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Unwanted repetitive thoughts and behaviours


Most of us find routines comforting. I have had the same breakfast (high fibre cereal with milk and decaf coffee) 5 or 6 times a week for several years. I have a small basket with my cereal and my vitamins all together that I fetch from the cupboard. It makes my life easy. I have a few other routines, my morning walk, Saturday grocery shopping, and my bedtime routine. I even have a routine about my socks. I have one type and colour of sock. I have 12 to 15 pairs of identical, black McGregor Happy Foot socks. It means I don’t have to decide what socks to wear and it makes pairing socks from the wash so simple.  I have been doing this for over a decade. 

 

These routines make my life easier and provide small daily anchors that keep me on track.  I don’t have to think about them. I don’t have to make decisions about my sock colour, where the grocery shopping bags are, or what I am going to have for breakfast. Some people would find it boring to have the routines I have.  That is OK, they don’t have to follow my routines. I find my routines comforting. 

 

But sometimes routines are not a choice, but a tyranny. Sometimes unwanted thoughts dominate and control peoples’ lives. Obsessive Compulsive Disorder (OCD) is an example of this. Obsessions are thoughts, impulses, or images that come back over and over again.  Obsessions cannot be controlled.  They are not comfortable but are unwanted intrusions. They cause anxiety and distress. People often try to avoid any triggers for obsessions. 

 

Compulsions are repetitive, unwanted behaviors.  Common compulsions include hand washing, ordering, and checking.  But compulsions can also be mental acts, such as praying, counting, or repeating words silently.  The person with compulsions feels driven to do them. They can be done in response to an obsession or because there is a rule that they must be done. 

 

Obsessions and compulsions can take hours each day. They interfere with work, school, social, and family life.  Obsessions and compulsions rob people of enjoyment of life. 

 

Obsessions and compulsions can focus on contamination by dirt or germs and result in excessive washing or cleaning. Some people have fears of harming themselves or harming others or having violent, insulting, or horrific images or thoughts.  For some, it is forbidden or perverse sexual thoughts, images, impulses, or hoarding and saving things. Some people feel forced to say lucky numbers or follow routines according to numbers, such as tapping one’s foot 3 times before stepping off the curb. With others, it can be obsessions about having sinned or having offended God and excessive prayer or reparations for offenses. 

 

The first difference between a comforting thought or routine and OCD lies in whether you have to do it or if you want to do it. If you feel compelled, if you have no choice, it could be OCD. 

 

The second difference is how much time it takes. If you delay for an hour getting to sleep because you repeatedly check to see if the doors are locked properly, that could be OCD. If you take 2 minutes to check the doors to the house as a routine before you go to bed, it is not OCD. 

 

OCD was once thought to be rare, but we now know it is one of the more common mental health problems. Often, it is not diagnosed because people are ashamed or afraid to talk to their doctor about it. 

 

There are two times that OCD may come on, which is a bit unusual. Women who are pregnant or just after delivering a baby may get “Perinatal” (around the time of birth) OCD. Children who get Strep throat (and some other infections) may get “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections” (PANDAS). We don’t know yet why this happens.

 

Fortunately, there are good treatments for OCD. One is the anti-depressant medications, the commonly prescribed Selective Serotonin Uptake Inhibitors (SSRIs), and related drugs. The second type of treatment is psychological treatment. The best psychological treatments involve purposely triggering obsessions (exposure) and stopping the compulsions (response prevention).  Combining both types of treatments seems to be the most effective. 

 

Doing exposure and response prevention is hard work, but not nearly as difficult as people anticipate. Most people find exposure and response prevention a bit of a challenge, but quite doable. 

 

It is very gratifying to see someone whose life has been made miserable by OCD gain control of their OCD and be able to live a much happier life. 

 

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