessions. For example:
An obsession may present the intrusive thought: “my hands are
contaminated by germs”, the compulsion than consists of the
action of hand washing to remove the perceived contamination
which cancels out the anxiety caused by the obsession.
Obsessions are commonly
categorised
as follows:
Fears of Contamination.
One of the most common OCD obsessions presents as
repetitive and intrusive thoughts that the sufferer has been
contaminated by germs or toxins, toxins such as those present in
general household products or even less commonly accessible
toxins such as asbestos. For many sufferers the concern is that
once they are contaminated they may as a consequence contaminate
others.
Fears of
harming others or self
Fears of harming others or ones self fuel most
obsessions and compulsions such as the fear of contamination
obsession described above. Fear of harming can also present as
fears of having
inadvertently
caused an accident such as running some one over even though all
evidence points to the contrary. A mother may be plagued
by obsessive fears that she will harm her baby, such as to throw
him out of the window, despite the fact that it is not in her
nature to do so. Or the sufferer may have fears that he will
accidentally stab someone with a knife having experienced an
intrusive thought or even visual image of committing such an
act, which once again is not in the nature of the sufferer. None
of these feared impulses are ever carried out yet the sufferer
continues to be tormented by them.
Intrusive offensive thoughts.
Such unwanted thoughts or visual images may concern obsessions
that include blasphemous thoughts, fears of shouting obscenities
in church and sexual thoughts that are offensive according to
the perspective of the sufferer.
Religious obsessions and scrupulosity
Such obsessions may include excessive moral concerns. Religious
obsessions may concern intrusive blasphemous thoughts and
excessive religious behaviours including a heightened sense of
responsibility. It is common amongst many sufferers of OCD to be
plagued with doubts concerning moral behaviours and many develop
a hypersensitivity about what is right and wrong.
Superstitious obsessions
Thoughts may concern superstitious beliefs that certain
numbers or colours are unlucky. Obsessions of this nature may
eventually be reduced to specific items or places, such as a
particular item of clothing is unlucky. Many OCD sufferers of
superstitious OCD may have their own unique set of superstitious
behaviours and compulsions involving just about anything along
with exaggerated concerns and behaviours involving more commonly
known superstitious practices.
Obsessions with symmetry
Obsessions of this type concern preoccupations with having
things just right such as the need to have pictures hanging
straight. Taking extreme concern with orderliness and
alignment
Obsessive
preoccupation with confessing imaginary sins
May be considered as a component of religious obsessions. It
concerns the thought that one has committed a sin and needs to
unburden this sin on family, friends or a minister of religion
such as a Catholic priest. Such “sins” may be very trifling in
nature according to the perspective of most non-sufferers.
Compulsions are
commonly categorised as follows:
Washing
and cleaning compulsions
This type of compulsion is carried out in an attempt to mitigate
or cancel out contamination obsessions. Its most common
manifestation is repetitive hand washing; washing rituals are
also carried out on the entire body, clothing, crockery,
worktops and such like. However virtually anything that can be
cleaned may be subjected to compulsive washing rituals. I
personally have cleaned car tyres, garden furniture, walls,
doors, the cloths line, pegs and so on, the list is potentially
endless. Washing compulsions are carried out whenever the
sufferer’s mind is beset by obsessive thoughts that he or his
personal environment has been contaminated. Sometimes when the
condition is severe items that cannot be washed are thrown away.
Often washing is supplemented by the use of disinfectant and
bleach. However major conflict may arise adding an extra
dimension of torment if the sufferer has obsessions concerning
contamination by toxins when the impulse arises to use cleaners
such as those already mentioned to decontaminate germs.
Compulsions increasingly become more frequent and severe as it
becomes more and more difficult to quell the anxiety induced by
the obsessions that present ever-increasing scenarios of doubt
concerning the effectiveness of decontaminating rituals.
Checking compulsions
Checking compulsions are also carried out to quell the anxiety
that arises from obsessive thoughts which cause the sufferer to
doubt if he has completed a vital task, for example turned off
the gas or locked to door. He may be so anxious as to return
time and time again doubting that the task has been completed
even though it was carried out only moments earlier.
Consequently in severe cases a sufferer may return home after
travelling some considerable distance to check that the gas is
off and the door is locked. A frequent compulsion amongst
sufferers consists of checking letters and any written documents
for mistakes or to check that nothing offensive has been
written. A common compulsion for motorists with OCD is to keep
checking that they have not caused an accident, the sufferer may
return again and again to see if there are any injured persons
in the road and may even check with the police or hospitals for
evidence that they have not caused an accident. As with
contamination compulsions checking compulsions grow in frequency
and severity as doubt increases requiring more and more time
consuming and exhausting checking rituals to subdue the mounting
anxiety.
Touching
This compulsion presents as an overwhelming impulse to
touch certain objects over and over again.
Counting
This presents as a compulsive urge to count any
collection of items such as books on a shelf, lampposts along
the road and so on.
Tidiness/
symmetrical orderliness
Presents as a compulsive urge to have everything aligned just so
the most typical example would be the person who continually
straightens pictures, has books arranged on his shelf in some
specified order, such as in alphabetical order.
Hoarding
A compulsive need to acquire and keep useless objects
most common of which are old newspapers. However as time
progresses the suffer becomes unable to throw anything away
keeping letters, receipts, bills, cloths, furniture occasionally
even food or unused medication for years and years. Eventually
the home of a sufferer of a hoarding compulsion becomes
cluttered, chaotic and a health threat as eventually nothing is
discarded.
Praying and confessing
A compulsive need to pray to negate the effects of an
imaginary “sinful” thought or action which by normal standards
of comparison would not be perceived as such, or to counter act
or block out an intrusive blasphemous thought. The compulsive
need to confess manifests as an overwhelming impulse to confess
imaginary sins and may compel the sufferer to repeatedly confess
sins to others that to most people would appear inconsequential
and foolish.
Superstitious compulsions
The sufferer may avoid unlucky numbers and colours manipulating
his activities and environment to avoid interaction with such.
Compulsive rituals are carried out to ward of unlucky
occurrences. Such rituals may include getting up at
exactly the same time of day or going for the same walk each day
or touching a certain object. The nature of the superstitious
ritual will be unique to each individual sufferer. Anxiety
occurs if the rituals are not carried out. I had a ritual of
touching wood each time I had a bad thought or whenever a
frightening thought came to mind. On some occasions I would just
sit and hold a wooden peg and put a peg in my pocket whenever I
went out in order to mitigate an unwanted mostly frightening
thought. Sometimes when the thoughts came in rapid succession I
would have to continually hold the peg concealed in my pocket.
At night I would sleep holding the wooden peg for invariably
upon waking I would be subjected to frightening or worrying
thoughts.
Repeating
May present as the compulsive need to read the same word
or sentence over and over, indeed any action can be involved in
this particular compulsion. Often the manifesting compulsion
bears no relation to the precipitating obsession. For instance a
repeating obsession such as the one mentioned above can be
carried out to rid the sufferer from perhaps an intrusive
thought of an offensive nature for instance. The sufferer will
repeat the action until the thought dissipates.
Other OCD characteristics
In addition suffers of OCD will compulsively be involved in
rumination. Such ruminations can be upon profound subjects such
as philosophy, religion and the meaning of life. However
ruminative contemplation can take the form of very trivial
matters such as how long should I brush my teeth. Many hours of
such can take place or ruminations can occur in the background
whilst the sufferer is involved in other activities or even
whilst involved in other obsessive–compulsive behaviours.
Doubt is another characteristic of the OCD sufferer, the French
once called OCD
la folie de doute the doubting disease. Doubt is the
emotion that feeds most obsessive and compulsive behaviours
particularly checking and washing compulsions.
Guilt is another characteristic of most OCD sufferers along with
feelings of over responsibility, both of these emotions can also
provide motivation for obsessive compulsive behaviours.
Home.
|
