OCD (obsessive-compulsive disorder) is a neuropsychiatric illness that afflicts at least two percent of children, adolescents, and adults. Symptoms vary widely and include checking and rechecking lights, doors, locks, water faucets, or appliances (perhaps as many as 50 or 100 times); spending inordinate amounts of time washing and rewashing one’s hands in desperate attempts to overcome feeling contaminated by “germs”; or spending hours trying to achieve perfect symmetry in one’s surroundings or appearance. Symptoms also include private mental rituals, unseen by observers, such as compulsive repetitive counting or praying.
Note that we are not speaking of psychotic delusions: OCD sufferers typically know that their compulsive behaviors are “crazy,” and they often feel intense shame about them. Some become skilled in practicing their rituals privately, due to extreme embarrassment about engaging in behaviors that they know seem bizarre. Many live their lives trapped between the agony of trying to resist their obsessions and compulsions on the one hand, and the humiliation associated with exhibiting weird behaviors on the other.
OCD has informally been dubbed “the doubting disease” because its sufferers lack the normal ability to tolerate any uncertainty in areas in which they are afflicted (e.g. “Even though I’ve washed my hands 20 times, I may still have germs” or “Even though I’ve checked the door ten times, I may have been wrong and not actually locked it”). As we now understand the development of OCD, this inability to override residual uncertainty reflects neurochemical differences in the brains of OCD sufferers. In these folks, the brain circuits that underlie the capacity (that we all have) to feel discomfort in the face of uncertainty are overly active, and those which underlie our ability to reduce this discomfort by making adaptive decisions (“no problem; the water is off and I don’t have to worry about it”) are underactive. In persons with this neurobiological vulnerability, a lifetime learning history ensues in which sufferers learn to reduce their heightened anxiety by performing rituals which, though nonsensical to the observer, do actually bring limited (temporary) relief. The fact that the problem is rooted in brain biology partly explains why folks with OCD can’t just “get over it” by simply forcing themselves to ignore their obsessions. At the same time, the fact that the disorder then takes hold through learning (i.e., a history of powerful reinforcement of the compulsive behaviors via the immediate though limited relief that they offer) provides the opportunity to treat this illness through properly applied therapeutic relearning techniques.
Although an explanation of the treatment of OCD would far exceed the scope of this column, there are numerous excellent books that explain both the disease and its treatment. Adults with the disorder, or with a family member whose OCD they wish to better understand, may gain tremendously by reading Freedom from Obsessive-Compulsive Disorder by Jonathan Grayson, Ph.D. (Berkeley Books, 2003). For families who wish to help their child or adolescent with OCD, a superb book is Talking Back To OCD by John S. March, M.D. (Guilford Press, 2007). Each of these books is available in paperback at under $20.00. Although these books include actual treatment protocols designed to be self-administered when professional help is unavailable, I would strongly advise individuals and families always to consult with a clinical psychologist or other mental health expert with appropriate knowledge and experience to properly diagnose and treat OCD.
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Dr. Stone, a clinical psychologist, is an Assistant Professor of Psychology in Clinical Psychiatry at Weill Medical College of Cornell University, and Director of the Dialectical Behavior Therapy Program for Self-Injuring Adolescents at the Westchester Division of New York-Presbyterian Hospital in White Plains, New York. He resides in Pawling with his wife, Susan, and their family.