Understanding Obsessive Compulsive Disorder

Understanding OCD: A Brief Tutorial About the Body’s Faulty Warning System

Written by: Sarah Groff, LCMHCS, PhD

When many people think of obsessive-compulsive disorder (OCD), they often picture someone like Jack Nicholson’s character in the opening scenes of As Good as It Gets where he is repeatedly washing his hands with scalding water and multiple bars of soap. Although this represents one type of OCD (contamination type), it is certainly not the only presentation of this condition, nor is it simply about someone being a “germaphobe” or a “clean freak.” While our culture often throws around the term OCD to refer to someone who likes a clean home or workspace or who is particularly organized or planful, the term is far more extensive than this. In this article I will provide a brief description of OCD and some of its many presentations, as well as an explanation for why the body responds this way to certain situations. I will conclude with a few suggestions for coping skills and treatment.

What is OCD?

According to the Diagnostic and Statistical Manual (DSM-5-TR), OCD is a disorder in which both obsessions and compulsions are present. The obsessions are persistent anxious or intrusive thoughts which an individual tries to alleviate by engaging in various types of compulsions designed to reduce the distress associated with these fears. Examples of obsessions include fear of harm (to oneself or another), contamination, or things being uniform (otherwise known as symmetry). Examples of compulsions include, but are not limited to, hand washing, double checking, looping thoughts, assurance seeking, avoidance, praying, or counting. To be diagnosed with OCD, these symptoms must not only be present, but must also cause substantial distress and be significantly time consuming. They also cannot be explained by some other medical or mental health condition.

Types of OCD

This list is not meant to be an exhaustive one of OCD presentations; however, these are some of the more common types:

 

• Harm OCD (Extreme fear of harming oneself or harming another individual. Individuals may fear they are suicidal even when they are not or that they will harm someone else even though they have no ill will toward another person.)

 

• Sexual Orientation OCD (Obsessions about one’s sexuality)

 

• Pedophilia OCD (to be differentiated from pedophilia) (This type of OCD can be particularly distressing to individuals because their obsessions do not reflect their desires.)

 

• Relationship OCD (Inability to tolerate uncertainty of intimate relationships, which leads to incessant questioning of the “rightness” of the relationship.)

 

• “Just Right” OCD (Not necessarily a specific fear, but rather a sense that something “just isn’t right” when not done a certain way.)

 

• Contamination OCD (Fear of getting sick or coming into contact with germs)

 

• Pure-O OCD (This type is somewhat debated, but is used to describe those individuals who do not exhibit visible compulsions; however, compulsions are still present, such as looping or ruminating thoughts.)

 

• Scrupulosity/Religious OCD (Obsessions about violating moral, ethical, or religious beliefs)
  

The Brain’s Faulty Warning System

Oftentimes, OCD is referred to as the brain’s faulty warning system because it perceives a threat when there is none. Although anxie

ty and OCD can be precipitated by an actual event, such as a car accident, this is not always the case. More often than not, the obsessive thoughts are an endless stream of “what if” scenarios that never happen. Biologically, the body is designed to keep us safe and it will go to great lengths to do so. In the brain of someone with OCD, it will engage in a cycle of obsessions and compulsions as a way of maintaining hypervigilance, believing this is what keeps the body safe. The unconscious rationale is that “As long as I continue to think about this thing and keep it at the forefront of my mind, th

en I won’t let my guard down and be hurt.” Because these thoughts are so distressing, however, the body also engages in compulsive behaviors to temporarily alleviate the stress, worry, and fear that come with them. The driver of this whole process is UNCERTAINTY. If the body detects uncertainty, whether false or actual, it will kick the cycle into gear. As mentioned above, for the person struggling with OCD, this can be an extremely debilitating process. The key to OCD recovery is breaking the obsessive-compulsive cycle and going to solution.

Treatment for OCD

There are a variety of effective approaches to treating OCD, including medication, which is necessary for many individuals. With appropriate medication, therapeutic interventions, such as Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) can be highly effective. The primary goal in my work with clients who struggle with OCD is to teach them why their body is responding the way it is, to recognize intrusive thoughts as they arise, and to learn to reassure themselves that they are safe. This involves a client thanking the body for keeping him/her safe and then identifying solutions to do this without the “help” of OCD.

If you or someone who know is struggling with OCD, therapy is an excellent tool for recovery. Please feel free to reach out to our office to schedule a session with one of our many trained and compassionate providers.

 

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Sarah Groff, LCMHCS, PhD is a counselor with Miracles Counseling Centers, Mooresville. She is experienced in supporting blended family systems, and a wide variety of issues, including grief and loss, marriage, divorce, blended families, infertility, parenting, adoption and foster care, depression, anxiety, and work-related stress. She is a passionate advocate in the field of mental health, and a compassionate, insightful support to her clients. 

 

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What does high functioning anxiety or depression look like?

You may have heard people around you using the term “high-functioning” to describe themselves and their mental health. Phrases such as high-functioning anxiety and high-functioning depression are being used more and more, but what do they mean?

High-functioning anxiety and depression are not technically clinical diagnoses because they are not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a handbook used by mental health professionals. However, many practitioners and researchers recognize that people can experience symptoms of anxiety or depression and continue to be highly functioning, productive individuals. Those who have high functioning anxiety or depression may not appear to struggle with it on the surface, despite experiencing symptoms internally. To others, they may seem to have it all together or go about their days as they normally would.

What Does High-Functioning Anxiety Look Like?

People with high-functioning anxiety may experience symptoms of anxiety disorders, such as excessive worrying most days, feelings of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or trouble sleeping. However, these symptoms do not cause significant problems across areas of their lives and do not inhibit daily functioning. Some common characteristics of individuals with high-functioning anxiety include:

• High-achieving, with a fear of failure
• Extremely organized & detail-oriented
• Engages in nervous habits, such as nail-biting, hair twirling, lip biting, leg shaking, etc.
• Perfectionist with a harsh inner critic
• Active & needs to keep “doing,” finding it hard to relax
• Appears calm on the outside, but may have racing thoughts 
• People pleaser who has a hard time saying no
• Procrastinates when stressed 
• Talks a lot or has nervous chatter
• Overthinks and overanalyzes everything
• Difficulty expressing emotions 
• Need for repetitions and reassurance 
• Tendency to dwell on the negative

What Does High-Functioning Depression Look Like?

Similarly to high functioning anxiety, individuals with high-functioning depression may not meet the criteria for a clinical diagnosis of depression, but are able to function normally most of the time. Thus, their depression is often not clear to others or themselves. Typical symptoms of depression would include persistent sad mood, feelings of hopelessness, worthlessness, and/or guilt, loss of interest in hobbies or activities, fatigue, irritability, trouble sleeping, changes in appetite or weight, or thoughts of death or suicide. The following may be characteristic of an individual with high-functioning depression:

• Feeling a little down most of the time
• Poor self-esteem
• Difficulty making decisions
• Low energy and motivation 
• Performs well at school or work, but has difficulty focusing on tasks
• Crying a lot without any concrete reason
• Forcing oneself to engage in social activities when they’d rather withdraw 
• Feeling overwhelmed 
• Feeling lonely 

The Role of Stress

Before determining whether or not you have high-functioning anxiety or depression, it is important to first consider current stressors and evaluate their impact on your life. April is National Stress Awareness Month. We all experience stress in response to challenging circumstances and some times are more stressful than others. This is our body’s normal response. However, if these symptoms persist well beyond a stressful event or are consistent and unrelated to specific stressors, you may be experiencing high-functioning anxiety or depression. 

This truly highlights the importance of good mental health care and scheduling check in’s with a mental health therapist. The opportunity for building insight and awareness of our emotional loads and the management of that load is done best with the help and insight of a professional who can guide you through this. Everyone should consider seeing a therapist! When you are ready to do so, you can visit our therapist’s page to find a clinician who fits you best. 

Sources: nimh.nih.gov, rtor.org, psyccentral.com, waldenu.edu, health.usnews.com, washingtonpost.com

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