Patrick Pomfrey, Psy.D., is a doctor of clinical psychology in Fairfield, Iowa.
Dear Dr. Pomfrey,
I live in a shared-housing situation, and one of my housemates has obsessive compulsive disorder (OCD). Everything she touches, such as faucet handles, needs to be thoroughly cleaned and sanitized. Additionally, she constantly washes her hands anytime she has touched an unsanitized surface. When we have pointed out her behavior to her, she seems to be oblivious about the obsessive nature of her actions. Furthermore, certain of her behaviors inconvenience the house members—not to mention the additional costs for cleaning supplies and water. Could you please explain OCD, how it originates, and if it’s curable—especially for someone who has had it for many years? —Housemate
Okay, this may seem silly, but indulge me if you would. Remember the last time you had to pee really badly, but you couldn’t because you were in the middle of an important conversation or in a giant mall where it takes a Navy SEAL team to locate the bathrooms? Could you really listen to the conversation or continue to shop? No, the only thing you could think about is doing what your body and mind were screaming at you to do—pee now!
Now you know what your friend experiences on a minute-to-minute or hour-to-hour basis—not with her bladder, but with her mind. The pressure of the thought that her hands are contaminated intensifies as the seconds pass. There is only one way to alleviate the anxiety—wash her hands.
Obsessive Compulsive Disorder (OCD) is officially listed in the Diagnostic and Statistical Manual of Mental Disorders-IV as an anxiety disorder. OCD consists of two parts. The obsessive part refers to the thinking process, while the compulsive aspect refers to behavior. In your housemate’s case, she obsesses about contamination, and then to relieve her distress is driven to the compulsion of washing.
The most common obsessions are contamination, fear of having hurt someone while driving, leaving the door unlocked, or the intense need to have things in a particular order. Many OCD individuals experience horrible mental images of a distressing nature, e.g., hurting one’s child or shouting out an obscenity in church.
Obsessions are so anxiety producing that the individual frequently develops rituals that defuse the perceived danger. One individual with severe OCD obsessed he would be burned by battery acid from an automobile accident. Every time he heard a siren he would jump in his car and follow the police to the scene of the accident. After the car was towed away, he would dress in a rubber outfit and wash the road. Many OCD rituals are much simpler. For example, frequently a person will tap three times on a table or count to ten several times in a row.
Most OCD people are aware that their compulsions are “crazy.” People with psychosis, another psychological disorder, believe their delusions. Not so with OCD. The behavior is only used to alleviate anxiety. If you talk to an OCD person, they will often tell you that they are completely mystified by their own behavior. However, one of the exceptions is obsession with contamination. It is likely that your roommate actually fears she is being contaminated. In this case, she may be unaware of the absurdity of her behavior. She may feel you are crazy because you subject yourself to so many dangerous contaminants. These individuals are technically classified as “OCD, With Poor Insight.”
How does OCD develop? We don’t know. It may be genetic or biochemical. Some behaviorists believe it is a learned behavior. My experience tells me it is a combination of these three.
Typically, OCD is treated with a class of pharmaceutical drugs known as Selective Serotonin Reuptake Inhibitors (SSRI). They can be effective, but they do have side effects.
OCD is also treated with behavioral therapies such as Exposure and Response Prevention. In these therapies, individuals are subjected to their fears while the typical ritual to alleviate the anxiety is proscribed.
Remember, your roommate is likely suffering more than those around her. Having a private, nonthreatening conversation with her may be helpful. Of course, no one around her should have to suffer because of her imbalance. But handle it with compassion—stress increases OCD symptoms. You might ask how she would feel about an appointment with a psychiatrist who can prescribe medication or perhaps with a therapist to learn tools for dealing with her situation.