The Doubting Illness: Obsessive Compulsive Disorder

By Rene Staskal

Obsessive Compulsive Disorder (OCD) was once thought to be
relatively uncommon, affecting only .5 percent of the adult
population. However, it is now believed that one in every 40 adults
will be affected by OCD in their lifetime. It is also now
recognized that OCD often starts in childhood or adolescence,
affecting one in every 200 children. This makes it the fourth most
common mental illness in the United States. Unfortunately, the
majority of individuals with OCD never receive psychiatric
treatment or only seek treatment after suffering for numerous years
in silence. This is due, in part, to the fact that many individuals
with OCD keep their symptoms a secret because they fear being
labeled as “crazy.” Fortunately, once this stigma is overcome,
there are several effective therapeutic treatments for OCD.

OCD is a brain disorder characterized by obsessions and
compulsions. Obsessions are unwanted thoughts, feelings, or images
that repeatedly intrude upon a person’s mind throughout the day.
The thoughts tend to fall into one of the following categories:
fear of dirt, germs and contamination; fear of acting on violent or
aggressive impulses; feeling overly responsible for the safety of
others; abhorrent, blasphemous religious or sexual thoughts; and an
inordinate concern with order, arrangement, or symmetry.

People who suffer from these obsessions find them frightening,
disgusting, or otherwise unpleasant. It is difficult or impossible
for a person to stop the unwanted obsessions from occurring.
Although individuals are able to perceive their obsessions as
unreasonable, they often cannot escape the doubt the obsession
creates in their mind. For example, if an individual has an
obsessive fear of catching AIDS through touching public door knobs,
he or she may be able to reason that it is impossible to contract
AIDS this way. However, the obsession is so powerful it causes
doubt strong enough to overpower reason and that’s why obsessions
are often kept secret. Individuals are often embarrassed by their
thoughts and are afraid of being labeled as “crazy.” The second
component of OCD is compulsions. Compulsions—often ritualized and
repetitive—are performed to reduce the anxiety caused by an
obsession. Common compulsions include: excessive washing, cleaning,
checking, touching, counting, arranging, ordering, or hoarding.
These behaviors briefly alleviate the distress from obsessions.
Compulsions are not always connected logically to an obsession in
the way that hand-washing rituals are connected to fears of germs.
Additionally, compulsions may turn into mental activities, such as
counting or praying repeatedly as individuals attempt to hide their
behaviors. Although some individuals hide their compulsions, it is
also common for individuals to ask partners or family members to
participate in their rituals. Unfortunately, this often causes
stress in relationships and families.

There are numerous resources available to the growing population
of children and adults with OCD seeking treatment. Most methods of
treating OCD help an individual stand up to his or her obsession
without a compulsive ritual. In exposure-response prevention, the
therapist and client rank the client’s obsessions and associated
compulsions in order of most disturbing to least. Therapy starts
with the client encountering his or her least disturbing obsession
without engaging in the associated compulsion for a given period of
time. For example, an individual who worries about germs may be
asked to sit with dirt on his or her hands for one minute before
washing. This gradual exposure to the feared obsession helps an
individual feel he or she can stand up to intrusive thoughts. There
are also several medications that can be effective for treating
OCD. However, therapy coupled with medication is associated with
the best outcomes.

For more information on OCD please visit the Obsessive
Compulsive Foundation’s website at www.ocfoundation.org. The
foundation’s website has links to local treatment providers and
support groups. Additionally, treatment locally is available at the
Hosford Counseling and Psychological Services Clinic (805-893-8064)
at UC Santa Barbara’s Gevirtz School.

Rene Staskal is a Ph.D. candidate in the Department of
Clinical, Counseling, and School Psychology at the Gevirtz Graduate School of Education
at UC Santa Barbara.