Habits: we all have them. We brush our teeth, we wash our hands, we lock our doors, we might even have little rituals that we do on a daily basis like taking a certain way to work or holding our keys in the same hand when we leave the house. But when these habits or any other type of behavior takes a turn into compulsion, it signals a deeper problem. This is when it turns into Obsessive Compulsive Disorder (OCD,) and the National Institute for Mental Health (NIMH) reports that approximately 2.3% of the world population has it.
We asked our friend, Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program, to help shed some light on this common brain concern, and what can be done to help:
What is it?
“Obsessive-Compulsive Disorder (‘OCD’) is a psychiatric disorder defined by recurrent or persistent obsessions or compulsions, which are thoughts or images that are experienced as intrusive and unwanted. It can be anything from a phrase that keeps repeating in your head or an image.
We all have a million thoughts a day. Most pass through our heads without our having to think much about them, but with OCD these get stuck and they’re in a loop in your brain. The closest thing to the condition most of us will experience is when we get a song stuck in our heads and can’t get it out. With OCD, they’re some of the most disturbing things anyone could ever think about, and the person with the condition can’t shut them out or stop them. It becomes a loop of disturbing thoughts that can be very distressing. The attempts ignore or neutralize them is where the compulsions come in, those repetitive behaviors someone performs in order to try and respond to the obsession.”
How does it work?
“They’re usually fears of something rather catastrophic. I work a lot with women during pregnancy, and you see a lot of OCD symptoms in the postpartum period around fears of what would happen if the baby stopped breathing. Fears like that are common and normal during that time, but sometimes those feelings take over and patients can’t get away from them. Compulsive behavior happens around that fear that they can’t shut down, and that’s when it turns into OCD.
Another common fear among OCD sufferers is of contamination or getting sick. They might have horrible visions of what would happen if they touch something in the bathroom that contaminates them or someone else they love. They can have recurrent thoughts and images of what might happen if they get sick which can cause a lot of distress. A person with contamination or illness fears might wash their hands compulsively. The OCD manifests by an increasing level of anxiety if they try to stop washing their hands or think they somehow forgot. People with contamination fears sometimes wash their hands hundreds of times a day, and suffer intolerable feelings of fear, anxiety and dread if they don’t.
Similarly, other classic manifestations of OCD are checking behaviors: did they leave the stove on, did they lock the door, did they close the windows, did they really see what they thought they saw, etc. They might have to check the stove/locks/windows over and over again for fear of burning the house down or of break-ins. Compulsions are really a response to obsessions that cause incredible anxiety, and are aimed at reducing the anxiety and protecting them from the continual thought of the harmful thing that might happen.”
When does habit become obsessive?
“It isn’t classified as a disorder unless it takes up a lot of your time and causes considerable distress. People with OCD usually know that the thoughts they’re having aren’t normal, but they get stuck in a fear loop of what would happen if they didn’t do whatever they’re compelled to keep doing, so they relent. It’s time-consuming and can really disrupt someone’s life. Normal avoidance of disease and a respect for safety are one thing, but if it’s running your life, it’s probably time to speak with someone.”
How do you seek help?
“Talking to your doctor about it is one way. You can also call or get a referral to psychiatrist or a psychologist. There are people who really specialize in the treatment of OCD.
There are also great books out there on the subject that can be very helpful. Stop Assessing is one that offers some basic treatment principles. But connecting to a therapist or a psychiatrist and getting some more information about it is probably the most effective course of action.”
What’s the standard course of treatment?
“The standard, evidence-based treatment for OCD is Exposure and Response Therapy, which challenges people to look at how their thoughts and behaviors are related to distress; it’s essentially a graded way of approaching fears. For example, for someone who has contamination fear, you create a hierarchy of things they can do in a bathroom from easiest to hardest, like touching the door handle without washing their hands and working your way up from there.
The thought loop is one of the main things that drives OCD, so people who are diagnosed traditionally create the compulsion to experience immediate, transitory relief of the anxiety. The problem is that the behavior isn’t protecting them, so the therapy teaches them tolerate the anxiety without engaging in the compulsion. It breaks the cycle, and it can change their life. SSRI medications can also be really helpful for people with OCD, but often the doses are higher than for depression patients, and you need to be on it for longer to see the effect.”
How can you help yourself?
“If you’re someone with OCD who is engaging in treatment, just be aware that it’s hard work. Don’t get trapped in cycles of avoidance, and see it through. You have to figure out how to tolerate the anxiety so you can develop other coping mechanisms, but most of it is not organizing your life around your obsessions.”
How can you help someone who is dealing with OCD?
“OCD can be really difficult for loved ones and family members because typically people who live with the condition will ask their loved ones for constant reassurance, which can itself become a compulsion. People with a contamination fear might demand you take off your shoes when you come in the house, and it might progress to the point where you have to take off your clothes and shower before you come into their house.
It can be really difficult and painful to live with someone with OCD, and there might be a high demand for reassurance and behavior that can take over your life as well. I think you first must recognize what’s going on, that it’s not their fault, that it’s an illness. Try to be compassionate, encourage that person to seek help, and ask for professional advice on how you can help without it negatively impacting your own life.”