OBSESSIVE COMPULSIVE DISORDER
I receive numerous referrals following ongoing treatment for Obsessive Compulsive Disorder, which I will refer to as OCD because it is much simpler. Individuals with OCD tend to exhibit behaviours that we are all familiar with during certain episodes in our lives. It is a way of dealing with mental and emotional anxiety that can be useful if not used as the predominant and exclusive manner in which we relieve ourselves of stress. In fact, obsessional and compulsive behaviours can be seen as beneficial when trying to cope with uncertain fears, distressing thoughts, or a sense of impending doom. Children may first experience this as they become aware of, or are exposed to, frightening events in life that they do not understand. For instance, a death in the family, break up of a marriage, a frightening experience in the community, or upsetting dream can be too much to handle for a young child. The child might use imagination and fantasy to contrive magical rules about life that may provide him/her with a perceived sense of security and control.
I vividly recall a similar phase in my development in which I was convinced that a nasty witch was climbing up to my bedroom window (which was on the 6th floor) by tying drain plungers onto her feet. Most certainly I was responding to the building’s water pump that became active during the night to deliver fresh water to the water tank on the roof. Fortunately, I had a plan! My collection of devoted and fearless stuffed jungle animals came in handy. Before allowing myself to fall asleep, I positioned the giraffe, with its long neck, at the windowsill as an early warning lookout. The stuffed leopard, with its glowing green eyes, was positioned underneath my bed so that it could pounce to my defence. Finally, the large furry bear (jungle, shmungle) slept by my side. Like an experienced field commander, I made the final check with each of my soldiers before saying my nightly prayer and falling asleep. It became a vital routine with clear procedural rules that needed to be followed perfectly. I am happy to say that my ingenious defence strategy worked. Eventually, I became distracted by other more important issues in my developmental journey and forgot about my little game. Apparently, so did the witch.
At other times you may have felt the need to meticulously organise the workdesk or sock drawer upon dealing with a stressful issue or anxious anticipation. Mostly, however, these strategies are temporary. We move on to more proactive and effective ways of dealing with inner angst. Obsessive Compulsive behaviours, like denial, has its place within a repertoire of coping mechanisms if not used exclusively. For some, alas, that is not the case.
For some individuals, OCD has not only become a way of life, but life itself. The most severe referrals include individuals who have been unable to leave their home for over 20 years. Various treatment techniques using medication, Cognitive Behavioural Therapy (CBT), and group therapy provide some measure of success in many cases. Contemporary research has begun to suggest specific brain structures and neurological transmitters are characteristically altered among individuals with severe OCD. Finally, we have seen a proliferation of self-help books available, which explain and recommend self treatment strategies that have some success with some people. One thing for sure: there is progress and that there are many answers to the same question.
My clinical experience has led me to several conclusions about OCD, which I would like to share with you.
- OCD is a way of coping with an internal distressing thought, emotion, or urge. It provides a false sense of control and security that is achieved mostly through avoidance, denial, and distraction.
- OCD presents much like an addiction. Similar to an individual addicted to alcohol, the urge for that first drink is powerful and frequently overwhelming. It promises immediate relief of internal distress although cognitively the alcoholic realises that this is an illusion and that the inner sense of anxiety, guilt, and lack of control will become worse shortly after succumbing to the urge to drink.
- OCD is a way that the brain provides meaning to underlying anxiety. This is, of course, the main function of the brain: to help us understand our environment in order to maintain balance and ensure survival So, when we experience an undefined sense of anxiety, the brain searches for an explanation in order to direct our reaction and behaviour. If no immediate cause is located, the brain invents a reasonable source of the anxiety, which could be external or internal.
- Individuals with chronic OCD put the cart before the horse. Whereas on most occasions we react to stress when sensing something alarming in the environment, the individual with OCD starts off with the underlying stress (for whatever reason) and then searches for a cause. For that reason, the content of the OCD behaviour (ritualistic counting and hand washing, fear of contamination, etc) is not important. It is the underlying anxiety and the way that we cope with that anxiety which must be addressed.
- We learn negative, avoidant reactions very quickly as opposed to positive behaviours. I have seen this demonstrated in my research with laboratory rats. Teaching a rat to avoid an electric grid is easy, quick and enduring. However, trying to get this unfortunate rat to unlearn this fear is not so easy. Perhaps, we have this defensive mechanism firmly etched from birth. Indeed, there is a small, primitive structure in the brain that is called The Amygdale, which serves as the first port of entry for anything that we perceive or sense. The Amygdale (which is the size of a pecan nut) makes two decisions very quickly: to run or to hide. If neither of these reactions is required, the sensory material continues to other parts of the brain for processing. However, if the Amygdale decides to react in fear or rage, the image is stored so that we do not need to think much about how to react in the future about similar events. This has an obvious value in terms of surviving in a threatening environment, but can be problematic for Humans in a more secure environment.
- CBT approaches to treatment are considered the most effective. Frequently this is true, but not always. My approach to treatment usually includes burning the candle at both ends. In other words, I directly address ways to reduce the distress that is evoked by specific cues or situations, but I also address underlying pervasive anxiety, reasons that the behaviours did not dissipate but became a way of life, and encouragement of positive goals and activities. I have developed a way to incorporate these principles into an integrative treatment programme on the computer, but have yet to find a computer expert willing to implement this. Let me know if you are that person, or know someone who is.