The Financial Times has an interesting piece about obsessive compulsive disorder. Richard Thomkins goes into depth about the history of the condition, celebrities with OCD, and the different stories of people who are dealing with it.
But even those statistics could be only part of the picture. According to a paper appearing in last month’s American Journal of Psychiatry, an estimated 21-25 per cent of individuals could be said to have borderline OCD, meaning they have obsessions or compulsions that meet at least some of the diagnostic criteria. Admittedly, more than one-third of these people are also suffering from another anxiety disorder or depression – but according to the paper, that still leaves an estimated 13-17 per cent of otherwise “normal” people – about one in 15 of us – suffering from at least some symptoms of OCD.
So, what is this disorder? And could someone you know be at least partly afflicted?
The term “OCD” has recently displaced “anal” in contemporary slang as a way of describing people who are more than usually meticulous, pernickety or pedantic – the sort of people who are never satisfied unless things are just right. If this reflected a greater understanding of obsessive compulsive disorder, it might be no bad thing. In fact, it has simply increased the degree of misunderstanding by confusing two different conditions with almost the same name. “Anal” people do not usually have OCD at all; they simply have an obsessive compulsive personality type, meaning they’re a bit fussy. People with OCD, in contrast, are suffering from a serious anxiety disorder that greatly impinges on their lives.
While being “anal” can be an asset in some circumstances, as in a job that requires attention to detail, there are no advantages in having OCD at any level. All it does is cause distress by introducing obsessive, irrational anxieties into the sufferer’s mind, typically involving perceived dangers or appalling images of one sort or another. A defining characteristic of OCD is that sufferers believe just thinking about bad things will make them happen unless they act to prevent it; so they feel compelled to carry out little rituals which to other people look odd and unnecessary but which to them have the magical power to counteract the perceived threat. Typically, the obsessive thoughts and compulsive behaviour reinforce one another in a vicious circle, causing the condition to become ever worse until it starts to interfere seriously with the sufferer’s life.
Although there are many possible obsessions, the most common of them fall into a surprisingly small number of categories. The best known is Howard Hughes syndrome – the fear of dirt and germs, commonly linked with compulsive handwashing and cleaning. Another common one is the fear of harming others or coming to harm oneself, often accompanied by compulsive safety checking – repeatedly making sure the door is locked, the cooker is turned off and the iron is unplugged. Many sufferers are obsessed with a need for symmetry, which results in compulsive rearranging of things. Others are tormented by thoughts that they will carry out some horrifying act of a violent, sexual or blasphemous nature, and often try to block out or neutralise these thoughts with mental rituals such as counting or the repetition of certain words or phrases.
Obsessed, obsessive and obsession are over-used words. People talk about someone being obsessed with recycling or being an obsessive gambler; there is even a perfume called Obsession. But it is not enough to be preoccupied or infatuated with something to qualify as an OCD sufferer. With OCD, the obsessions have to be unwanted, unwelcome and anxiety-provoking – they can never bring satisfaction or pleasure. They also have to cause a repetitive behaviour or ritual aimed at preventing some dreaded event or situation, and this behaviour must be irrational or excessive. On top of that, the obsessions and compulsions have to interfere significantly with the sufferer’s life and/or take up at least one hour a day.
These criteria are laid down in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in the US and used to a varying extent around the world. But as Mataix-Cols points out, “The definition’s entirely arbitrary. It’s just some blokes getting together in America and saying that if you spend more than one hour a day doing rituals, and if those rituals are distressing and interfere with your everyday life, then you’ve got it. If not, you don’t. But what we’ve found is that there’s a very large prevalence of OCD symptoms in people who don’t fit this definition.”
The personal stories in this piece are extraordinary. I was unaware of the true intensity of the disease for some people. The entire article is worth checking out.
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