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 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.

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