What is OCD?

I've written that OCD isn't an adjective to describe someone that likes organization and I have written about my anxiety, but I haven't really explained what OCD is. OCD is a difference in how worry and stress are handled in the brain by the amygdala and other structures.  What is the amygdala?  Here is a quick video:

The amygdala is known as the "emotional sentinel" because it sounds the alarms that triggers the fight or flight response to keep us safe both physically and emotionally.  It helps us respond to stimuli and it has the ability to learn from past experiences to streamline the response; like using a FastPass at Disney to skip to the front of the line. The amygdala is responsible for the feelings of sexual attraction, fear, anxiety, aggression, and pleasure. When overactive it can lead to anxiety disorders, like OCD.  I have written before that this is like muscle memory and it very much is.  Once it knows it knows, so you may have a "type" that you date or you just know that that fuzzy blanket is going to be amazing to head straight for it. When the amygdala has learned that something is a threat it will trigger the fight or flight response immediately upon recognizing the same or similar perceived threats again and again.  This was great for our cave man selves; see a giant beast that could eat you and in an instant the fight or flight response gives you that boost of adrenaline you need to run away.  But, what if the perceived threat isn't really a threat or, what if you got it wrong and not all giant beasts are going to eat you?  Now you have a learned response that isn't accurate, what do you do?

OCD has a nature vs nurture component to it.  It is clinically recognized that OCD can run in families which, logic prevailing, means that there is some genetic component responsible for how threats are interpreted and managed by the brain.  OCD can also spontaneously occur in an individual that has no family history at all.  The learned responses by the amygdala from previous threatening situations, like those of great trauma can also lead to OCD and, like me, it can be both nature and nurture. I use the example of the threat of a beast and the fight or flight response because it is easy to understand, but not all threats are that obvious.  There are different subsets of OCD that are associated with worry (the threat) of a variety of different stimuli....and If I miss one, please forgive me, there are a lot of subsets. 

Checking OCD

the worry is that a stove was left on and the house will burn down or a lock left open an a burglar will take everything. It can also be checking that something else was forgotten or incorrectly done. 

Contamination OCD

the worry that a germ or illness will infect or contaminate resulting in sickness or death.

Counting OCD

the worry that something doesn't feel right if it isn't repeated a specific number of times. A great example is the character on the Big Bang Theory, Sheldon Cooper, knocking three times on the door.

Existential OCD

the worry regarding the purpose of life or your purpose in life.

False Memory OCD

the worry that something has absolutely happened that didn't actually happen. An example is a false memory that a pedestrian was struck by your car while you were driving and they are laying in a ditch dying when no one was hit, and it never happened.

Harm OCD

the worry is that you will hurt someone as a result of your compulsions.

Hoarding OCD

the worry that something bad will happen if you get rid of something material. 

“Just Right” OCD

the worry that something isn't right about the way something was done so it must be repeated over and over until it feels right.

Magical Thinking OCD

the worry that if a superstition isn't followed then something bad will happen

Pedophilia OCD

the worry that you can't trust yourself around children and that you may act on intrusive unwanted thoughts about children.

Perinatal OCD

the worry that something will go wrong during your pregnancy.

Postpartum OCD

the worry that something will happen to your child or that your child is in grave danger.

Purely Obsessional OCD

this is like a game of whack-a-mole.  The obsession changes from one subset to another.  This can have compulsions attached or not.

Real Events OCD

the worry that something bad has happened as a direct result of something occurring (this happened because of a direct action I committed). What comes to mind is the child rhyme: "step on a crack break your mother's back". 

Relationship OCD

the worry that your relationship will not work out or that the partner doesn't want to be with you.

Scrupulosity (Religious) OCD

the worry that you will violate your religious convictions.

Sexual Orientation OCD

the worry that you are not identifying with the right sexual orientation or that you are in denial about your sexuality or attraction.

Suicidal OCD

worry that you may cause harm to yourself.

(subset list borrowed from A Quick Guide to Some Common OCD Subtypes | NOCD (treatmyocd.com))

So, as you can see OCD can come in many forms. The average person can and do have worries that would fall into any of these subsets of OCD, but it is not OCD unless it is debilitating, intrusive, obsessive thoughts about something that causes extreme distress and fear triggering the amygdala to engage fight or flight that can't be controlled. It is not OCD to have a fleeting thought about something that pops into your mind and quickly goes away.  OCD is plaguing, ruminating, infiltration of thoughts that cannot be stopped and often defies logic.  It cannot be controlled, so like humans do, the person with OCD adapts and figures out a way to calm the fight or flight response in the form of compulsions or rituals. Some of these are physical, like checking, counting, repeating or engaging in something; others are mental like seeking reassurance or fleeing.  For me, the reassurance seeking is like a drug and if I am unable to get the reassurance I am seeking then I begin to escalate and become more and more agitated from fear which results in me fleeing the situation, but before I do I will usually erupt in some kind of epic outburst that often includes threatening to unalive myself. My compulsion is also to talk about the situation that happened with anyone that will stand still long enough to listen. I compulsively need the reassurance that everything will be ok. It is important to note that not a single action is controllable while I am in this state.  I enter an autopilot state and it becomes a runaway train I cannot control; much like you don't have to really think about running away from the giant beast.

 Let's take a departure from Alice in Wonderland for a second to visit another of my favorite stories... Willie Wonka and the Chocolate Factory.  I was trying to think of something that would really explain what having OCD is like to someone who doesn't have it and this scene is a great representation.

In this scene Willie Wonka loads everyone on to a boat and they enter a dark tunnel while the boat goes faster and faster Willie speaks "The Rowing Song". It is ominous.  While the speed of the boat picks up and begins to make everyone feel like it's running away disturbing images bombard... an eye ball, the decapitation of a chicken, a millipede crawling across a face until the boat just stops abruptly and everyone is supposed to just return to normal like they weren't just terrorized by the boat ride.  Now not everyone has OCD affects them this way but, this is a day in the life of my OCD.  The racing and the intrusive thoughts and images are very much the same.  And just like some of the passengers on the boat found the ride fun or interesting (like Charlie and Grampa Joe) others didn't (like Mike TV's mom.  She was anxious from the beginning) and (Veruca Salt's Dad was able to use logic and demand an explanation).

So, what does all this mean?  OCD is a thing.  It's real. It's seated in biology and experience. Now what?  Well, there is a method to treat this called Exposure Response Prevention (ERP) Therapy.  How it works is that the person with OCD is exposed to the threats that trigger them in a controlled environment whether that means in a place of safety, like one's home, or in a clinical setting, and their Subjective Unit of Distress (SUD) is given a base line and you must "sit with it" or as I call it "sitting on the hill" until the SUD level comes down naturally without using a compulsion. 

Sitting on the Hill

So, the average person will have a stressor and their anxiety will climb up the hill to the peak and they will naturally come back down the other side and move on.  In clinical terms this is called habituation. Here is a really crudely drawn visual aide.

But a person with OCD doesn't habituate without avoidance, escape, or a compulsion. So, instead they start to climb up the hill until their anxiety reaches the peak and then they do what I call the swan dive off the top of hill into avoidance, escape, or compulsion like a cliff diver. When the dive off the peak happens it's like a high five to the amygdala rewarding it for great job it did protecting us from the situation, but that reward should come at the end of habituation, not from diving off the cliff.  Diving off the cliff is just as dangerous as the perceived threat, if not more, because it interferes with the ability to live a "normal life" and have "normal relationships". It is disruptive and exhausting which is why people with OCD are 10 times more likely to unalive themselves. (if you want to read more about this here is a link https://www.sciencedaily.com)

What ERP does is that it has the person with OCD sits on the top of the hill with intention resisting the compulsion until they are able to habituate like the average person.  It is hard, it is exhausting, and it is necessary so that they can stop feeding the Obsessive - Compulsive cycle. But, remember the amygdala is driving this and it is capable of learning so, by sitting on the hill until habituation it is re-programing the amygdala that this isn't an actual threat so you can stop overreacting to this stimulus.

So, I ask you to consider your worst fear.  Hold that fear in your mind.  Now consider what your anxiety level would be if that fear became a reality. How much anxiety would you feel? Now, that is the level of anxiety that a person with OCD feels about the things that trigger them. It's not an occasional fleeting thought, but every single day, every hour, every minute, and every second without relief, unless they engage in a avoidance, escape or a compulsion, they are bombarded with this thought devoid of logic.  It is uncontrollable fear.  The amygdala is literally driving the bus to hell.

But, as straight forward as I have described this OCD is still smarter.  So, when you start treatments, the OCD is like "whoa there a minute... what you're telling me is that that isn't a threat anymore but, surely there is another threat you're missing" and it starts to look for other perceived threats with a vengeance.  The amygdala is designed to protect you so when you tell it to stop it goes into hyper drive looking for other things to worry about and it makes you begin to question if the threats you are telling it to stop reacting to actually are threat after all.  It goes down fighting and making you doubt your own reality. So, often things get worse before they get better.  You're trying to recondition your brain after a long time of doing the wrong thing.  Just like when you start a workout regime after a long time off.  You get sore, you ask yourself if it's worth it.  This is what happens when you start therapy which is why having good support and participating in support groups helps a lot.  In support groups you meet people that are in the same struggle you are and experience similar feelings. Remember OCD is the "doubting disorder" so having that group of people that show you that you aren't alone in this can help starve off the doubt so that you can get better.

I hope this explanation helped explain how it works.  Again, I am not an expert, I am just a girl worried AF living with OCD.  I encourage you to do your own reading and research to better understand how all this works. My experiences are uniquely my own and I make no warranty that any of this is accurate.  It is just how it all makes sense to me. 

If you or a loved one resonate with this post and would like to learn more about treatment options or to get an evaluation, please visit NOCD.COM  This place changed my life.

-Alice