7 Things I Wish People Understood About OCD



mhw2017

Health

Even though I’m not obsessed with monsters under the bed
anymore, when something unpleasant comes up, like getting
called in for jury duty, my mind automatically brings me to
the irrational worst case.

Posted on October 03, 2017, 15:14 GMT

Almost every representation of people with Obsessive
Compulsive Disorder I’ve encountered portrays us as fearful
of filth and obsessed with being clean. Melvin
Udall (As Good As It Gets) keeps a stash of soap
bars in his bathroom so he can unwrap a fresh one every time
he washes his hands. Adrian Monk
(Monk) is so crippled by his obsession with
“contaminants” that he needs an assistant to perform basic
functions, like opening doors.

These representations build on — and give power to — the
stereotype that OCD is “just” a fear of dirt and an obsession
with order. This limited definition of OCD makes it difficult
for people whose OCD manifests in other ways to be
recognized. There are few things as frustrating as working up
the courage to admit to someone that you have OCD and have
them doubtfully respond, “But you’re so messy!”

The crux of the problem with most representations of OCD that
revolve around obsessions with cleanliness? They mistake the
compulsive behavior for the fear that triggers it. 

They also help sustain a culture in which people feel
comfortable making offhand comments like, “I’m a little OCD”
when they admit that they like to keep a clean house. These
comments may seem innocuous, but are minimizing to someone
who struggles with OCD because they frame a disease that can
be debilitating as a simple issue of being “fussy.”

In reality, OCD is so much more than that. While some OCD
patients undoubtedly are obsessed with cleanliness, it is
only a side effect of what really goes on in the mind of
someone with this disorder.

The crux of the problem with most representations of OCD that
revolve around obsessions with cleanliness? They mistake the
compulsive behavior for the fear that triggers it. As someone
who was diagnosed with OCD at age 11, I can explain.

OCD has two basic components: obsessive thoughts and
compulsive behaviors. According to the Mayo
Clinic, “OCD obsessions are repeated, persistent, and
unwanted thoughts, urges, or images that are intrusive and
cause distress or anxiety.” These obsessions could be almost
anything, but as the Mayo Clinic points out, they often have
themes, which could include unwelcome thoughts about
traumatic memories or being contaminated by distasteful
objects, people, or ideas. Many people with OCD also
experience persistent fears that they will hurt themselves or
others.

For me, these obsessions usually manifest as irrational fears
that I am somehow unsafe. Remember the monsters under your
bed when you were a kid? Remember how, no matter how often
your parents explained to you that there were no such things
as monsters, when they turned off the lights and shut the
door, you still had your doubts? Unlike most people, I never
grew out of that creeping, irrational sense of danger that,
even when all the facts tell me I have nothing to worry
about, keeps me believing I’m always at the cusp of peril.

With intrusive thoughts, simply doing some research and
discovering that your fears are unwarranted doesn’t help — or
it helps for about three minutes until the intrusive thoughts
push back in.

Even though I’m not obsessed with monsters under the bed
anymore, when something unpleasant comes up, like getting
called in for jury duty, my mind automatically brings me to
the irrational worst case. The thing is, I have a very hard
time discerning between what’s likely — or even possible — to
happen and what isn’t.

That’s how I end up crying on my therapist’s couch because I
really believe that I’ll be stuck in jury duty for months and
will lose my job and my apartment. No matter what she says to
allay my fears, I never really believe that I’m safe, so the
thought of losing everything keeps returning to consume me. I
become absolutely convinced that whatever I’m afraid of will
come true.

This is where the compulsive behaviors come in. When you’re
drowning in anxiety, you want to be able to do something to
control it, right? With intrusive thoughts, simply doing some
research and discovering that your fears are unwarranted
doesn’t help — or it helps for about three minutes until the
intrusive thoughts push back in. Thus, OCD patients develop
repetitive behaviors that help us feel like we’re in control,
that we’re actively preventing something bad from happening.

Kipras Štreimikis on Unsplash

Sometimes my compulsive behaviors are a practical response to
my anxieties, but usually they’re not.

In the case of the jury duty anxiety (and I should stress
that jury duty is not the only thing that triggers my OCD —
the list is long, with most items being a little too personal
to share publicly), I might stay up far too late combing
online forums for horror stories about the jury duty that
never ended, or compulsively call my boss, my HR department,
and my union to confirm that I’ll still get paid on the days
I miss work. These behaviors usually allay my anxiety
briefly, until my brain conjures up something else that could
go wrong. For example, if HR assures me that I won’t lose my
job while I’m on jury duty, I might find myself, half an hour
later, on hold with my union because I’ve been overcome with
the thought that HR was wrong and I want to confirm that the
union will protect me.

Usually, however, my compulsive behaviors have nothing to do
in practice with whatever I’m afraid of. This is because they
are not a rational response to a real problem – they are
compulsive manifestations of an irrational anxiety.

For example, if I’m worried that jury duty will snowball into
an apocalyptic scenario of joblessness and homelessness, I
might respond to these intrusive thoughts by getting stuck
washing my hands over and over because in my irrational mind,
washing my hands while envisioning a positive outcome
(dismissal from jury duty) will make that outcome a reality.
If I spend twenty minutes washing my hands, it’s not because
I’m afraid they’re dirty.

I often think of living with OCD as having two minds: the
rational mind, which knows that hand-washing will have no
impact on the outcome of my jury duty, and the irrational
mind, possessed by that same monster-under-the-bed terror,
that makes the idea of a long jury duty feel like both a
catastrophe and something whose outcome could be mitigated by
how many times I wash my hands.

Rationally, I know that my compulsive behaviors will have no
effect on what I’m worried about. I’m even able to admit this
while I’m stuck in a cycle of repetitive behavior. But
irrational fear usually wins its battles with my rational
mind, and the magical thinking that my compulsive behaviors
will keep me safe influences my behavior more often than not.

Unfortunately, the compulsive behaviors my brain uses to
process these anxieties often have the effect of intensifying
them rather than making them more manageable. They catch me
in a cycle where my fears seem immediate, and thus become
quickly overpowering. This is how I end up standing in the
doorway of my bedroom for five, ten, fifteen minutes past
when I wanted to be in bed because I have to keep switching
the light on and off until it feels “right.”

OCD is often described as an obsession with control, and it
is. But there is a dark side to imagining that you have
control over everything. 

Even though I consciously know that my bedroom light has
nothing to do with what I’m worried about, the little doubt
at the back of my mind – But what if it does? What if
switching off the light while imagining the perfect outcome
will make everything okay? Did you do it right? Did you
really imagine it? Do it again
– grows louder and more
insistent. The more room I give to that doubt, the more
urgent the compulsions seem, until the idea that I can make
everything okay by switching the light off the “right” way –
and, conversely, that everything will be a disaster if I
don’t – dominates me.

OCD is often described as an obsession with control, and it
is. But there is a dark side to imagining that you have
control over everything. I constantly feel the pressure to do
even small things, like washing my hands or flipping off the
bedroom light, in a way that will magically enact a positive
outcome in something I’m worried about.

This makes basic tasks really, really difficult, especially
because my compulsive behaviors could be anything. On my good
days, I can clean my apartment, organize my desk, and cook
dinner with minimal problems. At other times, it takes me
hours to do the dishes because I need to put the same cup in
the cabinet five times before I feel safe enough to move on.
I’ve become a night owl because the process of getting ready
for bed – brushing my teeth, taking out the trash, changing
into pajamas, turning out the light, getting into bed – can
be so time-consuming and stressful that I procrastinate doing
it.

One of the biggest objections I have to the way OCD has been
traditionally represented in the media is that, for the most
part, characters with OCD are presented as misanthropic,
consumed by their obsessions and, even if they’re brilliant
or good at their job, are otherwise not equal to the basic
challenges life presents.

Surely this is true for some — it has even described me at
certain points in my life. But a troubling effect of these
representations is that they make an OCD diagnosis seem like
a kind of death sentence. When I was diagnosed at age 11, I
was terrified it meant that I would not be able to live a
full life.

Yet, thanks to consistent therapy and the right dosage of
anti-anxiety medication, I am able to keep my OCD in check
enough to live a “relatively normal life” (whatever that
means). For the most part, the worst of my OCD symptoms don’t
come into play when I’m at work or with friends and family.
When I started writing about it earlier this year, most of
the people in my life were surprised to discover that I have
OCD at all.

Would I get rid of my OCD if I could? It’s a moot question:
as every therapist, psychologist, psychiatrist, and social
worker I’ve seen has reminded me, the goal of OCD treatment
isn’t to cure it, but to manage it. However, despite the
suffering it has caused me, if someone presented me with a
magical cure for OCD and all its related symptoms tomorrow, I
would hesitate.

Of course, I would want to get rid of the anxiety, the fact
that I can’t really trust myself when assessing risk, the
compulsions that occasionally embarrass me in public and keep
me up at night. I don’t know what it’s like to encounter the
world without an anxiety disorder on my back, and I would
like to try it.

At work, I’m the note-taker in every working group, and I
stumbled into labor activism because I was anxious about my
eligibility for health coverage and annotated the union
contract.

But I have also come to understand that the pitfalls of OCD
come as part of a larger package. Because I have had OCD from
the beginning — and it wasn’t triggered by a specific trauma
later in life, as some
cases of OCD are — I have developed with and around it.
As a result, some aspects of my personality and the way I
think are of a piece with my OCD.

From childhood, I have obsessively-compulsively deconstructed
and responded to arguments: if I had an opinion about
something, I searched ruthlessly for potential
counterarguments in order to control the responses of my
naysayers before they even opened their mouths. I won awards
as a leader of the Model UN debate team at my high school,
and now I teach argumentation and rhetoric for a living.

I am meticulously organized, obsessively thorough, and deeply
inquisitive. It’s a running joke among my in-laws that, if
they want to schedule something with my husband, they should
just call me because I’ve got a color-coded calendar that
runs six months out. At work, I’m the note-taker in every
working group, and I stumbled into labor activism because I
was anxious about my eligibility for health coverage and
annotated the union contract.

My perfectionism makes me an excellent student and teacher —
I am easily engrossed in new tasks, excellent at managing my
time and completing projects efficiently, and as a result, am
a natural leader and delegator. I have an uncanny memory for
dates because I track the landscape of my life in terms of
what I was obsessed with at any given point. For example, I
remember the exact start date of every job I’ve ever had
because I remember the ways that my anxiety about starting
new jobs manifested at different points in my life.

It would be shortsighted to say that these attributes are
separate from my OCD, because the habits of mind involved in
these strengths are very similar (and in some cases, are the
very same) as the habits of mind that drive me to brush my
teeth five times before going to bed. I’ve come to view OCD
as a (very) rough downside to characteristics that I
otherwise quite like about myself.

So, while I’d be kidding myself if I claimed that I’d turn
down a cure for OCD wholesale, I’ve learned to stop trying to
separate my mental illness from the rest of who I am, to be
ashamed of it, or to shun it. In some ways, it’s convenient
that my OCD isn’t going away, because it means that I can
continue to learn to draw on it as a source of strength,
while minimizing the ways that it can hurt me.

Shannon Azzato Stephens is a writer based in New
York City, where she teaches college-level writing and spends
most of her free time at the dog park.

To learn more about OCD, check out the resources at the
National Institute of Mental Health here.

And if you need to talk to someone immediately, you can reach
the National Suicide
Prevention Lifeline at 1-800-273-TALK (8255) and or the
Crisis Text Line by
texting HOME to 741741. Suicide helplines outside the US can
be found here.

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