Obsessive-Compulsive Disorder: “An anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviours that make them feel driven to do something (compulsions)” (www.psychologytoday.com).
Obsessive Compulsive Disorder (OCD) has become massively stereotyped, and used colloquially in day-to-day conversation. For example, an individual may prefer their environment to be clean and tidy, but that does not necessarily mean that they are suffering with OCD. Time and time again you hear the term OCD used to describe an individual who likes things to be clean or in a particular order for example, yet this is not necessarily an accurate representation of what OCD is. Granted, these behaviours may be part of an individual’s OCD, but may also simply be a part of a person’s personality that has no mental health implications.
I suppose I am someone that does exhibit some of the stereotypical “OCD behaviours”. I have a particular obsession with germs and illness which has resulted in compulsive hand-washing and avoidance of any potential triggers. This aspect of OCD is present in some, whilst not in others, and is essentially anxiety surrounding contamination. Triggers surrounding this obsession are public toilets, shaking hands, door knobs, bannisters and hospitals (extremely ironic, considering the environment that I work in and plan to work in for the foreseeable). This obsession resulted in a behaviour that is commonly linked with OCD – excessive hand washing. At its worst, I would wash my hands with boiling (yes, literally) hot water every 15 minutes or so. Without access to water and soap, I would carry hand sanitiser with me, which I would apply every 5 minutes. The rationale (if you can call it that) behind my thoughts were that I would be literally burning and scrubbing any germs on my skin that could make me unwell. This clearly links to my emetophobia – the fear of vomit and vomiting – as I was terrified that I would catch a bug of some sort which would make me sick. Thus I would carry out hand washing compulsions, and excessive checking of white meat etc etc to relieve the obsessive thought of vomiting. SPOILER ALERT: It never worked. Sometimes I might calm for 5 minutes, but no longer. Literally no longer. Yet I continued to carry out these compulsions anyway, probably because doing something to control it is better than doing nothing.
With that being said, I also experience other obsessions and compulsions that are less popularised within today’s society. One of these is excessive double checking. Anyone who knows me will know that I am constantly double-checking and ‘fretting’ over mundane things. I think there is a clear cross over here between OCD and generalised anxiety – checking switches are off numerous times, checking and re-checking locks, windows, appliances, lights, car doors etc. Alot of people may experience these obsessions – “Did I definitely lock my car?” – but the key difference is, they can ‘brush off’ this thought and continue their day without disruption, returning to their locked car much later on. OCD prevents the ‘brushing off’ mechanism from activating, thus resulting in excrutiating amounts of checking to calm the obsession. This checking is a compulsion in response to the obsession, offering brief relief from the anxiety the obsession provokes. For myself, the obsessions and compulsions I experience all surround one key component – reassurance. I constantly check, to reassure myself, and bring myself back to a calm state of being (ish). I check not only physical objects, but also times, dates, and locations of events, aswell as whether I am liked/loved/moral.
Additionally, when I was younger I frequently experienced intrusive thoughts. Most common were thoughts of my family dying, contracting illness, and failing exams. Intrusive thoughts could occur at any moment, and therefore I developed some..interesting..compulsions to soothe the anxiety these thoughts caused. Here is a scenario that is very real, and happened frequently:
Intrusive Thought: You’re going to fail all your exams and you will never get anywhere in life.
Intrusive Thought 2: There is something you can do to stop it though. If you get to the top of the stairs in 5 seconds, you wont fail.
So then I’d find myself running as fast as I could to the top of the stairs, counting all the while. Once I reached the top, I would feel calmer, but then sometimes only 2 minutes later another intrusive thought would take its place – “Your family will be hurt if…”. It sounds humorous, because rationally it is clear that reaching the top of the stairs in under 5 seconds has no causal influence on whether I fail my exams or not. I did know that, but if I didn’t carry out the behaviour, the anxiety would just increase until I was forced to carry out another behaviour. Intrusive thoughts are a relatively rare obsession for me now. They mostly occur when I’m anxious about something that I feel is out of my control – exams, illness in myself or those I love, and death. I do still carry out some compulsions related to various obsessions I have, but I’m trying not to be driven by “what ifs”, and I have found that letting go of the phrase “what if” has helped relieve obsessions, compulsions and anxiety.
When the topic of medication came up in a consultation with my doctor, he asked me various questions to assess which SSRI would be best suited. Considering the combination of depression, anxiety and OCD-like tendencies, he concluded that the most suitable medication would be sertraline. Sertraline is, I believe, often given to individuals who complain of obsessions and compulsions, and has a fairly high success rate. I am one of those successes, as since taking sertraline, the obsessions and compulsions that haunted me and disrupted my day-to-day functioning dramatically increased. They are still there, but I have the final say over my behaviour now, and my day is very rarely impacted by the existence of them. Of course, some may not agree that medication is at all beneficial, but for me it is. Perhaps it is a placebo effect, but as long as it is working for me, I’m not sure I mind whether the pill does “work” or if it “doesn’t really work”. As I often try to emphasise, medication alone is not necessarily enough, and I have worked hard to change my thought processes. If I start a sentence with “I’m really worried because…”, I will correct myself and start the sentence again. If someone offers me reassurance, I try my hardest not to respond with “yes but..” or “but what if”.
Sometimes altering your language usage can gradually alter your thought processes. Since cutting out “what ifs”, ive found that I am less likely to give in to obsessions, and I am less likely to let the negative voices in my head answer back when offered reassurances. I do believe medication has helped this, but so has strong will and determination.