At first, I rationalized the thoughts as me just being a worrier. Then they became too hard to ignore. I couldn’t stop imagining ghastly things happening to my family, friends, or even strangers. I’d cringe as a passerby approached the curb at the end of the block, sure he’d be run over even though no car was in sight. At night, I’d fall asleep but then wake two or three hours later when my brain served me the horror du jour—say, an intruder running down the hall and murdering my kids. I’d spend the rest of the night trying to think of something, anything, to replace those terrifying images. I’d been afraid to get help. I’d didn’t want to hear that I might be “crazy” for the rest of my life. But when I became so exhausted I couldn’t function at work, I broke down and saw a doctor.
She assured me that I wasn’t crazy. Then she explained that what I was enduring had a name—Obssessive-Compulsive Disorder (OCD)—and she’d helped plenty of other people overcome it. I sobbed with relief. There was so much I didn’t know about this condition, and I know I’m not alone. Keep reading to see how your knowledge stacks up.
MYTH: Obsessions and Compulsions are the Same Thing.
Actually, they’re two distinct parts of the condition, one following the other. “Obsessive-compulsive” sounds like it’s one behavior. Obssessions are recurrent disturbing thoughts (like mine), commonly around contamination, sex, religion, or harm to oneself or others.Compulsions are repetitive behaviors done in reaction to obsessions in an attempt to mitigate the distress they cause. While most OCD sufferers have both components, it’s possible to experience only one or the other predominantly. I never suspected I had OCD. The disorder is better known for its compulsions (hand-washing, counting, praying, etc), which I didn’t think I had. The obsessions get a lot less publicity. But as my own doctor noted, an individual can have a case of OCD that’s almost entirely obsession-based.
MYTH: People with OCD Wash Their Hands or Check the Stove All Day
OCD manifests itself in a range of ways. Depictions of OCD patients in the media often focus on handwashing and checking the stove, but they’re far from the only compulsions. Others include cleaning, arranging and counting items, checking locks, praying, or myriad other repetitive actions. And some compulsions might not be visible actions at all, but mental behaviors like asking for God for forgiveness, silently counting backwards, or checking one’s memory of old dates or names, says David J. Puder, M.D., a director at the Loma Linda University Behavioral Medicine Center in Redlands, CA. When I first sought treatment, OCD wasn’t something I ever considered. After all, I wasn’t alphabetizing my pantry or washing my hands every 10 minutes. My OCD is much more internally focused.
MYTH: OCD Patients Believe Their Compulsive Behaviors are Necessary
Most adults with OCD know what they’re doing doesn’t make sense. That encourages OCD sufferers to seek treatment, but it’s also what continues to drive frustration and distress as treatment begins, notes Jasleen Chhatwal, M.D., director of the mood disorders program at Sierra Tucson, an in-patient facility in Tucson, AZ. “Often, the loss of control over one’s own thoughts and behaviors is the most difficult thing to cope with,” she says. “They feel out of control.’” A University of Michigan study looked at why OCD patients can’t act on the knowledge that their compulsive behaviors are senseless. The results point to an impaired connection between the brain network that recognizes the irrational behavior as a mistake and the one that controls the ability to do something about it.
MYTH: Other People Don’t Have These “Crazy” Thoughts
The vast majority of people do. A study of healthy university students on six continents in the Journal of Obsessive-Compulsive and Related Disorders found that 94 percent had unwanted, intrusive thoughts in the previous three months, some more than once. They might, for example, think about running a pedestrian over with their car, or, while on a hike, contemplate jumping off a cliff. In people who don’t have OCD, though, such random flickers are dismissed as peculiar but meaningless. It’s as if their brains say, “That’s never going to happen, so moving on….” When an OCD sufferer has the cliff thought, the brain gloms onto it. “This is horrible! What kind of person thinks about jumping off a cliff? Am I suicidal?” That flurry of intense emotion marks the thought as important enough to be repeated over and over.
MYTH: You Can Stop Obsessions If You Try Hard Enough
“There is a common misconception that patients with OCD can control it,” says clinical psychiatrist Michael Genovese, M.D., chief medical officer of Acadia Healthcare in Nashville. “These symptoms, however, are not voluntary. We would never tell someone to stop having chest pain, so why do we assume we can tell an OCD patient to stop having obsessions?” OCD patients, however, may try to block obsessions via distraction (say, snapping a rubber band on their wrist), displacement (intentionally thinking a new thought), or avoiding known triggers. At my lowest point, I didn’t want to leave my house, reasoning that if I didn’t see people, I couldn’t have nightmarish thoughts about them. While such tactics can bring temporary relief, they don’t work long-term. And avoidance in particular can create new problems–like losing your job if you stop showing up for work.
MYTH: Having OCD Says Something About You as a Person
OCD is not a reflection of your morals, worth, or personality. “This is not some deep dark problem of behavior. OCD is a medical problem, and not anyone’s fault,” stated Kate Fitzgerald, M.D., associate professor of psychiatry at the University of Michigan, in a press release about her research. My own doctor told me that my thoughts of harm coming to people didn’t make me a bad person. In my mind, a good person wouldn’t be having such nightmarish thoughts. Which is why it was so reassuring when she said that, often it’s the most caring and sensitive people who are prone to such obsessions.
MYTH: Taking a Relaxing Vacation Will Ease OCD Symptoms.
Too little stimulation in your day can cause OCD to spike, according to the Anxiety and Depression Association of America. Lazing by the pool all day may seem calming, but a brain in the grips of OCD is apt to churn out more obsessions without work-chore-errand distractions. Plus, vacations (as fun as they can be) just throw off your whole routine. In fact, I was at a resort in Florida when I realized I had a serious problem. Every time I saw a particular little girl and her parents at the pool, beach, or breakfast, I kept envisioning her wandering out of sight and being kidnapped. I focused on it so much that that’s what I remember most about the trip. Not the beautiful weather, the gorgeous property, the view from our room, or the shelling excursion. For me, Marco Island will forever be the place where I seemed to lose my mind. The good news is that once you’re home and have resumed your normal routine, your treatment gains are still in place.
MYTH: People with OCD are Type-A Perfectionists.
OCD is a serious condition with a neurobiological cause. And while it’s true that Type-A personality traits include being controlling and inflexible, they don’t include a debilitating preoccupation with repetitive obsessions and compulsive behaviors. “Certainly, one of the biggest misconceptions and, really, misfortunes of OCD is how many people so loosely throw the term around,” says Vinay Saranga M.D., a psychiatrist in Raleigh, NC. “We hear people say things like ‘I’m so OCD,’ yet this is a condition that’s no different than diabetes, cancer or any other medical illness.”
MYTH: OCD Can Strike at Any Time
Diagnosis occurs primarily at two points in life: Usually just prior to puberty or in the late teens to early 20s, according to the International OCD Foundation. “Research is still ongoing to understand the reasons,” says Dr. Saranga. “However, if we look at environment alone, there are a lot of changes that take place at those points that could explain why they’re peak-onset periods for the disorder.” While it is possible for initial onset to come later in life, that’s definitely the exception. (It may seem like I was one of them, but actually, discussions with my doctor revealed two prior episodes, when I was 17 and 21, that I didn’t recognize for what they were at the time.)
MYTH: You Can Manage OCD on Your Own
If left untreated long-term, OCD will impact all areas of life. “The most difficult aspect for patients is the loss of time they could be spending on things that give them a sense of meaning and purpose,” says Dr. Pruder. But there’s good news. “We have therapies and medications that are effective,” adds Dr. Genovese. Usually, OCD is treated with a combination of cognitive-behavioral therapy and antidepressants, several of which are specifically approved for OCD.
For me, the treatment that worked was a combination of therapy and an antidepressant that I continue to take. But what also really helped was my doctor’s calm reassurances. When I get a flicker of a scary thought now, that’s what I draw on: Instead of recoiling fear, I’m able to let the thought wash over and past me, because I understand what’s going on and know I’ll be ok.”