Jane attended therapy with an initial complaint of feeling anxious. She was hesitant to disclose what it was she feared and how she was coping with these “crazy thoughts”.
An example would be hiding certain clothes in case someone broke in and strangled her with them. Other rituals involved spinning in a circle 4 times to avoid a feared disaster.
As the session progressed she was relieved to discover that many people have shared her experiences and have developed strategies to live a more peaceful existence.
Everybody experiences worries, doubts or superstitious beliefs at some point in their life. However, when they begin to interfere with everyday functioning or they make no sense at all, then a diagnosis of Obsessive Compulsive Disorder (OCD) may be possible. OCD involves obsessions, which are negative thoughts, images, or impulses. Compulsions are a thought or act that is performed (called a ritual), in an effort to reduce the anxiety and distress experienced by the obsession.
There are various types of obsessions and compulsions. The following provides examples of the more common thoughts and behaviors that an individual with OCD may experience.
These examples are by no means exhaustive.
(1) Washers and Cleaners: There is an unrealistic fear of contamination. In an effort to reduce this fear, the individual may engage in repeated hand washing, showering,
changing their clothes, or repeatedly cleaning and disinfecting their surroundings.
(2) Checkers: The thought is that either something bad will happen or has happened. To relieve these fears they must ensure that the stove, iron, door locks, etc. have been checked. It is not uncommon for checkers to repeat this behaviour multiple times before bed. They may get up in the middle of the night or return from work to verify that things are secure.
(3) Repeaters: Similar to checkers, they fear a disaster will occur if they don’t engage in particular behaviors. Jane had to repeatedly walk through an entrance a certain way until it felt “just right”. If she looked in the mirror six times before leaving for work, she knew she would not get in an accident. If she counted by 3s up to 333 before a phone rang, then she was assured some unknown disaster would not occur. She is still unclear why she has to put her feet 4 times under the bath faucet before the water rushes out. There is just a general sense of anxiety and tension if she does not perform this ritual.
(4) Orderers: Jane becomes distressed if her environment is not in perfect order. She ensures that every food can is aligned, with the name facing out and in alphabetical order. The pencils in the drawer must all be the same length and be perfectly aligned.
(5) Hoarders: There is a feeling of distress when throwing away useless items. They are convinced that years down the road they may need those 500 shopping bags or piles of newspaper. These individuals are usually content as their collections grow to astronomical proportions, taking up entire rooms in their residence. It is usually a family member who recognizes that their loved one’s behavior is unusual.