Obsessive compulsive disorder (OCD) affects millions of people today. This article details the different natures of OCD, the triggering factors, the symptoms and the treatments using the systemic approach.
The chains of habit are too weak to feel, until they are too strong to break
Samuel Johnson, 1789
Obsessive compulsive disorder in numbers
We can now say that millions of people around the world are affected by OCD. Up to 50% of cases fall into the severe category and less than a quarter are considered mild cases. The frequency of OCD in the Western population is thought to be between 2.5% and 4%, but as we said previously, today we consider it to be four times higher. However, it was recently ranked as the tenth leading cause of disability worldwide in the Global Burden of Diseases study and OCD is now considered the fourth most common mental illness in many Western countries.
Magic and elephants
Let's start with the story of a psychiatric hospital in which a patient continually performed a ritual of repeatedly clapping his hands. Another patient, intrigued by this seemingly bizarre behavior, asked him, “Why are you doing that?” and the patient replied: “to scare away the elephants.” To which the other patient replied: "But as you can see as well as I can, there are no elephants here." The patient who was repeating the ritual replied: "Yes, now you see why I do it, it works." This simple story, I hope, conveys to the reader the seemingly bizarre logic behind obsessive-compulsive disorder, a reality in which, logical and rational explanation may have little or no effect at all (more on that later and at length, in this blog, about ways to use a new approach to non-ordinary logic that allows us to quickly overcome some of the most complex psychological disorders).
Obsessions, compulsions, OCD, what are they?
An obsession is an unwelcome thought or image that repeats itself in a patient's mind and whose cessation is largely beyond the patient's voluntary control. These obsessions can be hard to ignore. These thoughts can be disturbing, which can cause a person to feel distressed and anxious. A compulsion is something we think about or do repeatedly to relieve anxiety. These rituals may remain hidden or be obvious; these are rituals such as saying a phrase in your head to calm yourself, or checking that the front door is closed. Patients may believe that something bad will happen if they don't do these things. They often realize that this way of thinking and behavior is not logical, but they still find it very difficult to stop. Obsessive compulsive disorder (OCD) can be considered as a perception of reality based on a phobia that causes the patient to react, through compulsive thoughts, formulas or actions, in an attempt to reduce their fears. It is also linked to stress , anxiety and anxiety disorders . The usual solutions adopted by patients with obsessive-compulsive disorder to deal with panic situations are either to avoid these situations or to perform compulsions or rituals. Certain situations, people, or objects provoke such fear that they are avoided altogether (Gibson, Portelli, & Papantuono, 2022). Rarely discussed in early clinical publications and until the early 1980s, OCD was generally considered a very rare disorder.
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Noticing and understanding ritualized behavior
OCD is expressed in different ways and there are as many modes of expression as there are people who develop it. The most common patterns are obsession with dirt and germs, followed by hand and body washing, and then finally avoidance of all objects that patients assume are contaminated. These are not always actually dirty places, but spaces and places that the patient perceives as dirty. So to the general population, some of these surfaces and some of these instruments and some of these places actually seem extremely clean and perfectly safe. We also regularly see patients who wash their hands excessively and sometimes avoid leaving the house altogether and end up being housebound due to their morbid fear of germs, dirt, and infection. Another common and frequent pattern we see is obsessive doubt, followed by a compulsion to repeatedly check things. Instead of resolving patient uncertainty, checking and rechecking increases doubt and often contributes to even greater doubts, which lead to further checking. These doubts can also create feelings of guilt for forgetting something essential or fear of having committed an immoral action.
Obsessive-compulsive disorders can involve:
- Fear of contamination
- Ritualized verification
- Intrusive thoughts.
- Perfectionism
- Hoarding Items
- Eating disorders, vomiting, bulimia and overeating.
Inability to recognize OCD
There are rarely, if ever, cases of OCD that are “easy” to treat. We usually find that patients or doctors fail to recognize the symptoms of this disorder, especially in its very early stages. Even at more advanced stages, patients fail to recognize their own seemingly irrational nature, leading to immense suffering for them and their families. Very often, we find that even healthcare professionals charged with caring for people with psychological or medical conditions do not regularly consider the possibility of OCD during clinical assessment, diagnosis, and workup. However, at the beginning, it is fundamental to identify anxiety disorders . Sometimes some patients exhibit both avoidance and control strategies , making the diagnosis complex.
Fear and pleasure, emotions at the origin of OCD?
We can distinguish obsessive compulsions based on fear (such as washing hands to avoid contamination) from those based on pleasure (such as compulsive shopping, vomiting syndrome or pathological gambling and so on), where rituals are continually repeated over a long period of time to generate a pleasant effect. This transformation from a problem based on fear or anger to a compulsion based on pleasure is greatly facilitated by the structure of the brain and its ability to find pleasure in repetition (Laborit, 1978). General differences in the description of OCD lead to different research designs and treatment methods. At the same time, the anxiety disorder contributes to remaining in the exhaustion of the stress mechanism .
Other OCD exist, for example the extreme habit of biting one's nails until they bleed, the OCD of hand washing, sorting clothes , 's thumb, or misophonia (hatred of sounds) or even Internet compulsions.
Treatment of OCD using the systemic approach
Systemician Padraic Gibson sheds light on the treatment of OCD with brief systemic therapy. Padraic Gibson is a family therapist and supervisor. He works in Ireland, Italy and Malta. He is a Senior Research Associate and Lecturer at Dublin City University and Clinical Director of The OCD Clinic® .
Through extensive practice-based clinical research, we have found that in many cases symptoms can begin to appear as early as childhood and early adolescence, and that in the majority of people we work with , the symptoms existed and began before the patient was twenty years old (Rassmussen & Eisen, 1992);
How does OCD develop?
1. Doubt : Some OCD begins with doubt which triggers a series of protective rituals that repair or prevent the fear problem. The doubt may concern the possibility of being sick or suffering from an illness, of being a pedophile or a murderer, etc.
2. Rigid belief, ideology, morality or superstition: When patients create a moral code that is too rigid to live by, it can lead to all kinds of mental obsessions, even eating disorders or relationship blocks. The patient who has this type of mental model and beliefs regularly tries to adapt himself or the world to his rigid moral beliefs.
3. The rational becomes irrational through thought: Obsessive-compulsive disorder is created this way when a person thinks too much to try to foresee all the possible consequences of a decision. At this point, the rational process of searching for a reasonable answer leads to an irrational outcome of endless compulsive questioning and answering. There are many other examples of rational processes that, when taken to an extreme, become irrational.
4. Phobia : When obsessive-compulsive disorder is triggered by preventative health phobia, it is achieved by trying to prevent a misfortune from occurring, such as an illness or infection. This fear of infection may be based on its effect on themselves or on the fear of infecting others, such as their extended family, work colleagues or children. In this process, the preventive approach transforms into a real phobic response.
5. Trauma: As we saw previously, PTSD generates a phobic response to intrusive thoughts and traumatic memories and in this case we see people doing things to numb themselves from the trauma. Showering, drug use, specific rituals or self-harm.
How to treat OCD
Faced with anxiety disorders and pathological doubt, how can you help a person? As we can see, attempts at solutions to avoid a frightening situation or to immunize oneself against pain or alleviate anxiety and fear, create the illusion that it works at first, but after a while, the individual is unable to stop them. When the disorder has been built up , the problem for the individual is no longer the original fear, which had pushed him to trigger the ritualized actions, but the inability to stop the execution of the rituals. This is the classic example of how an attempted solution becomes a problem. As Samuel Johnson wrote, “The chains of habit are too weak to be felt, until they are too strong to be broken.” We will delve deeper into this topic in later articles.
The systemic and strategic approach is very effective in the treatment of OCD. Hypnosis is also effective (Read about it: Overcoming Fear and Anxiety with Hypnosis and Self-Hypnosis. Michele Ritterman. )
I would like to consult for obsessive compulsive disorder (OCD)
Where to train?
Obsessive and compulsive disorders are part of the psychopathologies studied in the third year of the LACT course and in the Clinical Master of Giorgio Nardone (CTS) .
