Why some people have Obsessive Compulsive Disorder and others don't
1. What is Obsessive Compulsive Disorder (OCD)?
The average person is unable to understand why those who suffer from OCD and would love to get rid of it, don't just stop doing whatever it is.
So illogical it appears to the non-sufferer that numerous TV programmes have been made featuring sufferers. These unfortunate people have often filled their homes with junk of different sorts and would love to be able to throw it away but just can't - and they can't allow anyone else to do it for them either.
Various OCD symptoms
Not everyone diagnosed with obsessive compulsive disorder is a hoarder. In many cases the main symptom is compulsive behaviour of some kind such as repeatedly checking a door is locked or maybe counting certain things. Repeated hand washing is another common OCD symptom.
For another group there's an irrational fear, often of germs, that prevents them living a normal life by getting in the way of everyday activities. In some cases this dread of germs prevents the sufferer from sitting down anywhere except in their own home for fear of contamination.
2. Who gets OCD?
The figure often quoted for incidence of OCD in the adult population is around 1% (NIMH in the US) or 1.2% in the UK. (OCD-UK.org)
Most people think of Obsessive Compulsive Disorder, or OCD as it is often known, as a separate diagnosis, distinct from anything else. In reality Obsessive Compulsive Disorder is a slightly different way in which anxiety shows up in people with a certain personality type. It is not something which you either have or don’t have.
Most of us with a perfectionist tendency in our personalities have some obsessive tendencies.
In some respects such tendencies are good especially when organisation skills or attention to detail are important.
I can recognise many such tendencies in myself and at times of stress I can see how they might easily take a hold if I'd let them. Luckily for me I have a good understanding of what’s happening.
Occasionally, if I feel the need to go back and straighten something after putting it down, I stop and ask myself what I'm stressing about rather than doing what my head is telling me to do.
This means I am able to put a stop to them before they take hold.
Most people for whom OCD is diagnosed have not been able, or had the awareness, to do this.
So when would this sort of behaviour be regarded as Obsessive Compulsive Disorder?
If OCD-type behaviour is a common tendency in people with perfectionist personality traits, when does it become OCD? The answer to that is when the behaviour no longer serves any useful purpose, causes anxiety when you do it, and interferes with normal everyday life.
3. Where does personality come in?
We are each born with different personalities. Even as babies we show different traits from our brothers and sisters despite the fact that we may grow up in the same house and with the same rules.
I raised five children and applied the same rules about tidiness etc to all of them. They are now all grown up but, despite having been taught exactly the same behaviours as children, one is extremely tidy and organised, three are moderately so depending what it applies to, and the other is chaotic.
People who suffer from Obsessive Compulsive Disorder have usually inherited a quick acting arousal system as well as a perfectionist personality trait.
A perfectionist personality is not a bad thing. I have one myself. The world would be a very dull place if we all had identical personality types - we would be more like robots than people. Even our pets tend to have different personalities as anyone who has ever kept more than one will know. A perfectionist tendency can be an asset when applied in appropriate circumstances.
People with perfectionist tendencies like order and to know where they stand. Our brains like this too.
Any sufferer from Obsessive Compulsive Disorder will recognise that the symptoms get much worse when they are generally more anxious about things, or because unsettling or different things are happening in their everyday life.
4. How does anxiety cause OCD?
One of the two factors upon which the survival instinct bases its warnings, is being unable to match the new input with something it already knows to be safe. If this is not known the arousal level goes up and the survival instinct looks more actively for danger.
This is simply because things are going on which the survival instinct can't match to what it knows and isn't certain they're safe. So it raises the arousal level.
This in turn makes the person uncomfortable and they start to worry more about how they're feeling, which pushes the arousal higher still. The brain starts to feel out of control, which it certainly doesn't like. It therefore seeks a degree of control or predictability.
What is more predictable than obsessive behaviour?
So the development of obsessive symptoms, which are pointless in themselves, is simply the brain's way of trying to reduce the ongoing and uncomfortable high arousal by introducing predictability anywhere it can.
We know brains like predictability at a very basic level. Think how much babies and pets hate to have their routines disturbe. It makes them anxious because it is unexpected and so causes raised negative arousal.
But the Obsessive Compulsive Disorder sufferer also feels they shouldn't be having those obsessive thoughts and doing compulsive behaviours and stresses about them. This of course just pushes the negative arousal even higher... and so it escalates.
Because the brain learns connections between events, each time an obsessive thought or compulsive behaviour happens under particular circumstances, the brain remembers that. When it finds itself in those circumstances again, it will automatically send you a reminder to have the obsessive thought or carry out the compulsive behaviour.
Therefore, although such behaviours are originally learnt at times of stress, they are maintained afterwards by the brain which at times can be far too clever for its own good. Let me give an example.
5. An example of how OCD might develop
Suppose during a time of stress I started counting things. Let’s assume that one of the things I started to count was switches on the wall on leaving a room. In time, when my general stress/arousal levels have reduced, I still find that every time I get up to leave a room, my head will tell me to count the switches, even if I hadn't been thinking about doing it.
This is because the brain has made a link between leaving a room and counting switches. People who suffer from Obsessive Compulsive Disorder will then feel they should do what their head is telling them because they have an uneasy feeling that something bad might happen if they don't.
This 'bad' feeling is merely a reflection of the fact that when they first started this behaviour they were very stressed and they were getting danger signals from the survival instinct, so they did the counting because something told them there was danger if they didn't.
In my example, this feeling of impending doom has simply attached itself to the idea of leaving a room. So when I get up to go, my brain gives me both the thought, "count the switches" and along with it the sense of impending doom. Feelings get attached to events in the same way as thoughts.
Once we've learnt the tendency to carry out compulsive behaviours we start to worry that something bad will happen if we don't. Most of the OCD sufferers I've treated over the years, when asked if they really believe they have the power to make something bad happen simply by not obeying what their head tells them, will say they don't. But, on the other hand, they aren't willing to put it to the test because that gives them a level of anxiety which is uncomfortable.
Feelings get attached to events in the same way as thoughts do
6. How to go about overcoming OCD
This is done in the same way as overcoming any other anxiety habit. First you need to learn techniques to apply when your thoughts are telling you to carry out that compulsive behaviour. Then, when you are skilled at these techniques, you start to apply them starting with the simplest aspects of your problem first.
There is evidence from PET scans that when such links are made repeatedly, a track forms in the brain itself. The good news is that this track can be erased again. Although a person with perfectionist tendencies is unlikely to lose them, and why would they want to?
Our personality traits are what make us individuals. What those with Obsessive Compulsive Disorder need to do is learn to make their traits work for them and give them pleasure, rather than being at their mercy. The information on the Feelgood Way to overcome anxiety is relevant to OCD.
The steps to overcoming any anxiety habit are taught step by step in my online course.
I have also written a book which specifically focuses on the application of this approach to OCD - its causes and how to go about reducing the symptoms or even overcoming them. You can find out more about the book and download a sample chapter by clicking below.
"The Blackmailer in Your Head"
Self help in a book which explains how OCD happens and how to go about taming it.
7. OCD and Autism
One group of people who are often diagnosed as having Obsessive Compulsive Disorder are those on the Autistic Spectrum.
This is not true OCD.
The apparently obsessive behaviours of this group are not usually done out of anxiety but simply because they prefer things that way. People on the autistic spectrum are often seekers of predictability and routine because that's what their brains like. They therefore tend to adopt repetitive patterns of behaviour because these are what make them feel comfortable. They don't do them out of a fear that something bad will happen if they don't.