Dealing with the OCD Diagnosis

A year ago, all I knew of obsessive-compulsive disorder was what I saw in movies and television and the occasional overview courtesy psychology class. I watched Jack Nicholson's character in As Good as it Gets toss newly-used bars of soap in the trash can. I saw Tony Shalhoub's character in the television show Monk sanitize his hands after each handshake. These television and movie personalities did not reflect my experiences, so to imagine that I could have the same disorder felt down-right hypocondriatic. However, I have learned that its symptoms go far beyond the stereotypical fear of contamination.

In the beginning, the OCD diagnosis was relieving - almost liberating. I would remember things from early childhood and think, "Oh! That's what that was." I recall in the third grade needing to chew my food the same number of times on both sides of my mouth. Ignoring the need felt intolerable. In the fifth grade, I once witnessed a classmate blow her nose (leaving a particularly juicy tissue behind) at the trash can. For months afterward, eating a bowl of cold cereal in the morning conjured up images of thick, stringy boogers piled high in my bowl. Breakfast became particularly unappetizing at that point.

Finally, I had a name for the quirky rituals, the disturbing images, the revolving thoughts. During my "diagnostic interview," my newly referred behavioral therapist and I went through several questions pertaining to types of obsessions and compulsions, narrowing down the areas that pertained to me.

The most outward display of the disorder manifested itself in the form of compulsive hair-pulling called trichotillomania. For years, I have dealt with a seemingly irresistible urge to pull, inevitably leading to a thinning, fuzzy head of hair. A pony tail is a painful hairdo when the hair band only has so much hair to hold onto. Isolated spots on my head exhibit patches of short, unruly tufts of hair - too short to lie flat, too long to go unnoticed.

As I delved further into treatment, the OCD label became something of an obsession itself. Everything I did or said or thought became subject to scrutiny. I analyzed each action, wondering, "Is this OCD?" Case studies in reference books described children washing their hands until they were cracked and bleeding, but I had never exhibited such a habit - as a child or otherwise. Mingling with my newfound hunger for knowledge was a nagging skepticism; could I be making this up? I spent sessions with my therapist fighting the desire to ask, "What if this isn't OCD, after all?" I could imagine my humiliation when my therapist looked over his papers and came to the conclusion that no, I did not have OCD; I was just overly dramatic. So, what is the difference between an honest-to-God obsession or compulsion and a simple habit or personality quirk? Well, I'm glad you asked.

We all have habits, guilty pleasures, and addictions: nail-biting, spontaneous spending, smoking, for example. I know I shouldn't drink that Dr. Pepper, but its sweet, caffeinated bubbly goodness calls to me, I tell you! I might regret those extra calories after the fact, but I sure enjoyed them while they lasted (a guilty pleasure). I bite my nails on occasion, but generally leave them alone (a personal habit). My body has become accustomed to the caffeine, and sodas happen to be my median of choice (an addiction). No one lacks the random personality quirk; my roommate hates when I leave my jacket in the living room; my brother can't stand pets on the furniture; I practically crawl out of my skin when people smack their food. These examples describe relatively harmless actions and reactions that the typical person experiences from day to day. They do not interfere with daily life, and other members of society do not generally find them to be overly unusual. The obsessions and compulsions of OCD are quite different.

Obsessions, in the context of obsessive-compulsive disorder, do not refer to fetishes or crushes or what stalkers have. Obsessions, for the person with OCD, are distressing and unwanted thoughts or images that revolve in the mind. As Tamar E. Chansky, Ph.D. (author of Freeing your Child from Obsessive-Compulsive Disorder) put it, "Obsessions are intrusive, unwanted, distressing thoughts or pictures that barge squarely into your mind's eye, refuse to budge, and keep replaying themselves." My ninth grade year of high school, I sat in the front row of a class taught by a male teacher who walked back and forth as he lectured. I enjoyed the class thoroughly, but because of my seat placement and the height of my teacher, I was forced to face his crotch each time he passed by. To my complete dismay and embarrassment, images of my instructor's (insert euphemism here) popped into my head again and again and again throughout the class period. This didn't make for a very productive semester. Because of its distressing and unwanted quality, this image can be identified as an obsession. In contrast, had I found this instructor attractive (which I did not) and enjoyed thinking of his you-know-what, these images might be welcome, even conscious efforts on my part. An image of this sort (however repetitive) would not be considered an obsession.

While obsessions are thoughts, compulsions are actions. Compulsions are seemingly irresistible actions that temporarily relieve stress. Stress that leads to a compulsion is a nagging, poking feeling that won't budge until a certain action is performed. When I walk through a door, especially in public, I feel an overwhelming impulse to rake a thumb or finger across the width of the door. It must be all the way across the width and with no bumps or I must repeat the action again. I don't look forward to these impulses, and the uncontrollable feelings that come with them are distressing and return as soon as I approach the next door. These distressing and seemingly irresistible characteristics are what make this action a compulsion.

When faced with a diagnosis of OCD, it is imperative to understand exactly what obsessive-compulsive disorder is. No one can rely solely on snapshots drawn from fictional characters, which cannot help but provide a narrow window into the disorder. Dealing with the OCD diagnosis requires the ability to distinguish between obsessions and compulsions and the harmless actions and reactions of daily living. Understanding the disorder is the first step in identifying its hold and, in turn, learning to effectively fight back.