Will OCD kill me? Will OCD go away? Will OCD send me to hell? Will I ever get better? Are people with OCD dangerous? Could this possibly be linked to the trauma I experienced as a child, teen or young adult?
These are just some of the many questions asked by people (and their family members) with obsessions. Obsessive Compulsive Disorder (OCD) is often the punchline in sitcoms “you’re so OCD” or something said flippantly by someone who is being perfectionistic, “I’m just OCD.”, but for those who actually live with this disorder it can be very disturbing or even take over the person’s (and the family’s) life.
To receive a diagnosis of OCD there needs to be the presence of obsessions, compulsions, or both and to be time consuming:
1. Obsessions are defined as recurrent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. The individual attempts to ignore or suppress such thoughts, urges or images or to neutralize them with some other thought or action.
2. Compulsions are defined as repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
3. Time: The obsessions and compulsions are time consuming (take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
Howie Mandel, the comedian and judge on America’s Got Talent, has spoken openly about what it’s like to live with OCD. Most have been a witness to his compulsion (otherwise known as a ritual) with fist bumps instead of handshakes due to his obsessions with germs. He reports that he has spent hours washing, rubbing and scalding his hands to get his palms clean to his satisfaction—make that his OCD’s satisfaction. And, he says that the obsessions and compulsions go further than that, at times causing him to spend significant time away from his family to perform his rituals (compulsions).
OCD Can Be Frustrating For Everyone
Having a family member with OCD can be quite frustrating and extremely concerning due to the length of time they can spend performing rituals. OCD isn’t something I just combat professionally. I actually have a family member with OCD. So, speaking candidly as family member, I love this person and would do anything for them and yet, I can find myself frustrated because of all the things that need to happen to help them feel supported. Many times, what I view as a simple gathering of family has to be changed or cancelled due to a flair in this person’s symptoms. Or what I hate the most is, we have events without the family member present. Sometimes, we wait for a good amount of time to start dinner while the person is performing their hand washing ritual—or we all start the meal without that person. For my loved one, the OCD is combined with Panic Disorder (we find these diagnoses of OCD and PD combined at an extremely high rate of 13–56%). We have gotten to the point that we cannot discuss doing anything outside this person’s comfort zone. We all avoid certain things to make this person comfortable. The unfortunate part is that we didn’t learn & understand about OCD and how to treat it early enough as a family to get help to change the trajectory of the avoidance & limits on life. We all gave into the OCD and let it run our lives for years because we felt so bad for the person with the anxiety—we were witnesses to how this person was suffering! Now, we are doing better but that struggle is still very real.
People use avoidance as the primary means to “control” OCD. They begin by avoiding small things, and have an instant sense of huge relief when the anxiety, disgust, or guilt decrease. This creates a pattern of behavior to avoid more and more for that immediate relief again. This behavioral loop can be changed! But, first let’s look at the loops you or your family member might be caught up within.
There are many different types of OCD (from Yale-Brown Obsessive-Compulsive Scale “Y-BOCS”):
Obsessions
Aggressive Obsessions (fear that I might harm myself or others; violent or horrific images)
Contamination Obsessions (concerns or disgust with bodily secretions, germs, or dirt)
Sexual Obsessions (forbidden or perverse sexual thoughts, images or impulses)
Hoarding/Saving Obsessions (distinguish from hobbies & concern with objects of monetary or sentimental value)
Religious Obsessions (Scrupulosity); concerned with sacrilege and blasphemy; Excess concern with right/wrong, morality
Obsession with need for symmetry or exactness
Somatic Obsessions (concern with illness or disease)
Compulsions (Rituals)
Cleaning/Washing Compulsions (excessive or ritualized hand washing, showering, bathing, grooming, tooth brushing)
Checking compulsions (checking locks, stove, appliances, food rotting, making a mistake)
Repeating rituals (rereading or rewriting, need to repeat routine—in & out of a door, up & down from chair)
Counting Compulsions
Ordering/Arranging Compulsions
Hoarding/Collecting Compulsions
You Can Overcome OCD
Guess what?! Good news friends, there is something that people with OCD can do! It’s best to find a good combination of treatment that is right for the person. First, be assessed by a good psychiatrist who is very familiar with OCD and all its variations. Be honest with yourself and your helpers/supporters, uncover all the different obsessions and compulsions you experience. Give serious consideration about taking medication.
Second, find a counselor with a great deal of experience assessing and diagnosing people with OCD (you might not actually have OCD—just some symptoms). Communicate honestly with your counselor on all your obsessions and rituals. An experienced therapist will have a good survey or questionnaire to help with the discovery of all the different ways that OCD is trying to control your life. And, that looping we talked about before (avoidance that leads to relief from intense emotions), the therapist and client will start with smaller, less distressing patterns to teach the brain that it’s okay to stop the ritual and if they stop, nothing catastrophic will happen. The person with OCD and their supports/family members need to learn other ways to manage the emotions that might be intensifying the OCD behaviors/symptoms.
Third, the modality of treatment is important. Find counselors who are Certified in Eye Movement Desensitization & Reprocessing (EMDR) and have training in Exposure & Response Prevention (ERP) which is part of the Cognitive Behavior Therapy (CBT) family of modalities. The best way to truly take back control of your mind is through a combination of EMDR, Mindfulness Practice, and ERP. People with OCD tend to struggle the most with the emotions associated with the OCD (anxiety, disgust, guilt, & shame).
For a long time, CBT has been considered the “gold standard” of treatment for most disorders. However, we are finding that in many cases changing a thought or behavior isn’t enough to make someone able to change their brain for long periods of time. This is especially true for those who have experienced adverse childhood events. Dr. John Marr from Finchale Training College in Durham, United Kingdom, has a heart for those with unremitting OCD who have struggled for years receiving unsuccessful treatment for their OCD. He has been combining modalities to bring much longer lasting results with some early success stories. Marr, 2012 wrote about 4 case studies of people with OCD. They all had been treated with ERP alone, and their OCD symptoms had returned. Marr utilized EMDR with all 4 cases and they reported good improvement that were still stable at a 6 month follow up conducted by a different interviewer than Marr.
In simple terms, EMDR for OCD will first focus on the current OCD symptoms that show up in present life by targeting the obsession behavior that is most distressing and having the client imagine the blocking of the compulsion. Then, if there are any memories from childhood or adolescents associated with the initial behaviors of the OCD, the person and their therapist will target those past memories as well. Once both current and past targets are desensitized and reprocessed, the client and therapist can work on any future events that could cause the person to begin to have some OCD symptoms again. The person is asked to “run a video” of the future events. This allows for the most thorough clean out of all the associations for the OCD.
Writer, Stefanie Lyn Kaufman, shared her story of one of her worst OCD memories. Her OCD symptoms arose in a fast food restaurant bathroom and she was paralyzed with her thought cycles about being surrounded by germs. Her teacher had to get her and carry her out of the restaurant. The teachers and coaches treated it as if she had an eating disorder. In this example, her memory of embarrassment and invalidation as well as subsequent memories could become targets for sessions using EMDR for those traumatic events.
If you have heard that EMDR is “only for trauma”, then it would be good for us to be aware of how often PTSD is diagnosed in the same person who has OCD. PTSD and OCD are both anxiety disorders that are commonly diagnosed in people with a history of trauma. Research shows that the likelihood of a person with PTSD developing OCD within a year is about 30 percent. Somewhere between 4% - 22% of people with PTSD also have all the symptoms of OCD.
Still not convinced EMDR could be helpful? If your OCD developed around traumatic event(s) in your life, then using EMDR to reduce your symptoms of PTSD—those flashbacks, nightmares, poor sleep, intense intrusive thoughts/memories, powerful emotions, hypervigilance, inability to concentrate, negative beliefs about self, lack of interest in activities that bring pleasure, feeling of detachment from others…just to name a few—could really improve your life as you know it now.
You Can Find Relief From OCD Symptoms
Friends, if I can pour into your lives and have you take away just one thing, it’s this: OCD will not kill you! Additionally, OCD can go away. OCD will not send you to hell! You will get better—if you do the work. People with OCD are not dangerous! There’s a good chance that your OCD is linked to negative experiences you have had and EMDR can help break that link once and for all.
You can overcome OCD with the help of anxiety therapy. Reach out to my office today to get started.