Thursday, April 9, 2009
For some of us, the trouble starts once the exam begins.
Many students know the painful process of test days—cramming the night before, praying you retain enough information to avoid looking like a fool.
Making something picture perfect is often on the minds of people with obsessive-compulsive disorder. Keeping objects in an orderly fashion is an example of the compulsive aspect of OCD.
But for some of us, the difficulty reaches much further than memorizing definitions. When I was in high school, taking a test only heightened the probability I’d feel compelled to enact one of my repetitious rituals.
If I had a distressing thought while trying to answer an essay question, I’d carefully erase every word I’d written and redo my work. It was the only way to ease the pain of my troublesome thoughts and sufficiently “clear” my mind. This seemingly dumb practice was just one of the many “rituals” helping me to survive each day.
My world history teacher once suggested to my class I might be cheating when he caught me reaching into my bag. Anxiety-ridden, full of self-doubt and sufficiently embarrassed, I held up the tattered end of my pencil where the eraser had been. Apparently this was enough for him because he returned to his desk without uttering another word. Thank God, I thought—I don’t have to tell him the truth about my need to erase and then rewrite my work.
Fear of contracting illness through germs is a common characteristic of obsessive-compulsive disorder. Excessive showering, bathing, toothbrushing, grooming, toileting, cleaning clothes and personal items, and avoiding “contaminated” objects and places, are other examples of compulsive habits of people with OCD.
I have always been good at disguising my problem because I never wanted anyone to know. To me, I was a freak trapped in an otherwise normal society, and I was the only one of my kind.
The truth is, I have obsessive-compulsive disorder. I was diagnosed when I was 17. I’m not “OCD about this or that” as many people profess about habits they have. I am one of the estimated 5 to 7 million Americans battling obsessive-compulsive disorder every day.
What is OCD?
Obsessive-compulsive disorder, or “the doubting disease,” is a neurobiological anxiety disorder characterized by intrusive and distressing thoughts and the repetitive rituals aimed at dislodging those unwanted deliberations, says Dr. Lisa Hale, founder and director of the Kansas City Center for Anxiety Treatment in Shawnee Mission. Many illnesses categorized as psychiatric disorders are neurobiological, or an illness of the nervous system, including autism, bipolar disorder and OCD.
No specific genes for OCD have been discovered, but research suggests genes play a role in the development of the disorder. The risk that a child will develop OCD slightly increases when a parent has OCD, yet the risk is still low. When OCD runs in families, it is the general nature of OCD that is inherited, not specific symptoms, according to www.ocfoundation.org. This is apparent in my family—I have a constant urge to check and recheck while my mom compulsively organizes. Finding something in my parent’s house is never a problem considering my mom’s affinity for her label maker and my constant verification everything is in its place. But does the deodorant underneath my dad’s sink really need its spot labeled? I don’t think my dad will mistakenly rub the mouthwash underneath his pits anytime soon.
Despite a recent growth in OCD research, the specific cause has not been proven. Many studies suggest OCD involves miscommunication between the front of the brain and deeper structures. These structures use serotonin, a chemical messenger that plays a role in the regulation of mood, sleep, learning and constriction of blood vessels. It is believed insufficient levels of serotonin could be involved in OCD, Hale says.
The origins of this disorder are typically viewed as genetic in that certain individuals may experience OCD without any conceivable environmental triggers. However, it is likely that OCD may result from a variety of exposures to stress and/or trauma without a genetic component, says Ed Bloch, a licensed specialist clinical social worker and co-owner of The Life Enrichment Center in Lawrence.
The bottom line is the root of OCD has yet to be found.
OCD touches every segment of society for people with the disorder and I am a card-carrying member of this diverse group of people. OK, so we don’t carry cards, but each member of this cluster constantly works to overcome an equally diverse combination of obsessions and compulsions on a daily basis. It’s probably best we don’t have an ID—another thing to check and disinfect.
For those of us who suffer from OCD, life can be limited by hours of compulsive behaviors, making it difficult to find inner peace, to be productive, or simply to be happy, says Christy Olson, Lawrence, a doctoral student and research assistant who works with Hale.
“Those affected by OCD are often distressed by their symptoms because the disorder can be limiting in regards to everyday life,” Olson says. “It can narrow their life and sometimes prevent them from doing the things that they want to do.”
The brains of those suffering from OCD fixate on specific thoughts or urges and hold on for dear life. It’s the mental equivalent of being forced to stare at hideously ugly wallpaper in a room without any reasonable exit, except instead of covering only the walls, the repulsive décor textures the entire room—the ceiling, floors and even the furniture, says Jared Kant, coauthor of The Thought that Counts, an account of his experiences as a teenager with OCD.
OCD can present itself in different forms depending on the person. Some of the common obsessions for those suffering from OCD are the fear of contamination, the fear of harming one’s self or others and preoccupations with specific numbers.
Overcoming the dirt
For some of us, the real challenge starts with the first spec of dust.
Kant, now 26, was 11 years old when he was diagnosed with OCD. Kant’s onset of OCD was quick and personally destructive like a massive tornado suddenly striking on a beautiful spring day.
“One day I was fine and the next day I couldn’t move from my bed,” Kant says.
Kant’s OCD first surfaced during a two-week stay at a summer camp in Massachusetts—outdoors with dirt. His parents did not know the extent of his mental struggles, but they would soon find out.
“Contamination was a big thing for me and at summer camp everything is dirty,” Kant says, “because obviously you’re surrounded by dirt.”
From the first day of camp, Kant was miserable. He had been placed in his own personal hell with the dirt acting as gasoline working to intensify the flames. Fearing the possibility of contamination from the outdoors and believing an exit from his cabin would result in the harming of someone else, Kant retreated further into his safe place underneath the covers.
The fear of harming is a popular obsession associated with OCD. Kant truly believed that if he left his cabin he would contract a deadly disease and spread it throughout the camp.
“I went from an outgoing young kid the year before to literally being unable to set foot outside my cabin door,” Kant says.
Each passing day, his symptoms grew more severe until finally one of the camp counselors approached a psychologist about his troubling behavior.
The psychologist came to Kant and helped him understand himself. Together, they went through the Yale-Brown Obsessive Compulsive Scale, designed to determine OCD, and Kant began to realize he wasn’t the only person obsessing about his fears.
“He asked me a couple of questions and I was kind of thrown,” Kant says. “You start to think you’re crazy and then someone reads your mind. It was a mind-blowing experience to hear someone else say, ‘You’re not the only one.’”
This realization helped Kant understand himself and begin to overcome his troubling thoughts. With the help of cognitive-behavioral therapy, Kant learned to manage his obsessions. In 2006, he graduated from Curry College, in Milton, Massachusetts, at the top of his class.
Today, Kant works as a clinical research assistant at the Massachusetts General Hospital Obsessive-Compulsive Disorder Clinic & Research Unit. He frequently speaks about his battle with OCD at conferences and academic institutions across the country, and he contributes to Organized Chaos, the Obsessive-Compulsive Foundation’s website for teens and young adults.
Everything must be equal
For some of us, the difficulty ensues when the line is just left of center.
If the front door is not precisely flush against the frame, Kate McCormick, of Chicago, will recognize the flaw. A junior at Texas Christian University, McCormick was diagnosed with OCD when she was 12. From a picture on the wall to the arrangement of a room, everything needed to be symmetrical for her to be at ease. When her obsession overtook her life, McCormick turned to Hale of the Kansas City Center for Anxiety Treatment for guidance and learned to manage her OCD.
Walking into a room can still be difficult for McCormick because most doors never perfectly align with their frame. These imperfections eat at McCormick, but she has learned to control her impulse to obsess.
“In the past, I couldn’t do anything until I figured out how to fix the door,” McCormick says. “Sometimes I could simply lift or push the door back into place, but other times it would have taken much more to really fix the door.”
At her own house, McCormick would take the time to correct the imperfection, getting help from her parents, but the true agony came when a friend’s door wasn’t ideally situated on the frame.
“If it was a quick fix, I would adjust my friend’s door casually,” she says, “but if it was really messed up, I’d find an excuse to leave and obsess about it in private.”
At her worst, symmetry ruled McCormick’s mind—everything needed to be balanced. She could never lean down to touch a table with just one hand. McCormick would methodically reach both hands out, and at precisely the same time, make contact with the flat surface below making certain the pressure was equal on each hand.
This symmetrical obsession was only half the battle for McCormick. She, like other people with OCD, had to learn to manage her compulsions. When she felt the need to dislodge a thought, McCormick would find herself humming the same monotonous four-beat tune over and over until she felt comfortable. Some of the most common compulsions people with OCD face are excessive cleanliness, checking, repeating, counting and arranging.
Repetitious rituals
For some of us, peace can be found in the daily grind.
Every time Joel Thomas takes a shower he must repeat the same routine—wash hair, condition hair, wash body, wash conditioner out—or his day just isn’t the same.
“Structure and organization make my life easier,” Thomas, Overland Park senior, says. “Things just feel right when they are in order.”
I have the same problem. If I get distracted thinking while taking a shower, I must repeat my process until I’m satisfied I’ve completed every step. This annoying practice has led to three separate shampoo applications during one trip to the shower on several occasions.
To most people, it makes no sense. How do I forget if I washed my hair? Well, I really don’t forget washing my hair, but if there is even the slightest hint of doubt in my mind, I must repeat the process. Otherwise, my day just isn’t quite right. In many ways, it is certainty that we crave.
People with OCD are aware of their thoughts and behaviors, but the reassurance the rituals provide help ease their mind, says Bloch of the Life Enrichment Center.
The road to remission
For all of us who battle OCD, there is a light at the end of the tunnel—it’s just some days it looks a little off center and needs to be wiped off.
Though there is no cure for OCD, it can be managed and overcome. The goal we all have is to find our way to remission. Like a person who has overcome alcoholism, we are always in a state of recovery—never fully healed.
The common treatment for OCD today is medication, cognitive-behavioral therapy or both, says Hale of the Kansas City Center for Anxiety Treatment. The first line of treatment for OCD is exposure-and-response therapy. It is most effective in results because it can take place outside of the therapist’s office while guiding the patient through behavioral modifications, Hale says. If a patient is too paranoid to drive for fear of causing a 20-car pileup, the therapist will counsel the patient inside a car. Taking baby steps and easing into the process, the first few sessions might be conducted with the parking brake on, but slowly the patient begins to understand how exaggerated the fear is, and within weeks the patient is driving on his own. In Hale’s experiences, she usually sees 70 to 90 percent symptom improvement in her patients, sometimes in just three to four weeks.
“In some ways, it is a little bit selfish because we can see people get better quickly,” Hale says. “I find it very empowering to do this kind of work.”
Drug treatment is another option for OCD patients. This was the choice my therapist made when I was diagnosed. The majority of drugs that help OCD are classified as antidepressants. Usually depression results from the disability OCD creates. Using medications such as Paxil, Prozac or Zoloft, doctors can treat both the OCD and depression.
Zoloft helped reduce my obsessions and compulsions, but I didn’t like the way it made me feel, so I stopped taking it after a few weeks. I assumed I would revert back to my old habits, but so far I haven’t—at least not to the same extent. I have been in good remittance for a little over five years. I know there is a good chance my symptoms will come back, but I’m ready to fight them because I am more conscious of what it means to conquer my obsession about obsessing.
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