Obsessive-compulsive disorder is a complex condition, as it manifests in varying degrees and the symptoms can be very different in different people. Having said that, there are some traditionally and commonly accepted actions that depict the condition. These are repetitive rituals such as washing hands repeatedly or opening and closing doors, or turning lights off and on.
I have always felt concerned at just how many variations of mental illnesses are misdiagnosed and ascribed to the devil due to a lack of awareness, ignorance, fear and misguided religious beliefs or fervour. I am in no way casting aspersions on religious beliefs or faith but I have met countless people in the course of my career that have overlooked very clear signs of depression, stress and other mental health signals that have led on to more serious problems.
Obsessive-compulsive disorder is traditionally regarded as a neurotic disorder, like phobias and anxiety states. People with this problem can suffer considerable distress and often feel that they are helpless victims. Although neurotic disorders are generally considered to be less handicapping and disabling than psychotic illnesses such as schizophrenia, severe obsessive-compulsive disorder sometimes causes major incapacitation and drastically affects people’s lives.
Broadly speaking, neurotic disorders or neuroses, are relatively minor psychiatric illnesses. The neurotic patient is aware that he has a problem, in other words, they have insight about their condition. Their contact with the outside world is relatively intact. In contrast, psychotic disorders or psychosis are more serious mental illnesses where the patient has broken with reality.
An obsession is an unwanted, intrusive, recurrent, and persistent thought, image or impulse. Obsessions are not voluntarily produced but are experienced as events that invade a person’s consciousness. They can be worrying, repugnant, blasphemous, obscene, nonsensical, or all of these. I have had clients who have had recurrent thoughts that they had one major illness or another and they were consumed by the thoughts (some might describe this as a hypochondriac). Other clients have had recurrent thoughts of hurting a member of their family in the most brutal way. Others have had main features of obsession around cleanliness, with an unbearable and all consuming fear of being contaminated with germs. The most common themes of obsession include: contamination and dirt; disease and illness; death, violence, and aggression; harm and danger; and moral and religious topics. There are also sex-related obsessions.
A compulsion is a repetitive and seemingly purposeful behaviour that is performed according to certain rules or rituals. It may be wholly unacceptable or, more often, partly acceptable. The behaviour is not an end in itself, but is usually intended to produce, or to prevent, some event or situation. The activity however, is not connected in a logistical or realistic way with what it is intended to achieve. For instance, touching the picture of a loved one a certain number of times, in order to ensure that no harm comes to them; or it may be something excessive such as washing hands for half an hour or more at a time to get rid of germs. There are also times when a person engages in the compulsive act simply to ward off great anxiety, or even panic. The person usually recognises the senselessness or irrationality of the behaviour, and does not derive any pleasure from carrying it out, although it provides a release of tension or a feeling of relief in the short term.
As a society that thrives on superstitions, it might be useful to point out the similarities between superstitious ideas and some obsessions and between superstitious acts and compulsive behaviour. Superstitions and certain obsessions are similar in that the person recognises the irrationality of the idea or its associated activity, but prefers to err on the side of caution. Like compulsions, many superstitious acts are carried out in order to prevent a misfortune from happening.
When an obsessive-compulsive person engages in their compulsion, they need to carry it out precisely as they feel it ought to be done. If the behaviour is disrupted, then for many, the compulsive ritual is invalidated and needs to be restarted. For long and complicated rituals, this can be extremely time- consuming and exhausting!
There is a relationship between obsessive-compulsive disorder and obsessional personality (also known as compulsive personality). Obsessional personality characterised in a person includes orderliness, meticulousness, obstinacy, neatness and perfectionism. Many clinicians believe obsessive-compulsive disorder is only an exaggerated stage or version of an obsessional personality. However, from my own personal practice and other colleagues, it is my observation that people with the personality traits are comfortable with them, they seldom cause them distress or they are accompanied by a sense of compulsion and equally rarely provoke resistance.
As with many mental illnesses, there tends not to be unequivocal explanation for why people are affected with the condition. However, there is a consensus that the problems generally begin and develop gradually. The problem gets worse when a person is under stress (that word again!) The onset of the condition can also be sudden and dramatic, following on the heels of a traumatic event. I had a client who developed severe case of the condition related to the fear of illness after undergoing surgery for the removal of a growth. As always there might be some genetic predispositions.
The contents in this column are strictly meant for information purposes. It is not meant in any way to be used to diagnose or to treat any condition. Please seek medical attention if you feel you are affected by anything you have read.
What life has taught me
The gentlest lessons are sometimes the ones that teach us the most
Nothing stays the same, everything must change
I can change how I feel
The mind must be trained to be still
Acknowledgement is the door to healing and growth
All challenging, painful and difficult experiences or relationships, provide us with an opportunity for personal healing
Forgiveness is a powerful act of self love, and the deepest healing occurs when you can forgive
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