Naturopathic Control: Obsessive Compulsive Disorder OCD

Obsessive Compulsive Disorder OCD

Obsessive Compulsive Disorder or OCD is a mental health disorder that features unwanted thoughts and fears (ie obsessions), leading to repetitive behaviors (ie compulsions) that are extremely disruptive to one's life beyond the general population's normal levels of obsession or compulsivity (ie a disorder). OCD may be understood as a disorder of doubt or uncertainty because it is based on sufferers trying to regulate something that is not necessarily true or highly improbable. Sufferers are therefore trying to make certain that they remove uncertainty.

In this post, I will discuss each of the 2 diagnostic required components of this disorder; obsession and compulsion.

Obsessions

Obsessions are recurring thoughts, images or urges. Unfortunately however, they are disturbing, unwanted and intrusive. In other words, the unpleasantness is unwanted. The person therefore feels that the obsessions are out of his or her personal control which renders feeling of some level of powerlessness. When OCD sufferers struggle with obsessive intrusive thoughts without a corresponding physical compulsion, the condition is referred to as "Pure O" (to mean only obsessions'). To be clear, pure O is NOT a different diagnosis according to the DSM5.

A very important feature of obsessions is that they trigger distressing feelings. Those feelings are usually related to fear, disgust, doubt or the idea that something must be done in a very specific way. Regardless, this distress triggers the fight or flight response. So rather than have a trigger like war or rape, the same trigger will have occurred within the minds of OCD sufferers.

Pure O sufferers feel particularly stressed because the thoughts deviate so much from their normal values and beliefs that they are fearful that something within themselves has changed and they may feel compelled to act accordingly. Pure O obsessions usually take the forms of thoughts about physical or sexual aggression, visualizations of inappropriate images and frightening impulses.

Another feature is the repetitiveness of the obsession.

To be clear, they are irrational or based on low probability outcomes. For instance, while extra handwashing during the Covid-19 pandemic was based on a rational, probable fear of contracting the disease, a fear of contracting Ebola in most cities is not very probable.

Common obsessions include the following.

Contamination obsessions. Fear of contact with perceived contaminated things like body fluids (examples include urine, feces); Germs/disease (HIV, COVID-19); Environmental contaminants (asbestos, radiation); Household chemicals (cleaners, solvents) and Dirt.
Violence obsessions. These involve the fear of: acting on an impulse to harm oneself or others or; violent or horrific images in one's mind
Responsibility obsessions. Fear of being responsible for: something terrible happening (like fire, burglary, car accident); harming others because of not being careful enough (dropping something on the ground that might cause someone to slip)
Perfectionism-related Obsessions. Excessive concern about: things not being even or exact; not knowing or remembering; losing or forgetting important information when discarding something; performing tasks "perfectly" .
Sexual Obsessions. Unwanted thoughts or mental images related to sex, including fears of: acting on an inappropriate sex-related impulse; sexually harming or being aggressive towards others like children, relatives.
Religious/Moral Obsessions (Scrupulosity). Excessive concern with: offending God; damnation; and/or concern about blasphemy.
Other circumstance-related obsessions.

Obsessions about death/existence (like excessive preoccupation with existential and philosophical themes, such as death, end times.
Emotional contamination obsessions (like fears of "catching" personality traits, perceived level of luck of other individuals

Compulsions

Earlier, I mentioned that distress accompanies obsessions. The distress needing more cleanliness, sense of moral responsibility to avoid doing something to harm others and so on are the driving motivations for compulsions. Compulsions are repetitive behaviors or thoughts that one uses to try to neutralize the obsession-related distress. A key feature is repetition.

Ironically, OCD sufferers know that compulsions are only temporary fixes. However, without immediate alternatives, they rely on the temporary fix anyway, much like emotional eating, thoughts to cancel out the initial negative thought.

Common examples include the following.

repeatedly going in and out of doorways, even at the known risk of running late for important engagements.
re-checking the stove several times before leaving the house
re-checking that objects are set down correctly in their place, like a CD into the tray of a carousel.
scrubbing oneself until the skin is bruised.
nervous tics like eye blinks, nose twitches, grimaces, shoulder shrugs, heard jerks (ie simple motor tic-related OCD or 'tourettic OCD' but not really tourettes which responds to physiological triggers versus psychological ones)
refusing to drive or be driven for an accident. In such case, the fight of flight response is heightened.
re-checking safety packaging for contamination.
hand washing until the skin is dry or peeling
seeking reassurance numerous times about the safety of a route
thoughts to cancel negative obsessive thoughts

It must be stressed that the heightened sense of responsibility to neutralize the obsession is not only a key diagnostic feature but also an indicator that even sufferers have a strong conscience and are highly improbable of acting on obsessions like harming others. OCD sufferers obsess in fear that they will act on their bad thoughts (than humans all have). Others should therefore exercise care in considering obsessions as a potential for criminality. The difference between OCD sufferers and someone with an antisocial disorder is that the latter does not exhibit the second OCD component, compulsion (ie to neutralize the obsession). A criminally minded person may enjoy the obsessive thoughts and actually act on the obsession. Regarding pure O, I mentioned earlier that there may be no corresponding behavioral / physical compulsions. However, there may be cognitive compulsions. For instance, sufferers may ruminate, usually a lot more than usual.

Sometimes, when the obsession is not very well understood, it may be useful to consider that compulsions often correspond to specific types of obsessions. The following are common examples that might help in better understanding the obsessions and their underlying psychological challenges.

Obsession: ===========> Compulsion

Unsafety ============> Cleaning

Fear of bad situations ====> Repetition

Painful thoughts =======> Saying good thoughts

Obsession and compulsion must be disordered

Diagnosis requires that obsession and compulsion be disordered.

In the population of non sufferers, using these terms, people speak of "obsessing" over something, like a new social media influencer and will never miss a single new episode. It is also normal for people to double check what they have done. However, these types of so-called 'obsession' do not meet the diagnostic criteria because they do not feature the 2 components. For instance, following the influencer and simple double-checking do not disrupt life as one can still easily meeting meet life obligations as normal, like work and other social situations.

However, someone whose obsession and compulsion make them not only double check like normal but to re-check 3, 4, 5 or more times is disordered because these additional checks consume extra-ordinary amounts of time and ultimately disrupts their lives as sufferers always arrive late or other socially unacceptable behavior. Despite recognizing the risk of running late for engagements, sufferers prefer to perform their rituals.

For diagnosis, the DSM-5 requires

observation of obsession, compulsion or both. In the case of 'pure O', ie only obsession OCD involves obsessive thoughts that are not followed by physical compulsions.
compulsion should be time-consuming
disorder must NOT be explained by physiological effects of substances or other medical condition
should NOT be better explained by another disorder

Incidence & Triggers

OCD affects roughly 3% of the population and usually develops during childhood or adolescence between the sexes equally. Persons seeming most prone to OCD are those that are intolerant of uncertainty. It is likely that OCD is most likely during stressful periods (like starting a new job, moving country and so on).

Stress of any type, positive or negative can trigger OCD.

Famous persons suffering with OCD include David Beckham, Howie Mandel and Howard Hughes.

Other observations

OCD sufferers often exhibit higher levels of irritability. This is because their minds are already very preoccupied with fears that their capacity for tolerance to manage the normal amount of irritation is compromised.

If possible, sufferers may become avoidant of social situations because of fear that their rituals will likely illicit ridicule from others. (Read about social anxiety disorder / SAD)

Treatment

Treatment involves the following, often but not necessarily in combination. The purpose of treatment is to return the sufferer to a normal life experience.

psychotherapy aka talk therapy that helps sufferers to better manager their thoughts. It is best to pursue this type of treatment with only persons that are specially trained and experienced, like OCD experts, persons registered on the directory of professionals with OCD expertise via the International OCD Foundation (OCDF) website, directory of professionals via the Anxiety & Depression Association of America, the Advancement of Behavioral & Cognitive Therapy (ABCT). Even specialized OCD support groups may exist. Treatment often includes

safe exposure therapy, ie the sufferer is exposed to the obsession to retrain the mind into recognizing the irrational nature of the obsession. This usually reduces the distress associated with the obsession. However, the gold standard is exposure response prevention (ERP) form of treatment. The therapy requires the sufferer to sit with their anxiety in a safe place until the anxiety can subside, with a diminishing effect similar to reviewing the same scary movie repeatedly, ie 'habituation'. Another approach is that sufferers may also be encouraged to attempt dissociating themselves from the obsession and then responding to it saying "no", "no, x will not happen", etc ... The aim of responding this way is to develop a internal voice that overpowers the obsession in time. Visualization is yet another approach. For instance, one may visualize the obsession as a passing cloud. These methods may be used alone or in combination. Yet another approach is called cognitive restructuring (video below) based on calling out one's cognitive distortions to oneself.