February’s Theme: Extreme Organization: Obsessive-Compulsive Disorder

It is the start of a new month and time to introduce a new discussion topic.  This month we will explore an extreme perspective of organization….obsessive-compulsive disorder.

This month’s topic comes out of my own curiosity and desire to better understand certain extreme points of view about cleaning and organization.  How many times have you read a news article such as this one about the hazards of sleeping with your dog or this one about exactly how many germs are on kitchen sponges, door handles and other household items.

I see these articles all the time and I keep wondering, “Who cares about this stuff? Does it really help anyone to know all of this?  After all, we have been doing these germy-dirty activities forever and no one we know has been sick or died from them yet!”   I just scratch my head and find it amazing how many people are truly interested in this information.  Some other viewpoints that confuse me:

• People who can’t eat foods where the chef has to touch and arrange a lot of the ingredients.
• People who fret excessively about using public restrooms.
• The common refrain, “I can’t go to bed if there are dirty dishes in the sink.”

What is behind all of this?  I decided this month to try to find out.

My objective is not to cure people or provide any sort of therapy.  That is clearly not in my job description.  Rather, my goals are to share stories from people who have suffered from obsessive-compulsive disorder, to better understand and recognize the condition and to learn how obsessive-compulsive disorder affects all of us and our organizing habits.

Below is my continuum of the human condition when it comes to organization. (Click the picture for a larger view.)

There are two basic organizing styles.  On one side is a structured, controlled style with the extreme end at obsessive-compulsive disorder and on the other side is a loose, adaptive style with the extreme end at chronic disorganization.  In the middle of the continuum is the fictional “normal” (which no one really is).  Neither style is “correct” and each style has its advantages and disadvantages.  Most of us generally lean one direction in most cases but we most likely employ a mix of styles in different circumstances.  For example, many people have one approach to managing their physical environment and the opposite approach to managing their money.

Taking a few steps in either direction on the continuum doesn’t cause most of us any serious problems coping with daily life.  Everyone goes a little too far once in a while but most of us can recognize when we have reached that point and make adjustments to come back closer to center.  When a person either can’t recognize that they are far from the center or has no idea how to dial things back, this is often where professional mental help is needed.

Starting our journey along the continuum toward obsessive-compulsive disorder (“OCD”), first I thought it would be helpful to have a brief OCD Q&A.

What are the characteristics of OCD?

As the name suggests, there are two essential characteristics of OCD.

1)   Obsessions. These are excessive fears the person has about one or more situations.  While everyone may worry about these things from time to time, a person affected with OCD worries about their obsession all the time.  It’s like a giant tape loop in their head constantly repeating the worry.  What are the common OCD obsessions?

• Contamination and germs (the most common)
• Causing harm to others
• Being harmed or embarrassed by others
• Not being prepared when circumstances change
• Offending God or doing something immoral

2)   Compulsions.  Compulsions are activities the person does to relieve the anxiety caused by the obsession.  Sometimes the compulsion has a connection to the obsession, for example, washing and cleaning as a response to contamination fear.  Other times, the compulsion is something unusual like pacing a specific path or counting to a certain number.  The compulsion is generally something the person does not enjoy doing but feels is the only way to make the obsessive thoughts stop.  When the compulsions begin to take an hour or more per day or begins to otherwise interfere with normal life functioning, OCD is formally diagnosed.  Other disorders with an OCD connection include Tourette’s syndrome, certain aspects of hoarding, eating disorders like anorexia and bulimia and hypochondriasis (fear of having a serious illness).

What causes OCD?

The exact cause of OCD is unknown but OCD is generally thought to have a genetic connection related the structure of the brain.  Certain parts of the brain are hyperactive in OCD individuals.  Environmental stressors can influence the severity and frequency of the disease, however.  Some studies have also linked bacterial infection to OCD symptoms, particularly in children.

How common is OCD?

The International OCD Foundation estimates that approximately 1% of the population suffers from OCD.  A survey in the 1980’s by the National Institutes of Mental Health suggests the number may be higher, at around 2% of the population.

Many people with OCD are deeply ashamed of their disturbing thoughts and rituals and don’t want to disclose them to anyone–even a professional mental health counselor.  The condition causes them so much distress that often OCD sufferers also have anxiety and depression.  It can take an OCD sufferer a while to develop enough trust with a mental health professional to be willing to disclose the obsessions and compulsions.  It is possible, therefore, that the number of OCD sufferers is under-reported and that some people seeking help for anxiety and depression could also have OCD.

When is OCD diagnosed?

Approximately 1/3 of adult OCD sufferers are diagnosed as children. In most other cases, OCD appears in the teenage and young adult years and can come on suddenly.

How is OCD treated?

OCD is a challenging disorder to treat.  Generally a combination of various mood-stabilizing medications and cognitive-behavioral therapy is used to treat OCD.  The goal of most cognitive-behavioral therapy is to get the person to think about their obsession (or sometimes experience the actual fear itself) and to retrain the person to stop doing the compulsions and instead learn how to address the obsession in a more productive manner.  OCD is never fully cured but a person can learn to be effective and productive and handle their obsessions appropriately with proper treatment.

How does OCD impact family and friends?

OCD has a dramatic impact on close friends and family.  Often an OCD-affected individual will insist that family and friends adopt their compulsions.  Many family members will comply with such a request feeling that it must bring the OCD sufferer relief.  Surprisingly, it turns out that this harms the OCD sufferer more than it helps.

“Family members who participate in rituals are unintentionally reinforcing and strengthening OCD symptoms.  Recognizing the problem is easier than doing something about it.  Just stopping participation abruptly is likely to be met with anger, resentment and increased anxiety.  A better approach is to collaborate with the person who has OCD in a plan to lessen involvement with the symptoms.  This is most likely to occur in the context of cognitive-behavioral therapy with an experienced therapist directing the effort.”

–Bruce M. Hyman, Ph.D. and Cherry Pedrick, R.N., Obsessive-Compulsive Disorder

What should I do if I think I have OCD?

OCD is a very complex condition that requires accurate diagnosis. Often it is best to look for a therapist with an expertise in OCD.  You can find a searchable list of therapists here at the Obsessive-Compulsive Foundation website.

I hope this month’s discussion will give you a new angle on organization and motivation issues and may help you think more about your own psychology.

Where do you fall on the continuum?  What are your experiences with OCD?  Please share in the comments.