When compulsion governs daily life

Man sitting on a bank with his head in this hands (M.E./pixelio.de)
Patients withdraw from society and become more and more lonely (M.E./pixelio.de)

We are all familiar with harmless forms of constraints in our everyday lives. If, however, those dominate the behaviour, there is a so-called obsessive-compulsive disorder (OCD). The sooner it is treated, the greater the chances of recovery.

Imagine an everyday situation: After getting up, you do your morning wash, have breakfast, some coffee or a cigarette, iron a shirt for the meeting at nine o’clock, get dressed and leave the house for work. Then suddenly, the worries creep in: Did I turn off the coffee machine, and the iron? Where did I dispose the cigarette butts? Did I really lock the front door?

So, you are unsure and you will return home to check and find that everything is in order. Relieved you leave again. If that is all now, you do not have a problem with OCD. These daily uncertainties about things we do more or less automatically are normal.

Compulsion governs behaviour against your own will

The situation is quite different if the uncertainty continues and sets into a compulsion to control the same things over and over again. To stay with the example above: A person with OCD would return home to check, even being aware that it is completely absurd and it is getting late for the meeting. However, the person cannot act against the compulsion and needs to check again and again. The compulsion dominates the behaviour against the will of those affected.

When the obsessions become so strong that the affected people suffer or their daily life is severely restricted, this is called a morbid obsessive compulsive disorder. By definition, OCD means that obsessions and compulsions last at several days for at least two.

Uncertainty and anxiety

Connected to most compulsive behaviours is the thinking that something terrible can be prevented. If the action is not repeated over and over again, a feeling of insecurity, fear or disgust arises. With the repeated execution of coercive actions to, those feelings can be reduced.

The perhaps best known obsessive behaviour is obsessional washing and cleaning. People who suffer from such a compulsions are terrified of dirt and bacteria; their daily life is governed by the urgent need for cleanliness. Affected people do no longer let visitors entering their home to keep dirt out. By the sight of the slightest impurity, the entire home needs to be cleaned thoroughly.

People with this kind of OCD do not shake hands and if it cannot be prevented, they need to wash their hands again and again – sometimes even until they bleed.

From action to ritual

Compulsive behaviours may also turn into compulsive rituals. The acts are performed in a down to the smallest detail planed order. Affected persons need to execute the ritual every time in exactly the same way, according to certain rules. If the action cannot be completed, this creates more fear, and the ritual must be started again from the beginning.

Dark silhouette of a man in a tunnel-like circle (Gerd Altmann/pixelio.de)
OCD affected people are in a vicious circle (Gerd Altmann/pixelio.de)

Fear dominates life

Obsessions are thoughts, images or impulses that repeatedly intrude. Affected people find such ideas extremely worrying. Mostly, there are intrusive thoughts that revolve around accidents, diseases, disasters or acts of violence and that threaten especially relatives and friends.

Worries dominate life because the intrusive thoughts are almost limitless. They can relate to sexual content, religious and moral questions, or anything that relates to orderliness.

Numerous coexisting symptoms

Coexisting symptoms of the intrusive thoughts or compulsive behaviours are often a general nervousness, a constantly distressed behaviour, depression and low self-esteem.

Fatigue symptoms are also common because of the constant struggle against the compulsions- whether successful or not – take a tremendous amount of energy.

Affected people are in a vicious circle. The experience of unbearable intrusive thoughts is very frightening. Fight against or respond to the intrusive thoughts is done with compulsive behaviours, which in turn will keep the triggered fears alive. 90 percent of people affected by OCD show both intrusive thoughts and compulsive behaviours.

Hundreds of thousands affected

Until the mid-nineties of the 20th Century, OCD was still relatively unknown. This created the feeling among those affected to be alone with their illness. This increased the risk of suicide as well as it minimised the chance to benefit from therapeutic treatment.

Today, it is known that OCD is more common than previously thought. The real figure is high because affected people are ashamed of their disorder and hide it as long as possible. It often takes many years until an accurate diagnosis and appropriate treatment can be initiated. Experts believe that two to three percent of the general population are affected. Based on these figures, it is estimated that there are over 100 million sufferers of OCD worldwide.

The OCD is, after phobias, depression and addictions, the fourth most common psychological disorder. Approximately 20 percent of patients are already affected in childhood. In most individuals, the disorder begins in early adulthood.

Various factors responsible

Despite remarkable progress and findings in research it is not yet fully understood how an OCD occurs. Most experts believe that the combination of many different factors is responsible for the disease.

Frequent cause for OCD seems to be the concurrence of an existing psychological vulnerability - e.g.as a result of previous stressful life events - and having an acute mental overload. Studies on families and twins have shown that also the genes may be responsible. According to numerous studies of brain metabolism plays a role, since the momentum transfer in the brain is disrupted by patients.

Treatment at the earliest possible

The sooner the treatments of OCD, the better are the predictions. Today, there are tools to achieve a significant and lasting relief from the symptoms. In order to treat OCD successfully, it has proven to be useful to apply a combination of medication and psychological treatment.

In the field of psychotherapy, both in outpatient and inpatient care behavioural methods have been developed. The medical facilities are much better than before. OCD is a serious psychological condition; however, there good chances to overcome it.

Text: Patrick Gunti - 06/2011

Photos: pixelio.de