Ever since a neighbor from the opposite building was quarantined after contracting the virus, the fear of contracting a deadly disease gradually overwhelmed Susan's life — she began to avoid fibers, dust, and anything she couldn't touch with gloves on, and worried that she might get sick from it, no matter how far apart she was.
Susan's fearful condition has been getting worse in two months. Recently she has developed to washing her hands dozens of times a day, and after going out, she also has to strictly implement a complete set of disinfection and cleaning process before entering the room. In the repetitive and tedious ritualistic procedures, she felt exhausted and suspected that he might have OCD.
However, is it really what she thinks it is?
In fact, everyone worries more or less at times. It is normal to be overly worried at times in the face of life and death. In contrast, worry caused by OCD is often irrational, absurd, and irrational, and deliberately suppressing it can cause anxiety and stress. In other words, many people show compulsive behaviors without suffering from OCD.
What is OCD?
Most of the behaviors of people with OCD are compulsive, repetitive, and aimed at dispelling anxiety. They are overly concerned with details and procedures, overly concerned with rules and regulations, and must do things the way they think is right. In addition, in the vast majority of cases, people with OCD perceive their behavior as silly, useless and unpleasant, and sometimes even feel very embarrassed and ashamed.
OCD is diagnosed when it interferes with the person's normal life, affects their relationships with others, and impairs their social functioning. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there is a description of OCD :
Obessive-compulsive disorder is characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images (obsessions) and/or by repetitive behaviors or mental acts, which are so severe as to be very time-consuming (more than 1 hour per day), or by symptoms that cause clinically significant mental distress, resulting in impairment in social, occupational, and other important social functions. And these compulsive symptoms cannot be better explained by symptoms of other psychiatric disorders (e.g., overworrying in generalized anxiety disorder, etc.), nor can they be attributed to the physiological effects of a substance or other somatic disorders.
In this description above, obsessive thinking is a persistent impulse, thought, intention, or idea. It intrudes into a person's normal thinking and causes excessive anxiety and worry. Compulsive behavior is a mental activity or repetitive behavioral action with a view to reducing or stopping the worry and anxiety caused by compulsive thinking, usually with an attempt to avoid or stop the occurrence of some fearful or despairing event, such as death, illness, and some fantasy of bad luck.
Symptoms of Obsessive Compulsive Disorder.
Although there are many different kinds of ways OCD can manifest, the most common are inspection-type and cleaning-type compulsive behaviors. Other compulsive symptoms include demands for symmetry, unnecessary sexual fantasies or aggressive thoughts, compulsive counting behaviors, incessant seeking of affirmation from others, orderly organizing rituals, and collectivism. The following are some typical compulsive behaviors of the washing/cleaning type:
Excessive, illogical and uncontrollable
- Washing hands or bathing, usually in some ritualized way
- Cleaning houses, individual specific rooms, yards, sidewalks, cars, etc.
- Washing individual objects, housewares, etc.
- Use a specific detergent or a special cleaning technique, etc.
- Avoid contact with any “contaminated” objects
- Avoid going to specific places — cities, towns, tall buildings — that are thought to be “contaminated”
- Be careful to wear gloves or other protective measures to avoid contaminating yourself
In addition, there is a group of patients who show “obsessional slowness” (the most obvious symptom is slow movement, which can take several hours a day to wash, dress or eat). Other patients may have purely obsessive thoughts without specific compulsive behaviors. Such patients are more likely to have some recurrent thoughts related to infectious diseases, aggressive behavior, sexual behavior, etc. And here are some common, compulsive thoughts related to infectious diseases.
Extreme fear, disgust, or excessive concern for the following
- Bodily secretions. Example: saliva, sebum, blood, plasma, semen, urine.
- Dust or bacteria
- Sticky substances or debris
- Indoor cleaning products or chemical agents
- Environmental sources of infection: hydrogen, asbestos, radioactivity, toxic gases
- Contact with animals
- Disease caused by infection or by infecting others with disease
- Diseases: AIDS, hepatitis, sexually transmitted diseases, etc.
It is important to note that the pattern of OCD symptom onset is highly variable. One or several symptoms alone will not confirm a diagnosis of OCD; only when these behaviors lead to significant emotional impairment, low mood and anxiety, or are too consuming will a diagnosis of OCD be confirmed. In addition, many patients may have only one symptom throughout their lives, while many others may have multiple compulsive behaviors or obsessive thoughts.
Diagnosis of obsessive-compulsive disorder
The diagnosis of OCD is made on the basis of psychiatric examination, history of onset and presentation of symptoms, and analysis of the degree of disturbance in daily behavior. The doctor will distinguish OCD from other psychological disorders with similar symptoms (including schizophrenia, phobias, panic disorders, anxiety disorders, etc.) based on the nature and frequency of symptoms, etc. In addition, it is necessary to exclude that there are other reasons for the appearance of symptoms.
The research shows that about 80% to 90% of people experience unnecessarily disturbing thoughts, but most people are able to control these unpleasant thoughts in their brains without much discomfort — for them, these thoughts are shorter in duration, weaker in intensity and less frequent in occurrence. In addition, OCD symptoms usually show clear signs of flare-ups, which can cause significant discomfort and lead to a strong urge to neutralize or alleviate the symptoms.
What causes OCD?
No one knows the exact answer to this question, but researchers have tried to solve the mystery. In studies on OCD since 1930, it has been shown in 20% to 40% of cases that relatives of OCD patients also suffer from OCD. The probability of relatives of OCD patients having OCD and subclinical OCD is even higher. Those with early onset OCD may have relatives with OCD, and identical twins are more likely to develop OCD than dizygotic twins.
The most common theory about the etiology of OCD is that it is associated with abnormal levels of serotonin, an important neurotransmitter in the brain. Serotonin plays a role in many physiological processes, such as mood, some aggression, impulse control, sleep, appetite, body temperature, and pain sensation. Serotonin dysregulation is also thought to be associated with depression, eating disorders, self-harm, and disorders such as schizophrenia.
The onset of OCD symptoms is often very slow, but there are a few patients who develop symptoms suddenly. There is growing evidence that OCD appears to be caused by a combination of some genetic constitution and some apparent environmental factors. Genetic predispositions, including slight variations in brain structure and circuitry, and environmental factors, including large life changes, health problems, or the death of a loved one, can cause or exacerbate OCD symptoms.
What can we do?
In the past, OCD was thought to be a mental illness with little hope of cure. Fortunately, over the past few decades, researchers have made great progress in the effective treatment of OCD. A large body of clinical and scientific evidence suggests that a combination of cognitive behavioral therapy (CBT) and medication can be effective for people with OCD.
The cognitive aspect of cognitive-behavioral therapy refers to specific approaches and techniques to help correct erroneous thoughts and ideas in the mind of the person with OCD, while the behavioral aspect refers to specific approaches to change the person's behavior (e.g., the compulsive behavior of the person with OCD). The most effective technique of cognitive-behavioral therapy for OCD patients is Exposure and Response Prevention (ERP).
Exposure and response interventions, also called exposure and ritual interventions, are the primary behavioral techniques used to treat OCD. The goal of response interventions is to reduce the frequency of ritualized behaviors. Patients with OCD are asked to confront the source of fear, experience the urge to perform the ritualistic behavior, and then consciously discourage behaviors like hand washing or repetitive inspection. Initially patients may be asked to delay performing the ritualistic behavior and then gradually work toward complete resistance to the compulsive behavior.
For the true clean OCD sufferer, today's epidemic can truly be described as a major exposure therapy scene.