OCD Basics

By: Mary Torres, M.A., LMHC, NCC

Most healthcare professionals do not understand obsessive compulsive disorder. Graduate schools do not go into great depths in diagnostic courses to shed enough light on this complicated disorder. An OCD specialist learns to evaluate a new client using very specific questions, surveys, and symptom checklists. For a variety of reasons many people go misdiagnosed for years before finding adequate help or giving up.

Most of my clients who suffer with OCD are functioning in the world, but life is difficult. Not only do they spend most of their days fighting distress, they venture to hide it. I find it rare that my clients announce their OCD in public to explain their behavior. I might be generalizing but I think those who excuse quirky behavior by saying “I’m so OCD” really do not have the slightest idea how terrible OCD really is. Everyone has unwelcomed or intrusive thoughts. The intrusive thoughts OCD brings are accompanied by intense anxious or otherwise distressed emotions. The need to alleviate those emotions is the driving force behind the compulsions.

Most of my clients are aware that their compulsions don’t make sense. House fires rarely start from the toaster left plugged in. It is nearly impossible to know if refraining from washing hands after touching money will make someone or their family member sick. Tapping the table a certain way will not save lives. Looking at knives will not compel stabbing a loved one. Stepping on cracks will not break mother’s back, and yet very few of my clients will step on cracks.

The distress is real. It is intense. The urge to do compulsions is overwhelming. The statements, “I have to” or “I can’t” are true. The inability to refrain from compulsions is not a lack of will power or a character issue. The fight-or-flight response in the brain is a biological process. No amount of logic works when the amygdala is engaged to stay alive. And the amygdala is not aware that crooked wall-hangings will not kill us.
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There are as many manifestations of OCD as there are sufferers. A common thread for most OCD is the need for certainty. When we treat OCD we ask clients to embrace uncertainty, and to be willing to accept distress. This is a difficult and very important decision for clients as they start treatment.
Clients who find the most success reaching management or remission of OCD are those who comprehend exposure and response prevention, engage in therapy, do their homework regularly, and include medication .