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Understanding what drives OCD

Understanding what drives a person to continue performing the seemingly nonsensical and repetitive behaviours, that Obsessive-Compulsive Disorder (OCD) creates, is difficult, but partly it is due to the perception of the perceived level of danger and threat that a person with OCD believes may cause harm to themselves or a loved one.

For many people with OCD there is also an overinflated sense of responsibility to prevent harm and over estimation about the perceived threat the intrusive thoughts bring.  It is these factors which help drive their compulsive behaviours, because they feel responsible to try and prevent bad things happening.

For someone without OCD it may be difficult to fully understand how such an intrusive thought can have such power over a person. So for an example think of the person you love the most, picture them in your mind. Now imagine if we tell you that without a shadow of a doubt, convince you beyond question, the door handle you just touched was touched by someone before who had just been to the toilet and not washed their hands.  So your hand is now contaminated with deadly germs and unless you remove the germs you will pass them on to your loved one who will get a disease and die.  We have convinced you that your hand is covered in deadly germs and so you may have become a little anxious, but even if you believed me, the anxiety would soon fade after you washed your hands.  For someone with OCD that sense of anxiety will remain.

The problem that OCD creates is an increase in anxiety.  Whilst a normal response to an anxiety provoking situation is for the anxiety to slowly decrease after the initial event, for someone with OCD the anxiety is maintained and often increases, usually because of their overestimation of the perceived level of threat.

So for example, imagine driving in your car and you have to make an emergency braking manoeuvre; the level of anxiety for anyone in this situation would increase dramatically and very quickly.  However as the car grinds to a halt and stops safely, without major incident, the level of anxiety gradually reduces.  For someone with OCD, that level of anxiety will remain at that heightened level because they perceive that they will have to make another emergency stop around the next corner.

For someone with OCD, an anxiety provoking event creates negative interpretations about what might or could happen.  Even when nothing bad happens, the anxiety remains high until the person carries out their safety seeking behaviour - the compulsion.  Therefore because these negative interpretations still remain, the same anxiety provoking thoughts continue to necessitate further safety seeking behaviours, so instead of digging themselves out of a hole, they are digging that hole deeper.

The problem with the anxiety is that it is proportional to a person’s perception of danger and risk. The worse the perceived consequences the greater is the fear of something bad happening.

Imagine that you've been told that you have to walk a 30-foot-long plank, which is one foot wide and is two feet above soft ground. For most people, the perceived risk would be low and the task would seem easy and so the anxiety is low and manageable, and fades quickly.

As an example, imagine that you’ve been told that you have to walk a 30-foot-long plank, which is one foot wide and is two feet above soft ground. For most people the perceived risk would be low, the task would seem easy and so the anxiety is low and manageable, and fades quickly.

Now what if we tell you that the 30-foot-long plank, which was one foot wide and is two feet above soft ground is now just half a foot wide, and hundreds of feet above a canyon?

But then what if we tell you that the 30-foot-long plank, which was one foot wide and is two feet above soft ground is now just half a foot wide, and hundreds of feet above a canyon? The level of perceived risk would be considerably higher, and the resulting anxiety will become considerably higher too, and the need to prevent that risk becomes stronger.

The level of perceived risk would be considerably higher, and the resulting anxiety will become considerably higher too, and the need to prevent that risk becomes stronger.

OCD becomes a vicious cycle. As the obsessional thought causes a person’s anxiety to increase, they become besieged by the obsessive thoughts. In fact the word ‘obsession’ comes from the Latin ‘obsidere’ which means ‘to besiege’. Naturally the sufferer neither wants nor welcomes the obsessional thoughts and will go to extreme lengths to block and resist them. 

People with OCD realise that their obsessional thoughts are irrational, but they believe the only way to relieve the anxiety caused by the obsessions is to perform compulsive behaviours, often to prevent perceived harm happening to themselves or more often than not, a loved one.

Unfortunately, any relief that the compulsive behaviours provide is only temporary and often reinforce the original obsession, creating a gradual worsening cycle of the OCD.

To someone without OCD you may still find this concept difficult to understand, why someone knows their thoughts are not quite logical, but still carry on with their compulsive behaviours, ‘just to be safe’. Well, think about the scariest rollercoaster you have ever been on. You are strapped in tight, deep down you know you are secure and safe, yet as the car goes up the steep rails and slowly dangles you over the drop, teetering on the edge of the steep fall, you still scream and scream. It is that thought, that ‘what if’ something goes wrong that makes you anxious and scream loudly. You know that the risk of something bad happening is remote, your brain is telling you that you are 99.9% safe, yet you still scream in that brief moment where the car goes down the steep drop because the consequences of the risk. Even if the risk is just 0.01% it is still too great to ignore, despite the 99.9% part of your logical brain which tells you that you are perfectly safe.

The OCD Cycle - obsessions creates anxiety, which creates compulsions to provide relief, but drive the obsessions further and the cycle continues.

OCD is driven by the fear of consequences, no matter how unlikely the risk.

So that hopefully goes someway to explaining to you how OCD is driven, but what does OCD feel like?  The following descriptive words have all been used to describe how OCD makes people feel at times.

  • Depressed
  • Embarrassed
  • Secretive
  • Hopeless
  • Frustrated
  • Exasperated
  • Debilitated
  • Drained
  • Ashamed
  • Bullied
  • Exhausted

Finding a good analogy to describe what OCD feels like is virtually impossible, it is far more than just an increase in anxiety, it consumes a person, they get tight knots in the stomach, their mind becomes a battleground for increasing anxiety provoking thoughts and urges.

Imagine standing in front of a chalkboard, now place your hand at the top of the chalkboard and using your hand rub your fingernails all the way down that chalk board.  Feel the intense knots in your stomach as the sound of the fingernails screech against the board.  The noise and intense feeling makes it feel that something horrific is about to happen, even though deep down you know nothing will.   That intense feeling is overwhelming you, it’s going right through you, you just want it to stop, you want to pull away.

Now multiply that feeling many times, and that may offer a small insight into the intensity that the unwanted intrusive thoughts and feelings bring to someone with OCD.

The reality is that OCD is like a pair of Chinese handcuffs, the harder you pull to get away from the compulsions, the tighter the grip becomes on the obsessions.

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