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The signs and symptoms of OCD are directly related to the thoughts and behaviours that individuals experience. Specific thoughts and behaviours associated with OCD will be unique to everyone, however there are some general types that will be experienced by all; these are wide ranging and when examining them, it is easy to see how they can completely take over an individual’s life.
Examples of thoughts that an individual may include:
- Harming themselves or someone else: Usually by not being careful or because of a loss of control such as actually pushing someone off a train platform or into oncoming traffic.
- Violent: These can be regarding violence in any situation and can cause an individual to believe that they are a dangerous person.
- Religious or blasphemous: These can be very disturbing to someone who is deeply religious and can cause them great distress, such as if they question the existence of a god or think that they will burn down a church with people inside it. Because of this, they may pray excessively or engage in rituals that are prompted by religious fear.
- Sexually intrusive: These may involve thoughts about having sexual relationships with family members or with children, or engaging in violent sexual activities. These thoughts can lead individuals to believe that they are a paedophile or may become a rapist.
- Being contaminated: These are especially strong feelings for individuals who have a fear of germs. They may believe that their house or the people in it are full of illness and disease and as a result they themselves will catch it and may die.
- Fear about something happening if everything isn’t ‘right’: Perfectionism is a common trait of OCD and when someone feels like things are not how they should be, this can lead to obsessive checking behaviours.
- Fear of losing something that might be needed: Many individuals with OCD will repeatedly check that they have their phone, wallets and keys even if they have only just checked seconds before doing it again.
In response to these thoughts, individuals may then carry out one or more of these common compulsive behaviours:
- Excessive checking.
- Counting, tapping or repeating certain words.
- Washing and cleaning.
- Ordering and arranging things.
- Praying excessively.
- Accumulating items that are not needed.
- Checking in on other people multiple times per day.
What does OCD feel like?
Initially, many people do not ‘feel’ anything from their experiences of OCD because they are completely unaware that their behaviour has changed and that they are experiencing signs and symptoms of the condition.
This can be difficult because friends and family may be unsure about how to approach the person about how they are behaving and this may mean that the symptoms go undiagnosed and treatment is not sought as early as it might have been.
When an individual does acknowledge their symptoms, many report that it simply feels as though they are ‘going mad’.
This is because they may be completely out of control of their compulsions, thoughts and rituals and because many of those might be completely out of character for them or be completely irrational, this can make the feelings of ‘madness’ even worse.
For example, someone who feels the need to switch lights on and off eight times before leaving a room or who feels like they have to go back to their house three times on their way to work to check they have locked the door may see these as signs that they are losing their mind.
This can be a very frightening feeling but because their behaviour becomes so strange, they may feel the need to keep it to themselves, which is another factor that can worsen symptoms and make the illness more difficult to treat in the long term.
The fear of someone finding out about their behaviour may leave the individual feeling constantly anxious, which only serves to make the condition worse. Individuals may believe that if someone finds out about their thoughts or sees them carrying out one of their rituals, that they will be taken away and treated against their will.
Many parents and carers think that they will have their children taken from them if they are found to have OCD and this can be a very significant factor in why so many people feel as though they cannot tell anyone about their condition.
It is also common for individuals who have OCD to report feeling completely out of control of their life because it has been consumed by the compulsion to carry out rituals or to avoid places or people who they fear will trigger dysfunctional thoughts.
Many people’s lives will be changed because they can no longer carry out their usual routine or activities because the rituals that they feel the need to do have taken over.
This can make individuals feel embarrassed because they feel that they should be in control of their own life and even more so if someone has had to come and care for them because they can no longer get through a day by themselves. This can then lead to depression, which adds even more problems to the individual’s inability to live the life that they used to.
Anger can be felt by the individual because they become so frustrated at their inability to regain control over their thought patterns and the behaviour that these cause. Anger might also be felt by the people around them who may not understand why they feel the need to behave in the way that they do and think that they are behaving that way on purpose.
Anger often leads individuals to feel resentment of others who do not have OCD, especially in a family where one sibling may wonder why they are the only ones whose life has been changed by an illness that they do not fully understand or cannot comprehend why they are experiencing it.
The types of dysfunctional thoughts that someone has can often lead to them feeling shame, because they may be violent or sexual. For example, someone may have intrusive thoughts about killing their partner or having an affair with a neighbour. Being out of control of what they are thinking means that the thoughts will not go away unless rituals are performed and even then, the thoughts come back and can often get worse in their content if the condition is not treated.
Finally, the need to carry out rituals and avoid certain thoughts or situations can leave the individual feeling exhausted. This will almost certainly have an effect on their overall well being because they may still be unable to sleep because of their levels of anxiety. Exhaustion can have serious effects on someone’s physical health and the link between poor mental health and poor physical health is well established.
Types of OCD
The ‘type’ or ‘category’ of OCD that someone may fall into will depend on the types of behaviours that come about because of intrusive thoughts. Professionals who make a diagnosis of OCD will determine that most individuals will fall into one of the following types or categories:
- Washers: these individuals are afraid of being contaminated and so will spend inordinate amounts of time washing themselves and making sure that their home is so clean that it could not possibly contain any germs. Individuals who are ‘washers’ may avoid other places because they fear that they are not clean enough and so will contaminate them or other people.
- Checkers: these individuals are compelled to check things that may cause them harm over and over again. They will check door locks, windows, ovens, electrical sockets and anything else in the home that might be subject to intrusion, fire or anything else that they associate with danger and harm. Checkers may also continually phone or text their loved ones to make sure that they are safe.
- Doubters and sinners: these individuals are afraid that nothing they do is right or good enough and because of this, they have a persistent fear that they are going to be punished. They may repeatedly seek reassurance that they are doing things well but will not believe the person they have asked, even if that person tell them that everything is fine. This type of behaviour can even lead to an individual mentally correcting their own thoughts, even though no one else can hear what they are thinking. Individuals who fall into this category may pray compulsively to try and save themselves or others from sin.
- Counters and arrangers: these individuals are what other people normally associate with OCD because they have to have things placed symmetrically and in order or they fear that something terrible will happen. They are also likely to be very superstitious about certain colours or numbers and may spend large amounts of time getting things ‘just right’. Individuals who are counters may also find that they repeatedly tap themselves or an object a certain amount of times in order to alleviate a fear.
- Hoarders: these individuals believe that something bad will happen if they throw something out. This can lead to their homes being full of items that they no longer need and it makes their quality of life very poor. In extreme circumstances, individuals who hoard may be unable to throw out their rubbish and so this is left to accumulate and becomes a hazard both to them and to those people around them. Hoarders are also more likely to experience PTSD, compulsive buying or kleptomania although reasons why these should co-occur are not fully understood.
How OCD can affect the individual and their life
When left untreated, it is possible that someone’s life can be completely taken over by OCD and the symptoms that it produces. The main aspect of OCD, which can be all-consuming is the fact that the individual has to partake in so many rituals that their ability to continue their normal activities is taken away. This will impact on their family life, their social activities and any work and school activities, which may also need to be carried out.
For example, someone with OCD may need to check things repeatedly and this may mean that they have to do this dozens of times before that are satisfied that nothing bad will happen and that they can carry on, until next time.
This can take many hours from someone’s day and the thought of not carrying out the rituals is simply not something that they can entertain, as their fear that something bad will happen is so completely devastating.
Someone’s rituals may take up so much of their time, that there will come a point where they may have to give up work or they refuse to go to school because those are places where they cannot perform their rituals in the way in which they would like in order to ease their anxiety.
Some individuals may try and keep their rituals a secret, which can affect their life because they will feel a need to hide themselves away from others, possibly even lie about why they cannot attend a social situation, work or school.
This may lead them to isolation because they are too ashamed to admit what they are doing or, that there is in fact a problem at all. Many individuals will try and convince themselves for as long as they can that what they are doing is perfectly normal so that they do not have to face up to the consequences of what their behaviour is doing to their quality of life.
OCD is commonly linked with agoraphobia, which is a fear of going out somewhere where there may be no escape if someone begins to panic. Since panic disorder and OCD are connected, it is easy to see how someone who is prone to either (or both) may have problems with social situations of any kind.
Physical health issues often develop as a result of OCD and these can affect someone’s life, especially if they too go untreated or unacknowledged. The anxiety of having to carry out rituals is thought to lead to possible heart conditions and the development of stomach ulcers – both of which have been linked to consistently raised levels of anxiety.
Furthermore, those individuals who have hand-washing compulsions are more prone to skin lesions that can become infected and infections may be worse as anxiety can also inhibit the functions of the immune system, meaning that illnesses are much more difficult to fight off.
How OCD can affect others
OCD can be a very difficult condition for others to understand because it is characterised by behaviours that are often completely out of character for those who exhibit them and many go against social norms in specific situations.
For example it is not a social norm for someone to hold a door open with their elbows when entering a room and then washing their hands ten times because they are afraid that the door was contaminated with germs. It is this lack of understanding that may cause other people to stigmatise the individual because they are not aware of the driving forces behind the behaviours being exhibited.
Lack of understanding may cause individuals to lose friendships because others are embarrassed by their behaviour or because they have been told to ‘pull themselves together’ and to ‘get a grip’ – neither of which is useful because it just serves to make the individual feel guilty and ashamed.
Parents may blame themselves if it is their child who has OCD, thinking that they have passed on a ‘faulty gene’ or that their parenting techniques have somehow caused their child to behave in this way. This may lead them to being overprotective of them or it may mean that they cannot face what they feel responsible for and so they avoid their child despite not wanting to actually do this.
Living with a person who has OCD is exhausting and demanding and this can put a strain on relationships because it may feel as though the individual’s need to carry out rituals is taking over everyone else’s life, as well as their own.
It can also be very distressing for other people to see the effects that OCD is having, especially when these are physical, such as if their hands are raw from continual washing or their hair is thinning because it has been subject to being pulled out at times of extreme anxiety. Families will need to be flexible in their routines to accommodate the symptoms of OCD, which may well take some time to manage, even after professional help has been sought.
Social relationships are affected because individuals may be trying to hide their symptoms or they feel that they cannot invent the time in going out because their rituals take precedence in their daily life. Friends may be lost because of this or they may become involved in caring for the individual who they can see has become completely out of control of their own life.
Sometimes the individual may eventually need a carer to do all the activities that they cannot because of rituals. Many carers find their responsibilities difficult to cope with and, as such, begin to feel resentful towards the person who needs care because of the impact that their condition has had on their own life.
Carers need to ensure that they take care of themselves and do not neglect their own lives; they should continue carrying out activities, which bring them enjoyment. Also, they should monitor themselves for any signs of deterioration in their own mental or physical health, which can easily happen when they are so consumed by caring for someone else.