Count the stairs, turn the key in the lock exactly three times clockwise and twice counterclockwise, step over cracks in the pavement, wash your hands until you get blisters… This is how OCD (Obsessive Compulsive Disorder) often appears. How to recognize the line after which our rituals and obsessions become a problem and interfere with life?
Obsessive-compulsive disorder became widely known after the movie As Good As It Gets, where Jack Nicholson’s character is a walking example of this diagnosis. The baton was picked up by Leonardo DiCaprio in The Aviator. Remember the scene in the toilet when the main character couldn’t get out for fear of touching the door handle? Why is there so much focus on OCD now? Have there been more cases?
“Today, in general, there is a growing understanding and acceptance in society of the problems of mental disorders. For example, about panic and depression now we can talk quite freely. And even 10 years ago, people were afraid of the reaction of others, — explains clinical psychologist Yakov Kochetkov. — At the same time, OCD is a less clear story even for specialists, which is still in the shadows. It is more difficult for people to talk about it, they experience burning shame. At the same time, OCD is less common than depression: from 1 to 2% of people suffer from its clinical forms. Therefore, we can calculate that in our country at least 3 million people suffer from obsessive-compulsive disorder consistently and rarely get help.”
Contrasting obsession
In the philistine mind, in movies, in magazines, the disorder is presented through the simplest, most understandable things — the fear of contamination when people wash their hands many times, or the desire to arrange things symmetrically. But this is only part of the possible options. Approximately half of people with OCD actually fear pollution. As far as symmetry is concerned, this is a rather small part.
The other two types of OCD sufferers are often overlooked. The first one is more or less known: these are people who constantly check whether the gas is turned off, whether the lights are off, whether the door is closed correctly. We all do it sometimes, but it’s a matter of balance, the balance between healthy security controls and an obsessive state.
“If you check gas in such a way that you yourself do not believe your test, then it is worth considering. People with OCD may experience the reality of their actions dozens or hundreds of times. They cannot leave the house for hours. They are late for work, disrupt meetings. Communications are broken. Often their social life is complicated.”
The main problem is that people try to fight intrusive thoughts, but the more they fight them, the worse they get.
And finally, the fourth type — a fairly common option — is the so-called contrast obsession. Obsessive thoughts exist in contrast with the true beliefs of a person, they come to the head «by themselves», and they do not like the «owner» of the head. We all have strange thoughts from time to time, but we do not pay attention to them and send them to «spam». But people with OCD give too much importance to their thoughts.
“An ordinary young mother, only very anxious and responsible, suddenly watched a TV show about a woman who killed her children. And then she asks herself, am I not like that? She begins to have images in which her child is bloody, murdered. She begins to be frightened of her thoughts, tries to suppress them, to do something so that they do not climb into her head. But the more she does it, the more they come. And gradually the situation comes to the fact that the woman winds herself up and develops a plan on how not to stay near the child, hides knives and everything that can “kill” him, asks others to watch her, because she considers herself abnormal. It is important to understand that such a woman will never harm her child and her «danger» exists only in her head.
A believer comes to church and finds blasphemous thoughts in his head. He tries to drive them away, but fails. “Or a person suddenly begins to think that he is gay, while it is very important for him to be a person of traditional orientation,” explains Yakov Kochetkov. “And he constantly checks himself to see if he is attracted to members of the same sex.” The main problem is that people try to fight intrusive thoughts, but the more they fight them, the worse they get.
family message
But why does an ordinary person suddenly have such features? “There is evolutionary conditioning. We have genes for repetition and cleanliness. They were useful to our ancestors. If you are clean and clean up after yourself, do not live near excrement, then you are much less likely to get sick with something. Our ancestors checked everything related to safety a lot: whether the entrance to the cave was closed, whether they covered their tracks well. Scientists say that genetic predisposition explains 30% of the appearance of OCD in humans, and 70% is the influence of environmental conditions.
What are these conditions that force a person to be very anxious and awaken excessive obsession in him? Education plays a huge role. In some families, the fear of infection is instilled from childhood, which means that increased hygiene is necessary. In many families, the message is broadcast: the world is dangerous and unpredictable — check everything many times.
Relationship patterns in the family also have an impact. “We have a very common symbiotic relationship between mother and children, especially sons. And often this also contributes to obsessive-compulsive disorder, says Yakov Kochetkov. Every second call to our center is not from patients, but from their parents, who say that their “boy is sick”. And when we ask how old the boy is, it turns out that he is 20 and 30 and 40.”
It is very difficult for a person in a symbiotic relationship to trust himself, to be responsible for his actions and even thoughts. Parents patronize with the best of intentions — they just do not know how to behave properly: for example, to allow a teenager to gradually separate. Understand that he needs a separate room, his own secrets, his own thoughts — good or bad. In symbiotic families, parents usually actively intervene in the treatment process. And psychologists have to conduct therapy not only with patients, but also with parents, so that gradually they give their grown children more independence.
Features of national thinking
Ordinary people control their actions. A person with OCD also tries to control their thoughts. For him, thought is identical to action. We very often get angry on the road when someone cuts us off. Who in their hearts did not wish all the misfortunes on the head of the offender? The OCD patient believes that his words will materialize, and he is a bad person, which means, as a result, shame and guilt, and again torment and self-abasement.
The prevalence of this disorder also depends on cultural characteristics and traditions. “OCD responds very subtly to the cultural situation. For example, now people have begun to passionately rush into pseudo-religiousness, and there are much more cases associated with the fear of “bad”, blasphemous thoughts. A man comes and says that he is a believer. We begin to understand: it turns out that he does not quite correctly interpret the basic religious postulates. “God will punish me because I have bad thoughts in my head. I have to get rid of them.» But this is more about superstition than real religion, the expert believes.
Self-help methods are unlikely to help here — this is too complex a disorder.
“I recently spoke in Germany with a report on the cultural characteristics of the Russian ROC. We have a very widespread so-called magical thinking — more than in Western Europe, — says Yakov Kochetkov, — and it is strongly supported by the media. Faith flourishes in the omnipotence of otherworldly forces, in the fact that it is possible to act with energy on some objects. If I burn a neighbor’s hair, then the neighbor will burn or die. And this leads to the fact that in Russia a person with OCD finds support for his fear with thoughts of harming someone. If I thought now that my mother has cancer, then she can really get sick, because thoughts are material. I have to do many, many rituals to prevent this, present a bright positive image or knock on wood. How can OCD not arise here? Perhaps this is due to the fact that in Russia there are regions where magical thinking has become part of the national culture for centuries — for example, Altai, the Far North, Mari El.
How can a specialist help?
Self-help methods are unlikely to work here — this is too complex a disorder. And how can specialists — psychotherapists, clinical psychologists help? “We do two central things that have been proven to work in research around the world. First: exposure. The term means moving towards your fear. Is the client afraid of pollution? For example, after careful preparation, we agree with the client that he will try to touch things that he considers dirty. After that, he will not wash his hands, but in our presence he will wait until the anxiety itself begins to decrease. People with OCD feel like this hell will never end. Our task is to show him that even with dirty hands he will soon calm down, that his anxiety is finite.”
The second important focus of attention of the psychologist: work with errors of thinking. The client is shown that thought is not equal to action, thought is not equal to reality. If the client believes that his thoughts can harm other people, he is invited to conduct a series of behavioral experiments: can he force a flower in the therapist’s office to wither with his mind, or can he guess the number conceived by the psychologist. Experiments show that no matter how hard the client tries, his thoughts do not affect either the psychologist or those around him. Gradually, psychotherapy helps to get to the most “terrible” thoughts of the client and make sure that his relatives or friends do not get sick or die from the fact that a person thinks badly of them.