Dear Mirel

Copyright by Mirel Goldstein, LPC July 2011

Although some forms of anxiety are helpful because they motivate us to take healthy action (for example, anxiety about illness might lead us to seek treatment), there are other times when feelings of anxiety can lead to a disorder (for example, if the anxiety doesn't make sense in a given situation, or if it is either so much or so intense that it interferes with a person's sense of wellness or quality of life). The diagnosis "Obsessive Compulsive Disorder" (OCD) specifically refers to a type of anxiety disorder in which anxiety over unwanted thoughts leads to repetitive behaviors meant to decrease such anxiety. In this article, however, I will actually be using the term "OCD" rather loosely to refer to anxiety disorders in general that include components of OCD; either anxiety over unwanted thoughts, or repetitive behaviors that a person uses to manage anxiety, or both together.

While obsessions or compulsions can be extremely painful symptoms to have, they are also highly treatable. Trying to determine the best kind of help for your individual symptoms, however, can be somewhat of a maze to sort through!

In my practice, I have seen a number of different types of obsessive or compulsive symptoms as well as approaches for coping with them that clients have found helpful. One common type of obsession has to do with worrying about what other people will think of you. You might be overly concerned with how you look or how you perform. As an example, this kind of obsession may lead to compulsive dieting or exercise behaviors, or a compulsive need to check your work over and over again to make sure that you don't make any mistakes. Or, you might be compulsively nice all the time to everyone and have trouble standing up for your own needs. Everyone's obsessions/compulsions are different. You may even be perfectionist about certain things but pretty relaxed about other things.

Here are a couple of examples: Your obsessions might be triggered by interpersonal conflict, such as a fear that someone is angry with you; you may start to worry excessively about whether you did something wrong or whether the other person will stop liking you. You might feel like you need to call this person over and over again to make sure that everything is still "okay" between you. For someone else, however, a trigger for obsessive thoughts might be work-related; a fear of making a mistake on the job and being criticized or causing harm to someone.

In the above cases, the root of the anxiety and obsessive compulsive symptoms may be a need for approval from others or an underlying self-esteem problem. The OCD could also be due to a history of trauma and a belief deep down that you are "bad" and "unlovable" and that that is why bad things have happened to you (for example, a germ phobia might represent a feeling of being "blemished" deep down). Another possibility is that your obsessive thoughts and rituals are a way of punishing and tormenting yourself for feelings that you have (perhaps out of your awareness) which you feel guilty about or that make you feel out of control, such as angry or greedy feelings.

There is also another type of OCD, which doesn't seem to have much to do with other people and wanting approval from them, but is more about wanting a sense of "control" over your own life or environment. If you have this type of OCD, you might feel a strong need for certain "things" in your life to be in a certain "order" or to go a certain way. For example, you might feel like you constantly need things to be more "even" or "neat" or "clean". You might rearrange things many times a day or wash your hands again and again to prevent "germs". Sometimes this can have to do with not feeling enough "control" in other areas of your life or not having had enough control in an earlier traumatic situation. Controlling the things around you, things that you can control, makes you feel like at least there is "something" that you are in charge of all on your own, or that you can prevent upsetting things from happening to you in the future.

Sometimes this kind of OCD can lead to a need to "control" things to an extent that it makes it hard for others to live with you. You may even want to stop needing to control so much but find that you are actually controlled by the need for control. For example, if you are a mother who is obsessed with avoiding germs and you have a two-year old who likes to play outside in the dirt all the time, this can lead to conflict; either you will allow your child to play in the dirt (which may be healthy for your child at his stage of development) and feel anxious as well as maybe even angry with your child for doing something which increases your anxiety, or you might excessively control your child and restrict his play in a way that will be constraining to him.

Most people with OCD know that the thoughts they have and the things they do don't make a lot of sense, but feel like they cannot help their thoughts or behaviors anyways. If this is the case for you, you may have shame about this or perhaps feel out of control by your symptoms. You may even try to hide them from others and they may even become part of a secret world that puts up a painful wall between you and other people in your life. Or, you may feel fine as long as you can manage to "control" everything you feel the need to control in order to manage your anxiety, but you still might be driving everyone around you crazy, leading to interpersonal conflict! There are also some times that a person with OCD may actually not know if his repetitive thoughts and actions make sense or not; this can lead to a feeling of craziness if others around you are telling you something different from what you believe inside.

Among the different types of help for obsessive compulsive disorder are medications which decrease anxiety; cognitive techniques which help a person learn to think differently (for example, challenging the idea that germs are really so dangerous); behavioral techniques which help a person act differently (such as ignoring obsessive thoughts and not repeating compulsive behaviors over and over again, or exposing oneself to the feared situation- such as germs- until you get used to it and no longer fear it); and psychodynamic approaches which might try to uncover whether there are meanings to the obsessions or compulsions that are not immediately obvious (they are subconscious), such as underlying feelings of guilt for certain feelings or for things outside of your control (such as trauma).

While it may take a trial of several approaches until you find the one that works for you, it is usually a good idea to see if you feel comfortable with the therapist you see and with the approach that the therapist uses. Don't be shy to ask about that in your initial consultation and to "shop around" for the person who will be just right to help you with your individual types of symptoms. Remember, the "label" OCD describes a set of thoughts, feelings, and behaviors that you are having trouble with, but doesn't really say that much about the cause of your symptoms, their meaning, or what will help you manage or eliminate them!