Do you sometimes worry that you’ve left the oven on or the door unlocked? Or do things like not stepping on the cracks between pavement slabs?
Mostly, these worries and small rituals are simply amusing. Others are actually helpful, like the bedtime routine that settles you down to sleep. And everything depends on context. Like rearranging shoes all day is normal in a shoeshop. But weird at home. And fears and rituals can sometimes take over your whole life. For example, someone who’s obsessively scared of a disease can end up washing their hands for hours every day.
Common obsessions include dirt and germs, deadly diseases, being preoccupied with death, imagining doing someone harm, or having inappropriate sexual impulses, or making a fool of yourself in public.
Common compulsions include repeatedly washing, refusing to touch doorknobs or to eat outside your own house, repeatedly checking locks, lights or stoves, touching some object a certain number of times before leaving a room, constantly counting, such as when climbing stairs, or always finishing a flight of stairs on the same foot, having to buy three of everything, or always washing your hands five times, constantly rearranging things, eating foods in a special order or hoarding stuff.
OCD is common everywhere, and affects men, women and children regardless of their background. It can start any time, and sufferers often develop other anxiety disorders, depression or substance abuse. They’re usually of above-average intelligence and know their obsessions and compulsions make no sense. But that doesn’t stop them. They feel distressed, ashamed and alone.
There are many theories about its origin. For example, habits such as washing are useful, which suggests that OCD may just be an extreme case of normal behaviours.
But it also runs in families, and environmental factors are known to be triggers. For example, abuse, illness, death of a loved one, relationship issues in adults and some types of streptococcal infections in young people.
Fortunately, treatment is usually very successful. The most effective approach is Cognitive Behavioural Therapy, especially the specialised technique called Exposure and Ritual Prevention (ERP), which gradually reduces the anxiety that sets off a ritual behaviour.
So for example, the therapist asks the sufferer to touch something that’s only very mildly ‘contaminated’ such as a tissue that has been touched by a toothpick that has touched something threatening, such as an animal.
That’s the ‘exposure’. The ‘ritual prevention’ is resisting the urge to wash. Anxiety levels quickly drop as the experience is repeated, and so the process can continue with more and more ‘contaminated’ situations.
OCD sufferers can do these ERP exercises very effectively themselves, though it definitely helps to start off with a professional.
Their spouses can also benefit from talking to a psychologist, who will help them to control the stress of living with OCD - and show them how to become their partner’s personal ERP therapist!
