This week’s question comes from Medical Monday guru herself, Lydia Kang. Be sure to pop over to her blog to get your writerly medical questions answered! Here’s the link: http://lydiakang.blogspot.com/
And remember, this is meant for those who are searching for authenticity in their writing and is NOT intended as a substitution for medical advice or treatment.
Question: OCD. When is it pathological and when is it just, well, helpful? and how is it treated?
Firstly, I must say that Obsessive-Compulsive Disorder, Obsessive-Compulsive Personality Disorder, and Obsessive-Compulsive Spectrum Disorders (such as Body Dysm0rphic Disorder, certain impulse control disorders including pathologic gambling, compulsive shopping, trichotillomania/hair pulling, eating disorders, tourette’s disorder, and hypochondriasis) all represent forms of Anxiety Disorders.
Criteria defining each disorder has been outlined by the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV). This allows a clinician to determine a diagnosis as well as provide a common language between mental health professionals. (The material below is from the DSM-IV.)
Obsessive-Compulsive Disorder specifically is made up of two categories:
- Obsessional thoughts and/or
- Compulsive behaviors
- Repetitive, intrusive, persistent thoughts, ideas, impulses, or images that are recognized as excessive or senseless but cannot easily be resisted, dismissed, or ignored.
- This causes marked anxiety or distress
- Thoughts, impulses, and images are NOT simply excessive worries about real-life problems
- The person attempts to ignore or suppress the thoughts or tries to neutralize them with some other thought or action
- The person recognizes the thoughts are products of their own mind
- (Ex. Step on a crack an you’ll break your momma’s back)
- Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession
- The behaviors are aimed at preventing or reducing distress or dreaded event or situation
- These behaviors are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive (Ex. Must check the stove exactly 10 times and turn the stove burner exactly 20 times to prevent the house from exploding.)
- (Ex. Do everything you can to avoid stepping on a crack)
In order to meet diagnostic criteria, the obsessions and compulsions must take over one hour of every day (some people literally spend HOURS a day on their obsessions and compulsions!) or significantly interfere with the person’s daily funtioning, activities, or relationships.
The most common obsessions center around:
- fear of contamination
- fear of mistakenly harming others
- doubt (gotta check the stove!)
- fear of punishment for thinking evil thoughts such as obscentities and sexual thoughts
- need for order, exactness, and symmetry
Common behaviors inlude:
- hand washing
- refusal to touch an object
- collecting unusual or worthless items
- physical or mental ordering
Treatment usually entails a combination of medication (generally anti-depressants, like Prozac) plus Cognitive-Behavioral Therapy where the person examines their thoughts (cognitions) with their therapist and attempts behavioral changes to reduce symptoms.
Now on to what everybody’s wondering about…
Can OCD be “normal?”
Think of it this way: If the person is able to function (meaning is able to hold down a job, have meaningful relationships, hobbies, social engagements, and does not experience overwhelming distress), then they don’t necessarily have the disorder.
Interestingly enough, people can have symptoms of many psychiatric disorders without meeting full criteria for diagnosis. You know the person who likes to keep a clean house, who lives by the adage, “a place for everything and everything in its place.” This person does not necessarily have OCD, per se. Furthermore, we ALL have wonky thoughts pop up into our minds. It does NOT mean a disorder exists.
In fact, certain activities pull for obsessive-like thinking. Demanding classes (ahem, med school-ack!) and careers can demand a mind that can think and re-think and re-think certain topics. Organizational skills are key too.
Come to think of it, these things are pretty important for writing too! And, for the most part, it does NOT mean writer’s have OCD.
Thanks, Lydia, for such a great question! Lemme know, folks, what other mental health questions you have so you can bring authenticity to your writing!