Rechecking that a door has been locked can take an hour for someone with OCD. Returning home after work and needing to check for intruders may take several hours. Especially when you feel as though even the refrigerator must be examined to see if someone is hiding inside.
Going to sleep at night can be delayed indefinitely when your nightly prayers need to be said with a pure heart…. And you always find some way in which your heart remains impure.
Types of OCD
Obsessive-Compulsive Disorder tendencies express themselves in a variety of ways, some more common than others. What the compulsion is focused upon is a helpful way to parse OCD in order to understand it better.
Below is a list of the most common types of compulsions. Although most people who suffer from OCD will generally fall into only one of these categories, it is certainly possible to have compulsions within several of these groupings.
What triggers the washing/cleaning: anything that might contain germs or give rise to feelings of being contaminated or dirty.
What sort of intrusive thoughts occur: “This is disgusting. There must be germs all over this thing. I’ll get sick if I touch it.” “I better hold my breath, that pile of trash is foul and probably letting off airborne germs that will infect me.”
What sort of compulsive behaviors occur: Avoidance of places/things where this fear arises. Relentlessly washing hands, cleaning surfaces, disinfecting objects.
What triggers the checking: anytime when a mistake might be made which could result in harm (this includes leaving home, making a fire in the fireplace, ironing clothes, etc.).
What sort of intrusive thoughts occur: “Did I check that the front door is locked? If I forgot to do that someone could sneak in and rob us.” “Did I put the fire out in the fireplace? If a little hot ash rolls out to the floor we could all die in a fire.” “Did I turn off iron? I can’t be 100% sure I did. I think I did. Hmmm. If I’m wrong the house could go up in flames. Let me go check one last time.”
These fear-laden questions create even greater anxiety that then leads the person to check ‘one more time’ that the door is locked, or the fire has been put out, the iron turned off, and so forth. Eventually, the double-checking results in just enough of a sense of relief to free the person to move on in his/her day.
Even so, it will not be long before another fear emerges and requires similar compulsive checking behavior.
When you suffer from OCD that leads to repetitious behavior it is usually due to believing that certain things must be done perfectly. No exceptions.
Moreover, what needs to be performed with perfection is not necessarily something of intrinsic importance. It might be the way one enters a room or grasps a doorknob, or sets the dinner table, and so forth.
This is what makes the compulsions particularly maddening. If one felt such a need for perfection because brain surgery was being performed it would be understandable. But over how the laundry is folded, or the garage is swept?
The thoughts that propel one to repeat this behavior focus on unrealistic but calamitous consequences if perfection is not attained. Someone may die, or fall ill, or others will decide to leave and never return.
The OCD sufferer usually recognizes that these fears make no rational sense at all. Zero. Nada.
But at a gut level, it feels as though they are pressing in from all sides. A sense of dread and urgency mix together forming a final certitude that unless perfection is acquired, horrible consequences will follow.
The result is that certain thoughts, or behaviors, are repeated again and again until a sense of perfection is acquired. This may take a few minutes, or it may take several hours.
The term ‘hoard’ comes from the Old English word ‘hord’ which referred to a treasure, some valuable stock, or storage. Not surprisingly hoarder comes from the Old English term hordere meaning “a treasurer, steward or chamberlain.”
The OCD hoarder does not focus on the treasure. Far from it. In fact, often there is no focus at all other than the steady refusal to discard worthless items. As a result, these folks tend to accumulate massive amounts of clutter.
What type of clutter? Could be virtually anything: gum wrappers, stacks of magazines that fill entire bedrooms, clothing that is worn out or no longer fits, empty soda cans that are never recycled, etc.
The fear that most hoarders have is that once they throw something away they will, sometime later, find that it was needed. An even more compelling reason many hoarders give for not throwing items away is that the object has sentimental value. The problem here is that hoarders become sentimental about many items. For example, a hoarder may keep the fast-food bag that contained hamburgers from their junior prom date.
Many hoarders will also admit that when they throw things away it provokes an odd sense of being incomplete. A feeling that they are missing something essential in their life.
Their solution for avoiding such discomfort is to hang onto things that others easily discard.
The end result of hoarding is a life that becomes smaller and smaller. The OCD hoarder’s home becomes filled with items that give him, or her, little pleasure. Disorganization is the norm, so as the collection of hoarded items grows so does a depressive sense of chaos and lack of control.
Eventually, the hoarder finds it difficult to navigate his/her own home due to the massive number of objects that clutter the floor, and are stacked ceiling-high against the walls. Friends are not invited overdue to embarrassment about the state of the home. A sense of helplessness and self-reproach is common.
The last subtype of OCD we will look at is the ‘obsessors.’ Some might think that this type of anxiety does not really fall under OCD because it often lacks the traditional compulsive solution that momentarily resolves anxiety.
That is, unlike other types of OCD where a specific ritual, behavior, or thought, is performed and anxiety subsequently resolves, the solution for obsessors is often not quite so clear.
The ‘obsessor’ OCD individual becomes anxious when various thoughts come to mind. These may be random, and nearly always are meaningless. It may be that after reading a news report of some tragedy the person thinks “What if that happened to my child?” An image of their child in that tragic situation briefly forms whereupon the obsessor thinks “I wonder if I want that to happen to my child?” This question then proceeds to haunt the obsessor, and a sense of nearly unbearable guilt/shame frequently follows.
Such intrusive thoughts are not limited to themes of violence but also include sex, impulsive behaviors that break societal norms, and activities that go against the person’s deepest held beliefs regarding right and wrong.
The response to having these intrusive thoughts, as noted before, is to question one’s own integrity and virtue. It is as if the unbidden thought (which most people would discard as being an odd and meaningless neuronal hiccup) holds dark secret truths about one’s mental state.
The person will normally proceed to dwell on the thought, examining it from every angle with the hope that by doing so he, or she, will discover that the thought does not mean what they fear.
This compulsive behavior generally provides little relief, and what it does provide is short-lived. Other common reactions include repeatedly praying, silently counting, repeating a specific phrase or word, and seeking reassurance from a trusted confidant.
Patterns Of Anxiety
Before going further, it is important to briefly look at how OCD-related thoughts, feelings, and behaviors work together in a way that makes it difficult to stop worrying.
I want to start by pointing out that each of the OCD subtypes we just looked at shares one fundamental similarity. Namely, some event or thought triggers an intrusive thought which gives rise to anxiety that in turn is responded to with a compulsion (through behavior or thought) which eventually creates a sense of relief.
The graph above shows why OCD does not lessen or resolve, on its own. The compulsive behavior (or thoughts) do serve a purpose – they lessen the anxiety. When anxiety is reduced in this way, the compulsion grows stronger.
That is because it has been reinforced. Using compulsive behaviors to reduce anxiety is not healthy. It ends up creating more problems than it solves. Even so, because it effectively leads to a sense of relief, this solution (using compulsions) is reinforced. Anything that is reinforced is more likely to occur in the future.
One unhealthy result of using compulsions to get rid of fear is that the unrealistic thought that gave rise to anxiety is never pushed back upon. It is never put to the test.
It is similar to what would happen if a little child, who is fearful of jumping into the family swimming pool and being caught by her father, remained on standing next to the pool. Imagine if that young child made such a fuss that her parents gave up and told her to go play on the swings.
She would be relieved. Making a fuss and tantrums would be reinforced. Learning that it was safe to jump into her father’s arms would never happen. Her fear of being dropped, allowed to flounder in the pool, would remain intact.
Similar to the ‘repeater’ who fears that his wife will die unless he perfectly arranges and rearranges items on his desk, he feels relief once the compulsive ritual is completed. But the unrealistic fear that drove him to enact this compulsion has not been confronted.