Obsessive-Compulsive Disorder (OCD)
part 5

It is easy to see how some disorders are disabling.  For example, severe hyperactivity in ADHD is obvious to everyone.  Likewise, a person who is too depressed to go to school or leave the home also has an obvious disability.  In OCD, many times the type of disability is less obvious.  Here are the main ways in which OCD disables a person.

It can take up a lot of a person's day to obsess or do compulsions. The definitions of OCD state it must be at least an hour a day to be disabling. In reality, it is almost never just an hour. By the time most people get professional help, they are spending lots more time than that. Usually the majority of a person's waking hours are "used up" by OCD. The time that is "stolen" by OCD is most likely quiet time when nothing particular is going on - waiting to fall asleep, time by yourself, and car rides are common times.

Up until this year, Dick had done fairly well in school, played basketball, held down a part time job cleaning a fish plant, and spent most weekends with his girl friend.  Over the last year, he has had to let most of this go.  His girlfriend found someone who had more time, he quit his job, and he stopped going to basketball.  He could barely get his schoolwork done.  Why?  It took him about three hours to get ready in the morning, another three hours to get ready for bed at night, and a good 3 hours after school obsessing and doing rituals.  Dick said he felt like a hamster going around in a wheel.

Sometimes it isn't so much the time OCD takes, but the mental Hell it puts a person through that is the most disabling.  This is often the case with very embarrassing, sexual, or aggressive obsessions and also with very unusual compulsions.

Curtis used to be kind of a carefree 11 year old.  Lately, he looked as if something horrible had just happened.  In fact, his teacher told his mother, he looks like those pictures on TV of who are wandering around in refugee camps in Africa.  Curtis's life seemed pretty nice by most standards.  On the other hand, inside his head was like a war.  About 10 times a day, Curtis would think that he will probably loose control and strangle someone.  Some weeks it is his baby sister, sometimes it is his mom.  He has never hurt anyone, but he can't help thinking about it.

Sometimes certain OCD symptoms will make school, work or social life impossible.  At school, having to do things over and over or having obsessive fears about masturbating in public, for example, will make it very difficult to concentrate on school.  Working with the public and having obsessions about catching illnesses makes most jobs impossible.  Children and adolescents who check, touch, hoard or who are very slow become social outcasts.

After reading some books on OCD, Charnelle said she would rather wash her hands 100 times a day and check every door than have her problem.  The only way Charnelle could get to school was if she wore green shoes, blue jeans, and a green sweatshirt.  She washed this outfit every day and put it on clean the next.  It didn't take very long for the other kids in grade 5 to start noticing this.  Charnelle told no one why except to say, "it's stupid, but I can't help it".  She was teased constantly and was on the verge on refusing to go to school altogether.

The examples above give a snapshot at one time of obsessions and compulsions.  Almost no one has one obsession or compulsion.  The course of OCD shows a huge amount of change over time.

Changes in the types of symptoms

Some children will have one obsession or compulsion for a few months and then it will disappear.  There may be no obsessions or compulsions for years, and then they might return for no apparent reason.

When Jody was 6, She had a little "habit".  Before she picked up anything in her hand, she would very lightly touch it once with her index finger.  When her parents asked her why, Jody just said that she liked to.  There were no other obsessions or compulsions.  Although no one mentioned it outside of the family, Jody's mother and father became worried when Jody's little sister, age 3, started imitating this habit.  They were about to go see their family doctor about this when it started to go away and never really came back.  Two years later, after no signs of OCD, Jody started counting.  She thought her mother, who had had a routine hysterectomy, would die if she made a mistake.  She was counting and checking her counting for errors each day.  Only when they were in the pediatric psychiatrist's office did they remember the "habit" she had at age 6.

A common pattern is for a person to have a number of obsessions and compulsions which are quite severe, but which then lessen, at least for awhile.

When Tim was 8, he told his mother that she needed to make an appointment with their family doctor for him.  " Why?", asked his mom.  Tim said it was too private to tell her.  His parents wondered for two weeks what this could be, but figured it had something to do with a birthmark he had on his leg that he was occasionally teased about.  Well, Tim told his doctor that she had to promise not to tell his parents what he was going to say.  Reluctantly, she agreed.  Tim then told how he was having horrible obsessions about killing his neighbor, doubts about whether his parents really wanted him, and how each night he had to turn his head one way and then exactly the same amount the other way.  Well, eventually his parents found out and after about 6 months of treatment, he was better.  He only obsessed about one hour a day.

Two years later, the obsessions moved up to hours a day and he started checking and ordering everything.  He again was treated for OCD and it improved again, but he was still checking things and obsessing at times three years later at age 13.

Sometimes the symptoms change with every visit

Rebecca was 13 years old when she saw a show about OCD one day when she was home from school on a snow day.  She told her mom that she had this, too, and wanted to find out for sure.  Her family doctor sent her to a pediatric psychiatrist to see if something could be done about the "touching problem".  By the time she was seen by me 6 weeks later, the "touching problem" was pretty much gone.  Well, that sounded like good news to me.  "No," said Rebecca, I would rather have the touching problem any day."  What do you mean?"  Rebecca meant that she would rather touch than think about what she was thinking about.  What Rebecca was thinking about was so embarrassing and private that I never ever heard about it until she was mostly better.  Rebecca was afraid that she would start masturbating in class and not realize it.  Rebecca had only masturbated once in her life a year ago.  By the time we got down to discussing what the treatments were, that obsession had become milder and she was checking all the time again.

Sometimes OCD seems to either stay the same or worsen, without any real periods of improvement.  People get used to their obsessions and compulsions, but then they seem to just get worse.  This is the worst course and most often is accompanied by depression.

When did Judy start having obsessions and compulsions?  Only in the last 10 years, she replied with a little laugh.  Judy is 13.  Her life has been ruled by OCD as long as she could remember.  She never even thought much about it until she was 8 and stayed over at her friends house for an overnight.  That was the first time Judy realized that she was different.  She thought OCD was just part of being human.  Well, when the other girls got ready for bed in 10 minutes and she was still getting ready for bed an hour later, she realized she was different.  Judy was amazed that the other girls could fall asleep in that room with everything so "wrong".  So, once Judy's friends were asleep, Judy spent the next hour tip-toeing around them and straightening books, papers, backpacks, and other stuff which was not lined up right.  She then went to bed and cried.  Now Judy has another fear.  She has learned a lot about OCD, and is sort of sad, as so much of who she thought she was seems to be either obsessions or compulsions.  She had calculated that about 15 minutes a day were free of OCD.  She is glad that the treatment is working, as her life had become totally controlled by constant obsessions and compulsions.  But who is she?  Now that she is not totally controlled by OCD, what kind of person is she?  Judy isn't sure yet.