Obsessive Compulsive Disorder (OCD) is an uncontrollable urge to engage in repetitive ritualistic behavior to prevent an anticipated fearful event. OCD is difficult to spot because people with this disorder often hide it. Unfortunately, OCD almost always gets out of control and when it impacts everyday living a person will seek professional help.
As a psychiatric disorder, OCD is not frequent. Some epidemiological estimates place it at 2 to 3 percent of the population world-wide. It frequently gets mixed up with normal hygiene behavior, such as handwashing, so the behavior itself is not problematic, but its exaggerated frequency is where the problem resides.
After all, people, for ages, have engaged in excessive ritual behavior to prevent fearful events. Think about it. Catholics, prior to an act that might be considered risky or dangerous will make the sign of the cross over their heart. This act has no objective preventive value, rather it is a symbolic gesture to invoke divine help. Other religious rituals are defined by their massive repetitions (The Rosary). The repetition has no objective meaning but is symbolic of deep faith or belief.
OCD is ritualistic behavior emanating, not from a religious source, but from one’s conflicted psychic center. The goal of OCD is frequently to prevent an anticipated disaster. At its most potent, the behavior may be construed as mandatory for catastrophe avoidance. “If I don’t do this I will die.”
Take Contamination OCD.
Contamination OCD: Is when people, terrified they might become contaminated or they might contaminate someone else, engage in ritual (washing hands) to prevent contamination (spread of germs).
John can’t use the bathroom without washing his hands. Hand washing at a superficial level, seems reasonable enough, although John washes his hands for at least 10 minutes after he has used the toilet. He believes that he MUST wash his hands, and in hot water and scrub under his fingernails to ensure the he (or someone else) isn’t harmed by germ contamination from feces or urine.
When John leaves the bathroom he employs added measures, a paper towel that he soaks in rubbing alcohol (from a bottle hidden in his pocket) to clean bathroom knobs and doors before he opens them. John tries to avoid touching anything before entering or exiting any restroom.
Why is John putting himself through such an ordeal every time he uses a public bathroom? Because John “fears” contamination.
Why does hand washing lower John’s anxiety? Because the ritual reduces his internal “conflict.”
Conflict is intra-psychic turbulence.
Below is a raging river. Note the rock in the middle. The water can’t go through the rock. The water can engulf the rock, but it cannot displace it.
The jagged white lines in this picture depict turbulence. Turbulence is the water backing up behind the rock. Remove the rock, eliminate the turbulence.
To treat contamination OCD, it is essential to understand that the underlying cause is intra-psychic turbulence. Finding and removing it is the treatment.
MARY AND THE UNWANTED POODLE
Mary is a 37 year old professional nurse with three children. She shares custody of the children with her ex-husband, Frank. The children are 7, 10, and 13 years. Frank adores the children, but he dislikes Mary. This is why they recently divorced. Mary got the house, joint custody of the kids, and alimony.
As a Divorcee, Mary finds herself competing with Frank for the children’s attention. Mary calls Frank the “Disneyland Dad.” Frank showers the children with gifts, and trips. Frank is particularly found of the 10 year old daughter, Trixie. To Mary’s chagrin, Trixie often uses her affection to pit Mary against Frank.
The children want a pet, and this is one thing Mary knows Frank will not do. He doesn’t want the hassle of taking care of a dog or a cat. Mary, seizing an opportunity to get the upper hand, agrees to a dog. She goes all out in getting a dog, taking the children to look for dogs, adopting overnight dogs from the local animal shelter, buying doggy toys and books about dogs in anticipation of the new dog, and ultimately buying a pure breed poodle from a registered breeder and paying a healthy sum for it.
Mary never wanted a dog. She is afraid of dogs. Even so, Mary’s parents had a dog in the home. She recalls her parents regularly cleaning dog waste off the carpet. Mary recalls the smell of dog urine. All of these distasteful memories probably contributed to Mary’s childhood fear of dogs.
But, the children love the new poodle. Mary wants to keep it in the back yard, but somehow it finds a place in the house.
Over time, the poodle creates trouble. It is hard to train, Mary sees dog dirt everywhere. She smells dog urine frequently. She hates walking the dog when the children are not home. By de facto decree, the dog has become Mary’s dog, and it has attached itself to her. She starts seeing dog hair on her clothes, on her kitchen table. The kids eventually lose interest in the dog, but they still profess a love for it. If Mary got rid of the dog, Mary believes she would disappoint her children. Plus, the dog breeder, in the contract, declares that Mary must keep the dog or, if for some reason she cannot do this, then Mary must return it to the breeder and forfeit the purchase fee. It’s an impossible situation for Mary. Mary tries to make herself love the dog, but it is without fail when the dog urinates on the couch or barks all night, that a vicious cycle of conflict starts to build. Mary gets angrier with the kids for not playing with the dog, not caring for it, not walking it. She is angry with the breeder for coercing her to sign that contract. Trixie starts telling Mary that she hates her mother because she observes her Mom being mean to the dog.
Mary’s Contamination OCD symptoms begin in this crucible of conflict. Mary begins to fear that dog feces might infect her or her children. She becomes paralyzed at the thought of picking up dog feces. She must wear two plastic gloves, pick up the feces with an small telescopic pooper-scooper and when the feces are bagged, she must spray them with disinfectant. She begins to fear throwing feces in the garbage because she worries others might be contaminated by it. The dog barks and moans for walks and Mary lives in fear of walking the dog because this means feces on the ground. When she looks at the dog, Mary can only see the dog’s anus because, as she told me, “Dr., that’s where the feces come out and those feces are filled with parasites.” Mary has lost perspective in her focus on contaminated dog feces.
How did dog feces become so problematic for Mary?
What is the real source of Mary’s conflict?
What is the object of Mary’s OCD behavior?
What is OCD telling Mary about herself and her past?
How will Mary resolve her her Obsessive-Compulsive ruminations?
In my next entry I will describe how Mary was able to answer these questions, got her symptoms under control, and is managing her life and her co-parenting better.