Living with OCD is no laughing matter

Everyone has some obsessive-compulsive behaviors from time to time.

OCD site developer 311 (photo credit: Paul Kitagaki/Sacramento Bee/MCT)
OCD site developer 311
(photo credit: Paul Kitagaki/Sacramento Bee/MCT)
In the 1997 romantic comedy As Good as It Gets, Jack Nicholson portrays Melvin Udall, a romantic novelist who spouts sexist, racist and homophobic remarks during social interactions. The man is very difficult, unfriendly and best left alone, and that is the way he chooses to live his life. He goes to the same restaurant daily for his breakfast and gets waited on by the same waitress, Carol (Helen Hunt). Melvin has to eat food with plastic ware, sit in the same spot, avoid walking on sidewalk cracks and has to do everything five times (wash hands, lock the door, set up piles of paper and more). He wears gloves for everything. When Melvin washes his hands, he throws away the soap. Melvin’s excuse for his behavior is that he’s diagnosed as obsessive-compulsive.
OCD (obsessive-compulsive disorder) is well named, as it is a disorder where people have intrusive obsessions and/or compulsions. The first symptoms of OCD often begin during childhood or adolescence, however the median age of onset is 19. About 2.5 percent of the population will get OCD sometime during their life. It affects both men and women equally and it is prevalent in every country.
Obsessions are ideas, thoughts, images, impulses, etc. that intrude into one’s mind and that are upsetting, such as “I wonder if I left the gas on,” or “Did I lock the door?” Compulsions are things people do often, over and over, in a stereotyped way to reduce their distress. Everyone has some obsessive-compulsive behaviors from time to time and this is quite normal. However, the disorder is diagnosed if a person is suffering from these symptoms and it takes up significant time and energy and/or causes dysfunction.
Psychologists and behavioral scientists are not sure what causes OCD, but there is reason to believe it is partly genetic. What we do know is that contrary to Freudian thinking, it is not caused by bad toilet training. I see the OCD symptoms as an overlearned response to stress that has become a primary mode of behavior. People with OCD usually understand that they have a problem. The trouble is that they can’t control it and it creates havoc in their social and professional lives.
Evidence points to the fact that OCD symptoms tend to intensify when the person is under stress; nevertheless, they remain quite persistent and a central part of a sufferer’s character. Clearly, the OCD person suffers from intrusive thoughts and compulsive behaviors. The individual feels like he/she is out of control.
The treatment of choice for OCD is cognitive- behavioral therapy and relaxation training. Cognitive-behavioral therapy, or CBT, is a treatment method that includes doing things like intentionally exposing a person to what he fears (called exposure) and teaching the individual to try to refrain from carrying out compulsions (called response prevention). This seemingly simple but important act begins to do some very powerful deconditioning in the brain and counteracts OCD overlearned behavior.
In Melvin Udall’s case, a therapist would instruct him to try to tolerate one of his disturbing and irrational beliefs that is always followed by a compulsive behavior, such as “if I don’t use my own plastic spoons, I will become deathly ill from the germs transmitted by my using the restaurant’s silverware.” Within the context of this psychological prescription, Melvin could be taught some deep breathing, a very useful relaxation technique, and introduced to a meditation technique called “mindfulness.”
Mindfulness teaches a person suffering from intrusive and disturbing thoughts or fears how to observe and distance oneself from them, thereby giving the individual more control over dysfunctional thoughts. Response prevention aims at helping the individual to refrain from the usual knee-jerk compulsive behavior and to try to learn firsthand under therapeutic guidance that he/she will not fall apart if the compulsive behavior is not activated. This is a central component of the treatment of OCD and evidence-based research has shown this approach to be highly effective in treating its symptoms.
Contrary to what many would believe, psychiatric medication without psychological treatment has a poor track record in the treatment of OCD. However, when combined with CBT, relaxation training and mindfulness meditation, medication can be a useful adjunct in the treatment of OCD.
The writer is a marital, child and adult psychotherapist practicing in Jerusalem and Ra’anana.