In this article
Obsessive compulsive disorder (OCD), like many other mental illnesses is often very misunderstood. Most people believe that those who experience it simply have an urge to have things in order or have them very clean, and whilst this is symptomatic of some individuals, it completely undermines how serious and debilitating the condition can be.
The flippancy with which the general population refer to OCD means that it is difficult for individuals to be taken seriously when they have real and serious symptoms. For example, people often refer to having OCD when they like to put things in a neat order or when they like to clean up a single spot of dirt on the floor. This is not OCD in the sense that OCD is a mental illness, as OCD will impact an individual’s ability to go about their normal daily routine; cleaning a single spot of dirt off the floor every now and again will not.
OCD is thought to affect up to around 750,000 people in the UK and it can affect children as well as adults. It is often diagnosed in early adulthood but problems can be identified at any age. Often, the most serious of mental illnesses such as OCD show their first signs during puberty but it is unclear as to what this may be the case.
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.
Causes of OCD
There is little chance of OCD being caused by one single factor and, for this reason, it is important that a number of potential factors are examined to determine what might bring about the onset of the condition. Possible causes can be categorised as:
Signs and symptoms of OCD
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.
- 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.
The cycle of OCD
Any illness, which has the potential to occur in a cycle can become difficult to manage because once a cycle starts, the breaking of it is an action that in itself can cause such distress to an individual that they will try to avoid breaking it at all costs.
In relation to OCD, individuals often feel responsible for preventing terrible events from happening and these can be events that relate to themselves or to other people, for example:
- Staying away from busy roads – “I might push a child into the road”
- Avoiding bacteria – “my sister will die if she gets an infection”
- Not walking on bridges – “I will throw myself over the side”
- Not touching someone who has a cut or graze – “I will contract HIV”.
Once such a thought enters the mind of the individual they become anxious and feel the need to carry out some kind of compulsion to prevent the perceived terrible event from happening and so relieve their anxiety:
- “If I tap my hand 30 times, I won’t push someone into the road.”
- “If I pull out some of my hair, my sister won’t get an infection.”
- “If I pray every day and night, I won’t throw myself off a bridge.”
- “If I clean my hands in bleach, I won’t get HIV”.
Most individuals who are compelled to carry out such rituals are completely aware of how irrational their behaviour is and yet they are powerless to stop themselves because of the relief that they feel in carrying the rituals out and somehow feeling that the ritual has ‘saved’ them or someone else from being involved in a terrible incident.
However, carrying out the ritual does not prevent the intrusive thought from re-occurring and when it does, the individual once again feels compelled to carry out the same ritual.
This is how the cycle of OCD begins and without managing to control the intrusive thoughts, some individuals find that their life can quickly be taken over by carrying out rituals.