OCD Obsessive/Compulsive Disorder
By Norman Araiza (Mar 24, 2006)

Obsessive/compulsive disorder: even the name makes you want to clean up those words and put in a euphemistic term like "determinedly conscientious." I'm joking about a seriously common malady that is hidden in a very private place in those people who suffer from this syndrome. The symptoms range from mild to severe, and anxiety is the driving emotion. 

The disorder usually has two parts. The obsession is the thought or fantasy the person experiences. This thought, or obsession, appears to be uncontrollable and is highly uncomfortable, so the individual develops methods of ameliorating its discomfort by performing the second part, a compulsive act. It's as though the sufferer has made a deal with the voice in his head to stop the thought by performing the compulsive act. When the compulsive act is performed, the obsessional thought abates, at least temporarily. For example, if the voice in your head tells you that the table is not clean and it is your job to clean it, then to quiet the voice you have to clean the table.

We all have the voice in our heads. It never stops for most of us. It tells us what to do and we do it. If we don't do it, we are in conflict with ourselves, which increases anxiety and puts incredible stress on our systems. 

Any thought that creates anxiety and drives us to perform an act that is unnecessary or deleterious to the individual in some way can be an obsession. Depending on our emotional and behavioral programming, that voice can drive us to positive achievements, as in the case of an Olympic athlete. Or, it can drive us to destruction, as in the case of suicide. Somewhere between these two extremes are the individuals who suffer from this malady to a lesser degree. In this group are those people who have to check the gas heater or stove three or four times before they can leave the house. Or, those individuals who suffer from social anxiety and have difficulty inviting guests to their home because of their fear that things might be less than perfect. This could also include those people who get so nervous before and during a visit that they can't enjoy the company of their guests. 

I'm also referring to those individuals who can never seem to relax and do what they would prefer to do. A simple question to ask yourself when faced with a chore or activity that you are less than enthusiastic about is: Is this a "want" or a "should?" Do I want to do this, or is it something I should do? If it's a "want," then it's less likely to be an obsession than if it's a "should." If you are faced with a lot of "shoulds," ask yourself who it is you are trying to please. Because it's not you! I like to say, "Don't 'should' yourself!" Many of us are so driven by "shoulds" that we hardly find time for the "wants" in our lives. This town is full of artists and wannabes, but many of them are so busy doing the "shoulds" that they don't allow themselves to do what they say they want to do.

Then there are those people who never do the "shoulds" and only do the "wants." Maybe the answer lies in making everything a "want." It's all a matter of attitude. The good news is that it is controllable. We can learn to change what the voice is saying.

A simple way of evaluating your situation is to determine if it's a difficulty or if it's a problem. A difficulty is something we can live with or handle and improve by ourselves. We become aware of the issue and attempt to get control of it, either by reducing its frequency to an acceptable level or eliminating it altogether. If, however, we have tried to reduce or eliminate it and it has persisted or worsened, then by definition it is a problem. Problems usually require outside assistance.

A behavior only becomes a compulsive act when it is driven by an internal critic that is rarely satisfied and becomes a problem to the individual and those she or he lives with. This is a very personal issue, and only those close to the person can define it as a problem. I'm not referring to psychotic behavior. Those with such severe symptomatology are usually hospitalized. I am referring to those individuals whose lives are impaired to the extent that they are reacting to something other than their own wishes.

Under the broad term of OCD we can include any repetitive behavior we perform to make ourselves comfortable. I have treated clients who say that if the books and magazines on a table are not stacked perfectly square and even, it feels as though someone is twisting a knife in their stomach. Other examples are the fidgeters who cannot seem to just sit and relax. They are always fidgeting with something, straightening, smoothing or making things just right in order to relax. But, the reality is that they never seem to get it right enough to relax. Or, they never finish a task so they can do what they really want to do. The fear of contamination or germs is another common theme that many people focus on, and they feel driven to protect themselves from the debris of life.

Other symptoms, such as a feeling of impending doom, might arise if the compulsive act is not carried out. There are a whole host of other anxiety disorders that are related to OCD, ranging from phobias to eating disorders such as bulimia. What they all have in common is the attempted quelling of anxiety. The anxiety, of course, is a response to the voice in the head.

Incessant talking is one unconscious attempt at quieting or controlling the voice. As long as chatterboxes are talking they don't have to listen to the voice. The problem is that others have to listen to their incessant prattle, which easily turns into complaining because one never runs out of things to complain about.

These kinds of problems rarely improve on their own. Usually, the behavior worsens without intervention. I have seen many clients who are so trapped by their compulsions that they are almost housebound. What makes treatment difficult is the tendency for the person to deny that this is a problem. Many have learned to live with the disorder and believe it to be just part of life. It is truly a matter of a person's willingness to tolerate the symptoms. Treatment usually involves a medication to reduce anxiety with concurrent counseling. Hypnotherapy has been found to be an effective modality in treating anxiety disorders in general. The good news is that we can learn to control the voice we hear so that it only says positive things to us and can reduce the anxiety to tolerable levels.

Invariably, clients with OCD state that they wish they had sought treatment sooner. 

Norman Araiza is a psychotherapist living in San Miguel. He enjoys a limited practice and can be reached at 152-4018 or by email at nearaiza@hotmail.com