“You feel like the world is about to end if you don’t brush your teeth with like seven strokes in the right direction, and that’s in- sane,” said junior Laura Smith, which is not her real name.
Smith is referring to one of the symptoms of her Obsessive-Compulsive Disorder (OCD), which is a disorder of the brain and behavior that causes severe anxiety. It involves obsessions and compulsions that can be time consuming and distressful, getting in the way of daily life. The frequent upsetting thoughts, images or impulses associated with the disorder are called obsessions, which are often accompanied by uncomfortable feelings of fear, doubt or disgust. Common obsessions include fear of germs, losing control, self-harm and perfectionism.
A person with OCD will feel an overwhelming urge to repeat certain rituals or behaviors called compulsions to try to control these obsessions. According to Dr. Reid Wilson, a licensed psychologist, author and Associate Clinical Professor of Psychiatry at the University of North Carolina School of Medicine, compulsions are the only thing that many people with OCD have figured out to quiet these obsessions down.
“You have people who are washers and cleaners; that’s about contamination,” Wilson said. “You have people that are checkers, who are afraid the door is unlocked or the window is unlocked…[They’re thinking], ‘If I leave that window open, someone could break in, hurt my family, steal all my things.’ It’s that little thing when you go on vacation and your mother says, ‘Did I turn the iron off? I can’t quite remember,’ but it’s [more extreme than] that. There are repeaters who think, ‘If I walk through that door and have a bad thought, Dad’s going to get cancer.’ They would have to walk out that door and walk through it again as many times as necessary until they have a neutral thought or a positive thought that gets rid of the negatives.”
People with OCD practice these repeti- tive behaviors or thoughts with the intention of neutralizing, counteracting or making their obsessions go away. According to the International OCD Foundation, 500,000 children and teens in the United States have OCD. An anonymous junior, who we will call Taylor Green, is one of them.
“Counting is a big one; I count steps,” Green said. “There is also the paranoia of everybody looking at me or people thinking I’m weird or dumb. I’ve gotten my symptoms under control, but when it first happened, the oven was a big thing for me. I always thought the oven was on, and I’d have to go turn it off. I thought the house was going to burn down. Hand washing is a really classic one, but mine is whole body washing. If I’m feeling really anxious that day, I’ll take like three showers. I don’t like to feel dirty; oil on skin and in hair drive me crazy.”
Smith also suffers from several aspects of OCD.
“I suffer from anxiety and panic attacks and several OCD compulsions like organizing, repeating steps, [doing things in] sets of the numbers 11, 12 and 13, repeating certain bedtime routines and stirring my coffee a certain number of times,” Smith said.
According to Wilson, Cognitive Behavioral Therapy (CBT) is the “gold standard” in terms of treatment for these debilitating obsessions and compulsions.
“The first thing to do, as far as I’m concerned, is to help people understand that the content of what they worry about is irrelevant,” Wilson said. “[OCD] is going to grab your attention with some- thing that is personal to you, but the treatment has nothing to do with the content. [The patient needs to] externalize and personify their OCD…. This has nothing to do with contamination, nothing to do with leaving doors unlocked; what it has to do with is, ‘I’m vulnerable to uncertainty and distress. I, as somebody with OCD, cannot tolerate doubt or the distress that comes with the doubt.’ The key to treatment is to understand that, and then find some ways to tolerate not knowing if the door is locked.”
Sufferers of the disorder often use medication. Specifically, a class of medications called serotonin reuptake inhibitors (SRIs) works best.
“I have a whole smorgasbord of pills to take twice a day,” Green said. “I kind of feel a little lobotomized because I know it’s a part of who I am, but I have to function. I would like to be off medication once I graduate college unless I really need it.”
Although researchers are unsure of the exact cause of OCD, it is likely that differences in the brain and genes may play a role. Research suggests that OCD involves communication problems be- tween the front part of the brain and deeper structures of the brain. Some experts think that genes may play a larger role in OCD that begins in childhood compared to when it starts in adulthood. OCD can be terrifying for those who develop symptoms during their teen years.
“OCD tends to start in the teen years, and what is so troubling is that when it suddenly hits, you don’t understand what in the world is going on,” Wilson said. “What some teenagers do when it first starts is they don’t tell anybody because it’s so shameful…. That initial stuff is so upsetting to people.”
Some people make a joke out of OCD, which can downplay the disorder for those with a clinical diagnosis.
“I hate when people say, ‘I’m being so OCD; I take such good notes,’” Green said. “I’m like, ‘Do you want my OCD? You can have it.’ A lot of people trivialize it, which is upsetting because it’s a real thing that I struggle with every day.”
Smith agreed.
“It’s not fair because it really takes over your whole life and pretty much ruins you,” Smith said. “It’s not cute, it’s not cool and it’s not funny.”
OCD can have a large impact on a person’s everyday life. What may seem like a simple task for some can take hours for a person with OCD.
“I’m definitely a really anxious person, and it really reduces efficiency because it takes up so much time to take part in all of these behaviors,” Smith said. “You really just aren’t as efficient as a person, and you have a lot more responsibilities in your brain.”
Smith says the disorder also impacts how she interacts with other people.
“My biggest struggle has probably been [with] my social skills, since I spent so much of my developmental years being really inside my own head. I’m really reclusive and really involved in meticulous counting and sorting, and I’m not very good around people.”
Some students are forced to justify their disorder to others.
“A lot of people think I use it as an excuse; because they can’t see it, they don’t believe it,” Green said. “I kind of understand, but at the same time, it’s really frustrating. If you have a broken leg, everyone knows that your leg is broken, and it’s understandable that you can’t walk. When you have something that is completely inside of your head, people often don’t validate that and don’t see it as a real thing.”
Despite the setbacks that OCD has presented her with, Green is continually improving and learning to control her disorder.
“In DBT, which is Dialectal Behavior Therapy, you have to teach yourself to recite this inner monologue and tell yourself it’s fine,” Green said. “[You have to say to yourself], ‘I will survive if my name is not written perfectly or if there’s oil on my skin. I will be fine.’ It’s a long process.”
– By Becca Heilman