OCD: the disease of constraints

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They can’t help but wash their hands, check that they have locked their door, and align their pens perfectly. They are afraid of creating an accident on the public highway, of letting out obscenities or of being contaminated. They have OCD: obsessive-compulsive disorder. This disease remains unknown to the general public and patients take seven to ten years to consult. However, with appropriate treatment, it is possible to return to normal life.

What is OCD?

OCD is a mental disorder that disrupts, more or less seriously and lastingly, behaviors and thoughts. A fixed idea arises. Source of distress, discomfort, or disgust, this thought is difficult to drive out of his mind. To get rid of it, the person has no choice but to perform repetitive gestures. Sometimes several hours a day. It is the disease of constraints. On the one hand, the constraints suffered, in the form of questions: is my floor clean? Is my hob turned off? Am I sure I did not leave a piece of glass in my daughter’s mash? This is called obsessions. On the other hand, constraints that we impose on ourselves: washing our hands, making lists for everything, accumulating trinkets … That we call “compulsions“.

Not “one” but “several” OCD

Obsessive and compulsive disorders take many forms, classified into broad categories: OCD verification (doors, lights, stove), washing/cleaning (obsession with cleanliness, excessive washing, disinfection), counting (long series of figures, mental calculations), accumulation (inability to throw away all kinds of useless things), order and symmetry (perfect alignment of objects), or aggressive type (fear of hurting others, causing drama). The benchmark assessment scale, the checklist of the Yale-Brown Obsessive Compulsive Scale-Y-BOCS, lists more than 40 obsessions and 30 compulsions.

The common point is the hyper control to which we submit, both for past things (did I close the door five minutes ago?), current (I do not touch the toilet bowl so as not to be contaminated), and future (I’m afraid of creating a disaster).

Some symptoms are more visible than others. Checking your hotplates, washing your hands, piling up paperwork, are easy to identify OCDs. Repeating prayers and counting numbers are much less because they are internalized. Still, others are painful to confess, because of their degrading aspect, like “bad thoughts” or unwanted sexual addictions.

Full awareness of his illness

“The peculiarity of this disease is that we know that what we are doing is absurd, even useless, but we cannot help it. The patient’s suffering is largely linked to this,” analyzes the psychiatrist. A permanent inner struggle takes hold, like a sword of Damocles. “We might not do it, but it’s so easy to relieve ourselves at the time, that we do it anyway, as a precaution,” he said. These ritualized actions encroach on daily life. Everything then becomes very framed, “to do well”. Little by little, the patient creates a veritable interior prison. Knowing full well that what he is doing is excessive or even abnormal, he dares not talk about it to his loved ones. And folds in on itself.

When should you worry?

Double-check your alarm clock before falling asleep, check that the stove buttons are set to “zero”, or that the refrigerator door is closed properly … 90% of the population has these types of obsessions, but at a lower degree. These “little habits”, which are normal at the start, are disabling when they become invasive. Therein lies all the complexity. OCDs are progressive: at first, I wash for twenty minutes in the morning, then thirty, then fifty. The hardest part for the patient is to realize that it goes to excess.

The time and intensity of the discomfort caused are good indicators of the severity of the disorder. From an hour a day of wasted time and interference, you have to worry. All the more so if these thoughts cause slowness, which impact the patient’s life.

How to treat OCD?

Typically OCDs expand and worsen over time if left untreated. On average, patients wait between 7 to 10 years before consulting. For fear, but also for lack of information. “Just yesterday, a woman in her fifties came to my office for the first time, for OCD that she had been dragging for over twenty years. The first thing she said to me was that she didn’t know it could be treated,” reports the expert.

If complete recovery is rare, symptoms can be reduced significantly. Via taking medication, which constitutes a large part of the treatment, and monitoring cognitive behavioral therapy (CBT ), on the basis of two to four 45-minute sessions per month.

Patient education is essential. He learns to react to symptoms, to avoid mistakes such as ritualizing his gestures. The goal of therapy is to manage him/herself. For this, confrontation exercises are put in place. In the presence of the therapist the first time, then in complete autonomy. A very careful person will have to break a cup. A phobic of the contamination will have to touch a toilet bowl without washing his hands afterwards, or lie down on his bed with clothes worn outside. CBT requires motivation and attendance, the patient having to confront his symptoms several times a day. There is a minimal risk-taking to accept, but if the patient comes regularly and of his own free will, he will get better and find a quality of life after six months.

Surroundings: finding the happy medium

Family, relatives, and friends often notice before the patient that something is wrong. At least when it comes to visible disorders: the parents of a child who keeps counting the numbers in his head will see only the poor academic results of their offspring, without necessarily understanding what is hidden in this catastrophic report card.

Do not hesitate to talk about it, ask questions, in the warmest and empathetic way possible. The main thing is to find the right balance. Being too willing to do the right thing can make things worse. Accepting to “play the other’s game”, washing your hands as often as the sick spouse asks, is not a good thing. “You have to find a compromise, establish a kind of contract with the other. For example, by encouraging him to take showers of thirty minutes instead of three-quarters of an hour, or by cutting the water yourself when it is too difficult for him. But how do you know where the line is?” From the moment an act seems to us unjustified or disconnected from reality, theoretically, we should not do it.

Not always beneficial “tricks”

Photograph the gas and water taps with your mobile phone to check that they have been closed during the day, film your car journeys to be sure you have not run over anyone… People with OCD find all kinds of tips to reduce them. As long as it reassures the patient, that it reduces his disorder and that he gains in time and comfort, no problem. But if it just replaces one form of OCD with another, then there is no point in doing so.

How to explain the appearance of OCD?

No “OCD gene” has been detected to date. Yet studies show that 15-20% of parents of children with OCD have it themselves. The family environment could contribute to the development of this disorder in children. OCD could also be due to a deficiency of serotonin, a neurotransmitter that controls behavior and emotions; or linked to a traumatic event (rape, physical assault, death), triggering symptoms. According to specialists, opinions differ. For the behavioral therapist, OCD is a disease in itself that must be treated. Conversely, for the psychoanalyst, it is an inappropriate behavior to take as a symptom of a deeper evil.

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