What does obsessive-compulsive disorder look like?

If you find yourself turning back every day because you think you might have left the oven on or forgotten to lock the door, you may have a disorder called obsessive-compulsive disorder.

If you can’t get out of the house unless you go through a specific series of actions, then you really do have a serious OCD.

If it occurs occasionally, this behaviour isn’t a big problem and might even seem a bit funny, at least the first few times it happens.

There have been a lot of movies made that use these behaviors as a comic motif.

Think As Good As it Gets with Jack Nicholson, the lead character in the show Monk, Sheldon from The Big Bang Theory or Monica from Friends.

It happens to everyone from time to time, especially in times of undue stress or lack of sleep.

But if these behaviours are present all the time, even when the person is rested and has nothing else going on, then these behaviours become a problem and cease to be fun.

All the more so because one check is usually not enough.

That’s how you actually recognize if you have the disorder or not. If you’re tired, stressed, or simply distracted by certain thoughts, you might stop in front of the house with the thought that maybe you forgot to lock up and go back to check. That check should be enough.

If, after checking, you go about your business, you probably don’t have OCD. But if you go back 4 more times after that to check again and again, chances are you have OCD.

I remind you that the above description doesn’t mean you should diagnose yourself, it just means it’s a red flag and you should see a psychotherapist to see what the situation is.

Untreated, OCD usually progresses, increasingly restricting the freedom of movement of the person affected.

It starts with turning around twice to check the front door, then progresses to not being able to leave the house unless you turn the light on and off 20 times, to not being able to leave the house for fear of a fire if you leave.

If you think I’m exaggerating, there’s a famous case of obsessive-compulsive disorder, that of billionaire Howard Hughes.

If you’ve seen the movie The Aviator, starring Leonardo DiCaprio, that movie is about his life. Howard Hughes made a huge fortune by various means (he built planes for the US government, owned an airline and was the producer of numerous Hollywood movies) but ended up miserably sick and malnourished and weighing 41kg at 1.93m tall.

Having been a famous playboy after turning Las Vegas into the metropolis it is today, he ended up never leaving his hotel room for months at a time, terrified of the idea of any form of human contact and constantly washing his hands for fear of germs.

Of course, Hughes’ case is an extreme one, and the development of OCD in his case correlates with other events in his life (devastating plane crashes) as well as other conditions. But his story can show you that this disorder is no joke.

Sure, you don’t have to end up like Hughes, immobile in an armchair for 4 months watching movies and eating nothing but chocolate, chicken and milk, but that doesn’t mean the disorder doesn’t affect your quality of life, mood or relationships.

By the way, the above story about sitting in an armchair for 4 months is true. There are dozens more such stories about it.

However, out of some such oddities, wonderful things have come, such as the modern hospital bed, which is based on a prototype created by aviation engineers at the request of Hughes, who was hospitalized following a plane crash.

Looking at it from the outside, you might think that obsessive-compulsive disorder isn’t such a serious problem and that obsessions and compulsions are easy things to control.

But you might think that only if you are not affected by the disorder because, in reality, people who repeat a behaviour do not get any pleasure from those actions, but feel they have no choice but to do them.

If they suddenly stopped, it would make them worse rather than solve the problem.

So any intervention on obsessive-compulsive behaviour must be done with care and patience.

Lack of control is precisely the nature of this disorder, which is why it is also called obsessive-compulsive disorder: it starts from an obsession (a repetitive thought, for example, that there are germs everywhere) and triggers a compulsion, i.e. an almost automatic behaviour that you feel you have no choice but to do. In the case of germs, the behaviour may be hand washing or washing the whole body.

It should also be said that there is not in all cases an obvious link between obsession and compulsion. In the case of microbe obsession, it’s pretty easy to understand why the compulsion might be hand washing.

In the case of someone who absolutely has to lock the door twice, then unlock it and repeat the process 10 more times before leaving the house, the obsession is harder to identify and it is harder to link it to the compulsive behaviour.

But the answer is usually found in the personal history of the sufferer and is an individual response that does not necessarily apply to others.

Because people generally regard the manifestations of the disorder as mere oddities, it is not given the attention it deserves, either by those around it or even by those who suffer from it. As a result, many people affected by this disorder do not receive the help they need to heal and live a peaceful life.

Another reason people don’t seek help is shame, caused by the thought that something as minor as a repetitive thought shouldn’t be such a big problem that it should be controllable. But, as I said, self-control is often not a solution, and may even make things worse.

Obsessive-compulsive disorder in children

The unusual behaviours that occur in this disorder are not specific to a particular race, gender or age group – anyone can be affected.

So even children can develop this disorder.

Parents often find it quite hard to realise that it could be a problem, partly because it is not unusual for a child to repeat certain gestures several times in a row, as part of their natural learning process.

A child can spend an hour or more playing with cubes, arranging them and then knocking them down, without this being a problem. It only becomes a problem when these gestures become rituals and start to affect everyday activities.

Parents often think that all these manifestations are just phases that the child is going through, and that they will grow out of them. However, if it is an OCD, there is little chance that the problem will be resolved only with the passage of time.

On the other hand, there’s no need to panic at anything your child does that seems strange. But if you have serious suspicions that it might be more than that, it’s best to consult a psychotherapist, because if it turns out to be the case, it’s much better to get the situation treated early before it gets worse.

How is OCD treated?

I’ll tell you the 3 treatment options and then you can decide how you prefer. My preferred option will be easy to guess once I present them to you.

The first OCD treatment option is medication. There is a theory that this disorder is caused by a low amount of serotonin in the body. And then, if the medication option is chosen, the patient will be prescribed drugs such as Prozac or Zoloft, drugs from the serotonin reuptake inhibitor class.

Cipralex is very popular in our country, and there are, unfortunately, psychiatrists who prescribe it very lightly, as if it were aspirin.

Drugs in this class are used for the symptomatic treatment of many conditions, such as depression, anxiety, phobias or post-traumatic stress.

In my view, and that of countless other specialists and scientific studies (e.g. the NHS in the UK), the use of these drugs only works for a limited time, after discontinuation of the medication the symptoms usually return after a while, give dependency and withdrawal reactions if discontinued, and generally do not treat the cause, only the symptoms. If they treat those too, because the effect is likely to be placebo only.

Anyway, if you want to take pills, it’s good to know that they are only taken on prescription and you only get the prescription after consulting a psychiatrist.

The second treatment option for OCD is cognitive behavioural therapy. This aims to train the patient to exercise increasing control over repetitive thoughts and compulsive behaviours, to the point where the disorder no longer affects the patient’s life.

This is, in my opinion, a side-effect-free option, but it is a long-lasting one. And another problem is that it doesn’t treat the cause, so the question is what do you do if the patient develops other symptoms in the future. The answer from cognitive behavioural therapists is that the patient has already learned how to cope with the disorder, so they will have the resources to deal with the new symptoms.

I’m not so convinced of this. Not because I don’t trust the patient’s ability, but because I have seen how inventive a disorder of this kind can be. Besides, do you really want to spend your whole life controlling your symptoms?

And that leaves the last treatment option, psychodynamic psychotherapy. This type of psychotherapy aims to get to the cause of the problem, and only then intervene on the symptoms, once the cause has been resolved. In this way, the chances of a full recovery are increased and the likelihood of new symptoms occurring over time is greatly reduced. Psychodynamic approaches include Adlerian psychology, in which I am trained, but this is not the only option, there is also psychoanalysis or analytical therapy. So you have a choice.

As I see it and as my experience has taught me, OCD should be treated in stages, the first stage always being to identify the traumatic event or series of events that led to the onset and development of the disorder.

Only after identifying and treating that trauma can you go on to treat the compulsion. Often, you don’t even get to treat it, because the person, once freed from the burden of the trauma, discovers for themselves the resources to overcome their disorder.

And if they still feel they need help, the help is basically a gentle and non-invasive accompaniment and guidance, just to leave room for the person’s personal resources to emerge.

And in some cases it is also necessary to treat anxiety separately, because anxiety is often accompanied by an anxiety disorder. There are even some authors who consider it to be a variant of anxiety disorder.

Is OCD a cause for concern? Not if you’re going to treat it. Yes, if you leave it alone and hope it goes away on its own.

It’s a much more common condition than you think and the reason you don’t hear so often about people suffering from it is precisely because they are reluctant to admit they have a problem and are even more reluctant to seek treatment.

But it is a disorder that can be cured and you don’t have to struggle with it all your life.