Every day, people use the phrase "OCD" to describe any number of behaviors, from being meticulous about appearance to the desire to get things completed a certain way:
"I just cannot go to bed with dishes in the sink. I'm SO OCD."
SPOILER ALERT: That ain't OCD (though it might be a different condition, so read on).
Obsessive Compulsive Disorder is a lifelong condition that usually shows up during puberty or early adulthood and is identified by (you guessed it) obsessions and compulsions. OCD is equally likely to occur in men and women, and affects around 2% of the population1. And it can be absolutely debilitating. This is not a "sink full of dishes" type concern. OCD can be a "I'm not leaving my house today because I'm too busy scrubbing my hands raw" kind of concern.
Aside from the obsessions and compulsions, most with OCD tend to worry, usually about how worried and anxious they are. But make no mistake; whether they are seen as over-reactors, as overly sensitive or as obsessive, the whole thing is scary as fuck. I really think that phrase should be a part of the clinical definition of OCD, which is why they will never hire me to write that book, though I guarantee mine would be more entertaining to read. Maybe I will write my own, dammit.
But first things first. What is Obsessive Compulsive Disorder (OCD)?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Obsessive Compulsive Disorder (OCD) is characterized by8:
- A. The presence of obsessions, compulsions, or both.
Obsessions are intrusive, unwelcome, pervasive and distressing thoughts or images that annoy the shit out of you but that won’t stop (paraphrasing here). The thoughts may involve sexual or violent content, nonsensical doubts about mundane things (“Did I pay that bill?”) religious preoccupation, constant concerns about morality or “blasphemous" thoughts, fear of hurting others, or constant thoughts of hurting the self. These thoughts may lead to behaviors (compulsions) in order to keep the thoughts and anxiety at bay.
Compulsions are the actions done to calm the anxiety. For example, thoughts about locks not being done may lead to constant door checking, and fearful thoughts about germs may lead to constant hand washing. Those with OCD may hoard or stash useless items, due to a fear of losing something vital, or repeat words or phrases. However, while adults tend to be more able to identify a thought such as, “I must check the door so someone doesn’t break in and kill me,” younger kids will likely have trouble identifying why they are doing these things.
- B. The obsessions or compulsions are time-consuming or cause issues in other areas of life.
- C. The obsessive-compulsive symptoms are not due to a drug use or other medical condition.
- D. The disturbance is not better explained by the symptoms of another mental disorder
And there are a few other disorders that look similar.
Obsessive Compulsive Personality Disorder
People with OCD may obsess about contamination, germs, sticky substances, bodily secretions or have an obsessive need for symmetry and neatness. However, there are other issues that mimic these tendencies. There is a closely-related condition called Obsessive Compulsive Personalty Disorder (OCPD) where individuals have persistent personality traits such as obsessive cleanliness, list making, inflexibility and trouble compromising or delegating. These are individuals who believe things must be done their way. More common in men, those with OCPD are not as bothered by their tendencies and don’t show as much impairment in their day-to-day life.
If you’re not a worrier and tend to think “everything would be fine if everyone just did it my way,” you might have OCPD as opposed to OCD, despite those around you telling you that you are surely obsessive compulsive. This is especially likely if you have little desire to change these traits because of the rush cleaning or organizing gives you.
Those with OCD do not get a rush. Instead they feel anxious, sad, guilty, frustrated and just overall shitty about the thoughts and behaviors and would like nothing more than for them to stop.
Postpartum Obsessive Compulsive Disorder (PPOCD)
While we are on the diagnosis part, I also want to mention Postpartum OCD, possibly one of the most misunderstood and misdiagnosed disorders after birth. While those with a history of OCD may be more likely to have a recurrence of symptoms, many new moms experience OCD for the first time in the postpartum period.
Because that’s just what the fuck we need when dealing with incontinence, third-degree tears and leaky breasts. But I digress.
In Postpartum OCD the thoughts and compulsions often have to do with the new baby, i.e., constant checking, bathing or changing. The thoughts and behaviors may also center on keeping the home clean or checking doors for the protection of the child. New moms may also have scary thoughts that involve harming the infant, or the belief that in order to avoid these behaviors, she must engage in the compulsions (i.e., “If he’s too dirty, I might hurt him, we need to bathe again.”). Women tend to be horrified, afraid of being left alone with their child while at the same time hyper-vigilant in their protection of them. (For more on these thoughts, check out The Evolution of PPD and the Drive to Abandon and What Women Need to Understand About Infant Harm.)
While there remains some debate about whether Postpartum OCD is a distinct subtype of the disorder2, it is clear that pregnant and postpartum women are at a higher risk for developing OCD than the general population3 with some researchers going so far as to recommend OCD screening for every new mom, particularly those with a psychiatric history4.
But why would OCD emerge after birth? Wouldn’t all that stress be ill-advised for new moms? What the fuck, Mother Nature!
Unfortunately, she knows what she’s doing. Because it is at our most vulnerable times that OCD would have been most beneficial to us historically.
The Evolutionary Roots of OCD: When Obsession Is Good Thing
Those with OCD tend to be scanners, constantly on the lookout for threats, hyper-vigilant in their worry about real or imagined danger. And this threat detection system may have had increased importance at vulnerable times such as puberty or during pregnancy and following childbirth. This may be why these issues tend to show up or spike at these times. But it is our ability to consider and worry about future scenarios and imagined thoughts and consequences that makes us uniquely susceptible to continuations of these thoughts5, compared to other members of the animal kingdom.
It’s Why Zebras Don’t Get Ulcers, people.
Okay, so early warning detection systems, hyper-vigilance and scanning for physical threats would have kept our ancestors alive by alerting the group to renegade tigers lurking in the underbrush. But it’s not all about watching for tigers. What else did our ancestors have to worry about?
Most common compulsions do tend to revolve around issues that would have posed a threat to our ancestors. Avoiding contamination in an age before Pepto Bismal was a pretty big deal (pregnant nesting drive, anyone?). We also needed to make sure not to burn our hut to the fucking ground, so “DEAR GOD DON”T LEAVE THE FIRE (I mean stove) ON!” OCD tendencies may also have helped our ancestors to avoid forgetting things on necessary survival checklists. If we left a tool behind, we may have been in dire straights should we find ourselves twelve miles away without the ability to fashion a new one.
In addition, we have evolved to be sensitive to challenges to our social position, and other types of social risk prevention, as being ostracized from a group may have meant death for our ancestors. This may be yet another reason why some obsess about how they look or how clean their home is even in the absence of germ concerns6.
Social threats may also contribute to the tendency towards violent thoughts. Obsessive aggressive thoughts may have been particularly handy should other individuals come against us, allowing us to initiate an immediate defense, since we had already imagined the violent scenario (more here in How Conflict Bred Cooperation) . However, this imagining doesn’t make people do morally objectionable things. We won’t actually hurt our kids despite the obsessive thoughts about doing so, or kill our mother in laws. But if your mother in law actually tried to kill you, you’d be more ready to defend yourself. Until that happens, those who have obsessional thoughts and feel guilty aren’t likely to hurt anyone. Worry when you wake up super excited at the thought of murdering your neighbor.
This whole social/group thing might play a role for other reasons too. Because while OCD clearly presents challenges for individuals, it would have been advantageous for the group at large7, referred to as group selection. It’s always beneficial to have at least one obsessive individual constantly checking to make sure there are no tigers, no invading groups, no fires, fewer germs, and who would check to make sure you had all your stuff, regardless of how uncomfortable that person was.
Thank you, OCD hominids of times past for letting our species survive to see today.
But this is no longer how we live. It’s an outdated system, at least for most of those reading this article. We exist in relative safety, a threat level of “Wayward Leprechaun Looking Nonchalantly For His Pot of Gold.” Unfortunately we still have systems primed for threat level “Rob Ford Without Crack”.
The fact that the majority of individuals tend to have obsessional thoughts at some point in their lives paints OCD as an adaptive system that springs into action in cases of extreme stress. But it only sticks around for some, possibly those with a predisposition to have a sticky switch in their brain. And OCD does seem to have a genetic component, possibly related to genes in the serotonergic and dopaminergic pathways1, but studies have had mixed results, making more research necessary before drawing conclusions. However, as most individuals that I have treated can attest, those with OCD tend to have someone in their family with those traits. But again, whether it’s the result of modeling or genes remains debatable.
Whether it’s genetic or learned, those with OCD have similar brain changes. Because, like depression, Obsessive Compulsive Disorder runs on physical wiring and signal transmission at the level of the brain.
It’s not you. It’s your OCD. And in the next post, we are going to check out what your brain looks like all hopped up on obsessive compulsive issues as well as discuss all the different ways to treat it. Don’t miss the next post: Obsessive Compulsive Disorder, Your Brain and How to Treat OCD.
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- How to Cope With Intrusive Thoughts: Introduction to Cognitive Behavioral Therapy and the Cost Benefit Analysis
- How to Stop Intrusive Thoughts: Cognitive Behavioral Therapy, Thought Replacement and Visual Substitution
- How to Deal With Fears, Phobias and Intrusive Thoughts: Exposure Therapy
- "You're Not Pretty (Enough)": The Media, Low Self Esteem, Porn and Rush Limbaugh
- Secrets Every Married Woman Should Know: What Penis Size Can Teach Us About Monogamy
- Why We Need Maury Povich: Sexual Selection, Trust and Misunderstanding