At what point does comforting ritual become Obsessive Compulsive Disorder?
By JUDY MONTAGUjack nicholson311(photo credit: courtesy)Obsession: a persistent preoccupation, idea or feeling – Collins English DictionaryThe thing that started me writing these lines was a half-comic, half-serious desire to know why, when I see a roll of toilet paper in its holder, it must unwind down over the front, and not dangle down the back. When I see the latter, it makes me uneasy and I often turn the roll around, even though I may never visit that place again.My curiosity about this predilection was only enhanced when I mentioned it to two or three people – who promptly admitted that they felt compelled to do the exact opposite.“It’s the way it tears off,” explained my friend Sara Schachter. “I also change it around – I have to.”We then waded deeper into the question of obsessive behavior.“You don’t have to look further than the (Jerusalem Sam Orbaum) Scrabble Club,” she observed, wryly. “Those of us who also play on the Internet cannot pass a computer without seeing if someone has made a move.”For many club members, attending every week borders on an obsession: Players will, as far as is humanly possible, schedule events and appointments, even departures abroad, so as to miss as few sessions as they can. Between sessions, they will “obsess” about games lost and opportunities missed.MANY people are obsessive about locking their front doors or turning off their gas burners, and will return home – sometimes more than once – to check that they have done so. Others (mainly women, this one) cannot abide disarray in their kitchens.“I can just about tolerate an unwashed cup if it’s in the sink,” my friend Ella said. “But used dishes lying on the counter-top – that’s intolerable to me. I have to wash them.“Most people clean up after they’re done cooking,” she smiled self-mockingly. “I clean my kitchen – stove-top, counters and sink – before I begin.”
There are those who cannot get into bed if their shoes or slippers aren’t perfectly aligned. Still others – as I learned when I sent out an email to my Post colleagues asking about their idiosyncracies – simply can’t bear it if a picture on the wall or article of furniture in the room isn’t straight.“Sometimes when I am at other people’s houses,” a colleague confessed, “I wait until they leave the room – and then straighten their pictures. A crooked picture will drive me crazy!”Here’s one you might not have heard:“I can’t deal with sticky honey jars. I go nuts when I see people drizzling honey all over the place when they take the spoon out of the jar. I’ve perfected a drizzle-proof method of spooning honey out, and it reached a point where I wouldn’t let guests at my house take their own honey unless they were pros.“I’ve since gotten better about that,” she admitted. “I just breathe deeply and let it go.”THESE sorts of obsessions one can giggle about. But at what point does personal finickiness become the mental problem known as Obsessive Compulsive Disorder, or OCD? It’s when such behavior starts to control one’s life.In the April 20, 2009 issue of Health magazine, Ginny Graves quoted an American freelance writer who has battled the disorder on and off for years:“When it first started, I’d check the locks and stove a few times. As time went by, I started checking more and more things – the iron, the hair dryer, the window-screen locks... dozens of times before leaving for work and before going to bed.“At its worst, the checking and re-checking took three to four hours a day. It became difficult to socialize, because it was exhausting, physically and emotionally.“I would look at a gas burner and see it was off, but the second I looked away a flicker of doubt would enter my brain, and I’d think, Is it really off? Maybe I accidentally bumped it and turned it back on. I wouldn’t feel safe until I checked it again.”Wrote Graves: “We all have our little rituals that give us comfort and help us cope... Some women count to 10 before driving on when the light turns green... kiss their children on the forehead three times every night before bed.“It’s even trendy these days for anyone who’s a neat freak or a little worried about germs to say, “I’m sooo OCD....”In fact,” Graves observed, “nearly half of us do engage in some of the rituals associated with OCD, and some of us have a subclinical version of the disorder.”She quoted Jonathan Abramowitz, director of the University of North Carolina Anxiety Disorders Clinic, who noted: “Almost everyone washes their hands sometimes when they don’t need to,” adding that it would be hard to find someone who hasn’t had an occasional obsession or compulsive urge: unwanted thoughts of something bad happening or the need to check a locked door.But “for most of us, those things don’t cause lots of distress, interfere with our jobs or relationships, or take an inordinate amount of time – and that’s what differentiates people with clinical OCD from everyone else.”One OCD patient rarely left the house, fearing that her germs would make others sick. Another was so worn out by his morning rituals – including making his bed over and over again – that he could barely function during the rest of the day.Sometimes sufferers understand that their obsessions and compulsions are not real. But at other times they may not be sure, or may be convinced they are genuine.TRIGGERED by fears and anxiety, OCD is known as “the doubting disease” because sufferers “cannot be sure of anything,” wrote Jerusalem Post health reporter Judy Siegel-Itzkovich in an August 2, 2009 article, quoting from American psychiatrist and hassidic scholar Abraham Twersky’s preface to Religious Compulsions and Fears: A Guide to Treatment by Jerusalem psychologist and Orthodox rabbi Dr. Avigdor Bonchek.Giving in to their compulsions grants OCD sufferers temporary relief from the anxiety that caused the compulsions in the first place; but the relief doesn’t last, and so the condition is self-perpetuating.“Someone may have washed his hands many times or spent hours in the shower,” Twersky observed, “but still doesn’t feel clean. He may have repeated a word in davening [praying] many times, but may feel it has not been pronounced correctly... An OCD sufferer may take on absurd and totally unnecessary precautions to avoid mixing milk and meat... In short, he is tortured by persistent doubt.”Many ultra-Orthodox Jews exhibit symptoms of OCD – or something very like it – in their excessive cleaning before Pessah.OCD typically appears in early adulthood, sometimes even in childhood.“My daughter won’t eat leftovers, even from the family,” the mother of an OCD sufferer in her mid-20s told me. “Her fear is she will get sick. She is also obsessed by the sell-by dates on foods lest she swallow something ‘tainted.’ “At night her blinds must be tightly closed because the sunshine mustn’t reach her medication.”Bonchek, who has treated a large number of OCD patients, believes that Cognitive Behavior Therapy, sometimes aided by guided imagery, can treat or even cure OCD by helping sufferers gradually “unlearn” their compulsive behaviors and obsessive thoughts.“OCD can seem insurmountable,” one former sufferer, now cured, told me.“But if you can come to believe it isn’t – often with professional help – it gradually becomes conquerable and fades away.”ABOUT the toilet roll having to hang down the “right” way: I cameacross an entire Web discussion dealing with the issue – though Ididn’t find out what I wanted to know, which is why it feels soimportant.Not that everyone agreed it was.“You are kidding, right?” was one comment posted on the site. “That’sone of the funniest and weirdest things I have ever heard of. I don’teven notice, I just do my biz and get out of there.”Added a pragmatist: “I don’t care how it hangs, just as long as it’s not on the floor.”