Doubts are more cruel than the worst of truths
I am not a mental health professional merely a sufferer of one of the most debilitating of the category of mental illnesses referred to as anxiety disorders. However in my personal opinion obsessive-compulsive disorder OCD is far more than what is referred to as an anxiety disorder and somehow the term diminishes the all-consuming effects that this illness and other anxiety disorders have upon the sufferer. Yes OCD most certainly causes anxiety, and anxiety is unmistakably one of its main symptoms. However OCD also causes depression, social isolation, extreme fear, feelings of hopeless, a sense of uselessness, profound regret for all the wasted years that it consumes and eventually it may lead to a plethora of psychosomatic disorders. At least that is my experience of this very incapacitating illness. It is a psychological illness with a biological/physical component rather than purely psychological; research suggests that chemical activity in the brain involving the neurotransmitter serotonin may be responsible for OCD. Although I believe the manifestation that it takes is purely psychological and is as unique as is each individual and is dependant upon education, upbringing, culture and eventually ones worldview. There are of course similarities amongst individuals and these can be put into categories, such as contamination OCD, religious/ scrupulosity OCD, checking OCD and so on. But each presentation of OCD is unique to the individual person, no two people present with exactly the same obsessive behaviours and compulsions. Nonetheless people who develop OCD are believed to be born with a genetic predisposition to develop the disorder, it is only the form that it takes that is effected by the circumstance of upbringing and so on.
A diagnosis is based on the presence of two main symptoms, obsessions and compulsions. Although one may be present without the other it is not usual. Other symptoms may be present as a result of OCD such as depression and anxiety. Still other disorders can exist comorbid with OCD, some of the most common are: obsessive-compulsive spectrum disorders OCSDs (consisting of Trichotillomania, Tourett’s syndrome, hypochondriasis, depression, and body dysmorphic disorder BDD), attention deficit disorder ADD and attention deficit hyperactive disorder ADHD and, eating disorders such anorexia nervosa and bulimia and any number of other anxiety disorders such as social phobia and panic disorder.
Obsessions consist of unwanted intrusive and repetitive thoughts and mental images, which consequently lead to compulsions usually to mitigate the effect of the obsessions. For example: An obsession may present the intrusive thought: “my hands are contaminated by germs”, the compulsion than consists of the action of hand washing to remove the perceived contamination which cancels out the anxiety caused by the obsession.
Obsessions are commonly categorised as follows:
Fears of Contamination.
One of the most common OCD obsessions presents as repetitive and intrusive thoughts that the sufferer has been contaminated by germs or toxins, toxins such as those present in general household products or even less commonly accessible toxins such as asbestos. For many sufferers the concern is that once they are contaminated they may as a consequence contaminate others.
Fears of harming others or self
Fears of harming others or ones self fuel most obsessions and compulsions such as the fear of contamination obsession described above. Fear of harming can also present as fears of having inadvertently caused an accident such as running some one over even though all evidence points to the contrary. A mother may be plagued by obsessive fears that she will harm her baby, such as to throw him out of the window, despite the fact that it is not in her nature to do so. Or the sufferer may have fears that he will accidentally stab someone with a knife having experienced an intrusive thought or even visual image of committing such an act, which once again is not in the nature of the sufferer. None of these feared impulses are ever carried out yet the sufferer continues to be tormented by them.
Intrusive offensive thoughts.
Such unwanted thoughts or visual images may concern obsessions that include blasphemous thoughts, fears of shouting obscenities in church and sexual thoughts that are offensive according to the perspective of the sufferer.
Religious obsessions and scrupulosity
Such obsessions may include excessive moral concerns. Religious obsessions may concern intrusive blasphemous thoughts and excessive religious behaviours including a heightened sense of responsibility. It is common amongst many sufferers of OCD to be plagued with doubts concerning moral behaviours and many develop a hypersensitivity about what is right and wrong.
Thoughts may concern superstitious beliefs that certain numbers or colours are unlucky. Obsessions of this nature may eventually be reduced to specific items or places, such as a particular item of clothing is unlucky. Many OCD sufferers of superstitious OCD may have their own unique set of superstitious behaviours and compulsions involving just about anything along with exaggerated concerns and behaviours involving more commonly known superstitious practices.
Obsessions with symmetry
Obsessions of this type concern preoccupations with having things just right such as the need to have pictures hanging straight. Taking extreme concern with orderliness and alignment
Obsessive preoccupation with confessing imaginary sins
May be considered as a component of religious obsessions. It concerns the thought that one has committed a sin and needs to unburden this sin on family, friends or a minister of religion such as a Catholic priest. Such “sins” may be very trifling in nature according to the perspective of most non-sufferers.
Compulsions are commonly categorised as follows:
Washing and cleaning compulsions
This type of compulsion is carried out in an attempt to mitigate or cancel out contamination obsessions. Its most common manifestation is repetitive hand washing; washing rituals are also carried out on the entire body, clothing, crockery, worktops and such like. However virtually anything that can be cleaned may be subjected to compulsive washing rituals. I personally have cleaned car tyres, garden furniture, walls, doors, the cloths line, pegs and so on, the list is potentially endless. Washing compulsions are carried out whenever the sufferer’s mind is beset by obsessive thoughts that he or his personal environment has been contaminated. Sometimes when the condition is severe items that cannot be washed are thrown away. Often washing is supplemented by the use of disinfectant and bleach. However major conflict may arise adding an extra dimension of torment if the sufferer has obsessions concerning contamination by toxins when the impulse arises to use cleaners such as those already mentioned to decontaminate germs. Compulsions increasingly become more frequent and severe as it becomes more and more difficult to quell the anxiety induced by the obsessions that present ever-increasing scenarios of doubt concerning the effectiveness of decontaminating rituals.
Checking compulsions are also carried out to quell the anxiety that arises from obsessive thoughts which cause the sufferer to doubt if he has completed a vital task, for example turned off the gas or locked to door. He may be so anxious as to return time and time again doubting that the task has been completed even though it was carried out only moments earlier. Consequently in severe cases a sufferer may return home after travelling some considerable distance to check that the gas is off and the door is locked. A frequent compulsion amongst sufferers consists of checking letters and any written documents for mistakes or to check that nothing offensive has been written. A common compulsion for motorists with OCD is to keep checking that they have not caused an accident, the sufferer may return again and again to see if there are any injured persons in the road and may even check with the police or hospitals for evidence that they have not caused an accident. As with contamination compulsions checking compulsions grow in frequency and severity as doubt increases requiring more and more time consuming and exhausting checking rituals to subdue the mounting anxiety.
This compulsion presents as an overwhelming impulse to touch certain objects over and over again.
This presents as a compulsive urge to count any collection of items such as books on a shelf, lampposts along the road and so on.
Tidiness/ symmetrical orderliness
Presents as a compulsive urge to have everything aligned just so the most typical example would be the person who continually straightens pictures, has books arranged on his shelf in some specified order, such as in alphabetical order.
A compulsive need to acquire and keep useless objects most common of which are old newspapers. However as time progresses the suffer becomes unable to throw anything away keeping letters, receipts, bills, cloths, furniture occasionally even food or unused medication for years and years. Eventually the home of a sufferer of a hoarding compulsion becomes cluttered, chaotic and a health threat as eventually nothing is discarded.
Praying and confessing
A compulsive need to pray to negate the effects of an imaginary “sinful” thought or action which by normal standards of comparison would not be perceived as such, or to counter act or block out an intrusive blasphemous thought. The compulsive need to confess manifests as an overwhelming impulse to confess imaginary sins and may compel the sufferer to repeatedly confess sins to others that to most people would appear inconsequential and foolish.
The sufferer may avoid unlucky numbers and colours manipulating his activities and environment to avoid interaction with such. Compulsive rituals are carried out to ward of unlucky occurrences. Such rituals may include getting up at exactly the same time of day or going for the same walk each day or touching a certain object. The nature of the superstitious ritual will be unique to each individual sufferer. Anxiety occurs if the rituals are not carried out. I had a ritual of touching wood each time I had a bad thought or whenever a frightening thought came to mind. On some occasions I would just sit and hold a wooden peg and put a peg in my pocket whenever I went out in order to mitigate an unwanted mostly frightening thought. Sometimes when the thoughts came in rapid succession I would have to continually hold the peg concealed in my pocket. At night I would sleep holding the wooden peg for invariably upon waking I would be subjected to frightening or worrying thoughts.
May present as the compulsive need to read the same word or sentence over and over, indeed any action can be involved in this particular compulsion. Often the manifesting compulsion bears no relation to the precipitating obsession. For instance a repeating obsession such as the one mentioned above can be carried out to rid the sufferer from perhaps an intrusive thought of an offensive nature for instance. The sufferer will repeat the action until the thought dissipates.
Other OCD characteristics
In addition suffers of OCD will compulsively be involved in rumination. Such ruminations can be upon profound subjects such as philosophy, religion and the meaning of life. However ruminative contemplation can take the form of very trivial matters such as how long should I brush my teeth. Many hours of such can take place or ruminations can occur in the background whilst the sufferer is involved in other activities or even whilst involved in other obsessive–compulsive behaviours.
Doubt is another characteristic of the OCD sufferer, the French once called OCD la folie de doute the doubting disease. Doubt is the emotion that feeds most obsessive and compulsive behaviours particularly checking and washing compulsions.
Guilt is another characteristic of most OCD sufferers along with feelings of over responsibility, both of these emotions can also provide motivation for obsessive compulsive behaviours.