Is OCD Making You Crazy?

A lot of people claim to have OCD. It appears to be a condition that varies in severity. The issue may well become a question of how disruptive or intrusive your obsessions or compulsions may be.  In its extreme level there are definitely biological issues. Sometimes treating OCD requires medicines for stabilization,  again in the extreme ranges, it requires surgery. At this extreme level it is almost completely in control of someone and they are not able to function or live a normal life.

Most times when someone comes in complaining of “OCD like traits” or situations, it does not rise to the severity level that would constitute a Disorder. However the reality is that people do become obsessive and do have compulsions to perform rituals that work “magically” to sooth or quiet their heightened levels of anxiety.

One of the interesting components of what the layman calls OCD is that there are patterns of ritual behaviors or obsessive intrusive thoughts. These behaviors, in particular, work as a displacement vehicle for anxiety from some source that the individual is not able to acknowledge, nor deal with directly.  For example, I may have a level of unconscious guilt over some behavior from my childhood. I may fear discovery, shame, and punishment. I know at some level that I have done wrong, and I fear that this will be exposed at some high cost in my life. I may not be in a situation where I can “afford” to remember this behavior, nor deal directly with the costs of discovering it.  Just because I cannot remember does not mean that I don’t or won’t suffer high levels of anxiety even without knowing what the cause of the anxiety is.

What seems to happen in this situation is that I accidentally discover that some behaviors which become rituals, which magically calm my anxieties. What is really going on is that I have “learned” that I can quiet my overall level of anxiety by performing some self-soothing behavior (such as organizing all my CD’s and DVD’s, or “arranging” my pocket change on the dresser in some “way” or put all my shirts in a sequence determined by the color wheel.) This behavior soothes or relaxes my anxiety and it allows me to have the illusion of being in control of life because I can narrow my focus and be in control of some manageable, tangible thing. This illusion of control will quiet down my over all level of anxiety.

A problem that often occurs with the development of these rituals that are self-soothing is that they loose their power. Then it becomes necessary to continue to add additional steps in the ritual. If I learn that I have to touch furniture in the house in a very specific and detailed sequence and pattern in order to quiet my anxiety so I can leave the house, one of two things will start to happen: one is that I will get interrupted for some reason and have to begin all over again. In this case I suffer a major loss of time. The second thing that I will discover is that there must be some other thing I must touch or some other step I must add in order to “satisfy” my ritual so that my anxiety stops enough and I can leave the house.


My understanding of what is happening when someone has OCD-like symptoms not requiring medicine or surgery is that they are suffering from basic anxiety levels for which they do not have compensating skills that allow them to quiet the anxiety. Remember I am talking about something that could, at this level, function like any other defense mechanism. We all learn to do things that self soothe and quiet us. This falls under the label idiosyncratic behavior, not dysfunctional behavior. It only becomes dysfunctional when its intensity and insistence become so strong that they interfere with my ability to function and live my life. I understand that I develop these patterns as a way to deal with my sense of being out of control and powerless.

In therapy sessions I teach my client to see the pattern in their behavior.  In order to lessen the anxiety and create a sense of self- control, we begin to examine whether there are other behaviors which might be substituted yet would return the same result.  The new compensatory behavior would not be disruptive or embarrassing. Then the client has the option of making a “choice” about behaviors and a “choice” about the level of cost of their behaviors and a better chance of feeling that their lives are not out of control. Lots of people struggle with these issues and develop these strategies to manage their distress without it rising to the level of a diagnosable severity. If you struggle with these issues, go and talk to a competent therapist about your symptoms and your compensatory strategies. They may be able to help you identify the patterns and the payoffs and help you learn other ways to achieve the “payoff” you need for a different, lesser, or more acceptable cost.


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