We all have minor obsessions...

Maybe we like our breakfast prepared in the same way every day, or we follow a route to work that takes in the paper shop and the park, and we’re comforted by the familiarity of it all. Maybe we don’t like sitting on the sofa until we have plumped the cushions up, just so. 

Mind, the organisation for users of the mental health services, says something like 80% of us have minor compulsions like these, almost always ones which don’t affect our everyday life in any major way [1]. But someone with OCD – perhaps two to three per cent of us - feels forced to perform certain actions in the same way, maybe many times, usually every day.

What happens with OCD?

One example might be the woman who cannot set off for work or even leave the house until she has made a cup of tea in her own way. 

She starts by lining up kettle, teapot and teabag, in a precise formation, wiping the kitchen counter with a clean cloth, disposing of the teabag with a spoon kept for the purpose, and then wiping everything down again with another fresh cloth – possibly repeating this several times, until she has done it ‘right’. She may need to get up earlier and earlier, because the ritual may become increasingly complex, with more aspects of it liable to go ‘wrong’. 

Often, the compulsive actions involved in OCD have to do with cleanliness, and the fear seems to be connected with warding off some form of contamination. So someone might need to wash their hands, in a particular, ritualised way, over and over again. If something interrupts the process, they have to begin the whole cycle again. Or someone else might check they have locked the doors, switched off the lights, and turned off the oven in a pre-set way, dozens of times before going out. 

Other thoughts might be that if the rituals aren’t followed, something terrible will happen to a member of the family, as if the rituals are protective in some way. 

‘Filling up the working memory’

Many compulsions involve a ‘negative’ action as part of the sequence, so the hand washer feels compelled not to touch the basin, but only the taps. Or the tea-maker doesn’t permit herself to touch the teabag with her fingers. These negative strictures make the ritual more difficult and use up more thinking – and researchers speculate that ‘filling up’ the working memory part of the brain with ritual might help quieten other, anxious thoughts.  

Peak times for OCD behaviours include pregnancy and early motherhood. New fathers, too, have been found to develop the behaviours, linked to fear of something happening to the baby. But they can occur at any age, too. 

There’s an irony with OCD, in that not performing the ritual, and even the idea of not carrying it out, can cause serious anxiety. Yet the ritual itself is not really ‘calming’ - the net effect is an increase in anxiety in the longer-term. 

From an evolutionary perspective

Some psychologists point to how over millennia, we evolved to be vigilant for our safety and well-being. Normally, we enact this ‘precautionary vigilance’ without a problem – checking the savannah for marauding lions, for instance, and then deciding it’s safe to walk on. Or in modern days, checking we have locked the back door before going out to catch the bus.  We get an anxiety-allaying signal into our brain after this, and all is well.

But with OCD, the signal saying ‘you’re safe now’ is interrupted, and has an increasingly reduced effect. So the precautionary behaviour is continuously repeated – until it begins to make a normal life virtually impossible. 

OCD is an issue that can be resolved. The first challenge for some clients is to acknowledge the impact of their behaviour, and to seek help. Outcomes of therapy can be very successful.

Reference:

1. Understanding obsessive-compulsive disorder. Mind. 

Image credit: Derick Melander