Obsessive-compulsive disorder (OCD) is often a private struggle. Kids, youths, and adults alike may not feel comfortable sharing their intrusive thoughts and compulsions. I can speak to this experience firsthand; my child was diagnosed with OCD at 4 years old.
My first role is as a mom, and my second is as a psychologist. What I have learned through my years of professional training and as a mom of a child with a mental health struggle is that finding professionals and programs that support children and families with OCD can be tough and overwhelming. Finding specialized training to help support others with OCD often requires travel to areas where specialists practice.
OCD can cause a great deal of shame and embarrassment for sufferers and their families. Intrusive thoughts or images that the sufferer has can be attached to thoughts and actions that are considered to be taboo. This can lead to an unwillingness to get support or share their concerns with people. The more taboo the obsession, the less likely the individual will reach out for support. Instead, the thoughts and compulsions can be left in the minds of the sufferer, often leading to depression and anxiety.
Obsessive-compulsive disorder is often a private struggle.
Intrusive thoughts range from sexual and violent thoughts to intrusive thoughts of self-harm. There are a variety of subtypes of OCD that are not commonly known to therapists or the general public. Contamination OCD, with handwashing compulsion, is often, erroneously, the archetype of OCD in many people’s minds, but additional subtypes of OCD have been identified through years of research. These include “just right” OCD; harm OCD; scrupulosity; pure OCD, which is obsessions with mental compulsions, not behavioural compulsions; and post/perinatal OCD. Common types of compulsions include checking, contamination, ordering and arranging, repeating, and mental compulsion (visit the International OCD Foundation’s website for more information).
OCD is often incorrectly diagnosed as anxiety, as the sufferer tends to explain their symptoms as worries, and, subsequently, as feelings of anxiety. What differentiates OCD from anxiety is that the intrusive thoughts are typically reinforced by some type of compulsion that temporarily decreases the anxiety, fear, or disgust that the individual experiences.
OCD is often incorrectly diagnosed as anxiety, as the sufferer tends to explain their symptoms as worries, and, subsequently, as feelings of anxiety.
Compulsions can appear to be “healthy” on the surface, but upon closer examination, the compulsion or coping strategy is actually interfering with the individual’s functioning. For example, a 40-year-old man came to see me at my clinic with concerns regarding his thoughts. Helping him explore his thoughts was the key to understanding what his compulsions were. He identified that yoga played a large role in his life and that he used it as a coping strategy. I learned that a previous therapist had wrongly advised him to use coping strategies to decrease his anxiety. As a result, my client spent more than four hours a day engaged in yoga and relaxation strategies to avoid his unwanted thoughts. Anytime he had unwanted and intrusive thoughts, he practiced yoga. The yoga became the tool that he was using to neutralize his fear or discomfort, rather than slowly increasing his tolerance to the unwanted, intrusive thoughts.
It is important for both individuals and professionals to know that there is not always an external compulsion to decrease the anxiety that develops from the obsession. I have supported individuals where they have “Pure-O” – meaning, there are no visible compulsions. Some people may need to repeatedly make comments in their head, count, draw images, or use some other type of internal dialogue such as praying. The compulsions are all cognitive.
How do you know if you may be struggling with OCD?
1. Track your behaviour.
- Is there an image, thought, or behaviour (obsession) that causes some type of negative internal state?
- Do the images, thoughts, or behaviours cause the negative feelings to increase?
- Do you engage in some type of behaviour (including avoidance) or thought to decrease the negative feelings (compulsions)?
- Does the cycle seem to repeat itself because the action, ritual, or routine that you engage in only provides temporarily relief from the negative feeling?
2. Identify if it is anxiety that you are really feeling.
- Is there perhaps fear or disgust that is causing the behaviour?
3. How are you addressing the negative feelings (anxiety, fear, disgust)?
- Are you avoiding certain events, situations, or places?
- For example, are you avoiding knives, areas that are high touch, or places that may trigger the negative feelings (malls, bathrooms, etc.)?
4. Are you adding a behaviour into the chain of events?
- For example, are you engaging in some type of routine or ritual to temporarily decrease the negative feelings that you are experiencing?
- The negative feelings do not need to completely disappear, they simply need to decrease.
5. Do you feel like your rituals or routines increase when there are any changes in your life?
- These changes can be either positive or negative.
6. Are your thoughts unwanted and difficult to manage?
7. Do you feel like, over time, you are spending more time on your rituals or routines?
It is estimated that between 2–3 percent of the worldwide population suffers from OCD, the symptoms of which can have a much more debilitating effect on the sufferers and their families than many other mental health conditions. In fact, the World Health Organization has identified OCD as one of the top 10 most debilitating mental health illnesses, with respect to loss of income and quality of life. Part of the reason for this is that it takes an average of 14 years to receive proper diagnostic identification and treatment. The journey to find appropriate treatment can be disheartening for those who suffer from OCD, as well as their families. “The life of patients with OCD is characterized by more years of disability than that of patients with Multiple Sclerosis and Parkinson’s Disease combined.”
If you answered yes to the questions above, you may want to reach out to an OCD specialist. A specialist who works with exposure and response prevention can help you decrease anxieties related to your obsessions and compulsions. Through practice, you can build up a tolerance to your OCD cycle and hopefully overcome your OCD. To keep any skills fine-tuned, you need to continue to sharpen your skills, and OCD is no different. Lastly, if you feel alone, reach out to many of the online groups for those who experience OCD. You will soon come to realize that OCD is much more common than you thought.
“Our patients all believe that their thoughts are odd or crazy; they are embarrassed by their habits and teased by their friends. They keep their ideas and actions secret; indeed, some become brilliant actors at hiding their thoughts or rituals.”
– Dr. Judith Rapoport, The Boy Who Couldn’t Stop Washing
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