Is OCD Real?

One day I went to visit a friend who had just moved into a new house. She said, “I’ve got to show you something.” She tool me up to her bedroom and opened her husband’s sock drawer. I saw perfectly folded pairs of socks fanned in neat rows organized by color.  She said, “Is this OCD or what?”

 Does my friend’s husband Allan carry the diagnosis of OCD? 

 Well, I don’t know.

OCD is a condition in which a person gets caught in a cycle of obsessions and compulsions. 

 Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.

 Compulsions are activities that alleviate the pain of the unpleasant feelings.

 We all have unwanted thoughts; it’s part of the human experience. Sometimes those thoughts get stuck in the brain, like a song you hum all day.

 We all have thoughts about the future that cause us to have anxiety; it’s part of the human experience. What if I fail the test or don’t get that job or freeze up when I make my presentation?

 And we all have ways of managing anxiety and other unpleasant feelings. Some are healthier than others. You could go out running or meditation or call a friend. Others try numbing their feelings with alcohol or shopping or binge-watching Netflix.  

 Does that mean we all have OCD?

 No. For people with the clinical diagnosis of OCD, their brains get stuck. It’s like backing out of the driveway and then not being able to shift out of reverse. Most importantly, the obsessions and compulsions get in the way of living life. Our kids with OCD can start avoiding situations that trigger obsessions. The can withdraw from friends or stop going places because they’re embarrassed about their compulsions, like rituals around getting in and out of cars. The can invest hours each day to the compulsions.

So let’s talk about the differences between a more neuro-typical brain and a brain wired for OCD.  

 The “Normal” Brain vs the Brain with OCD

 Healthy brains are wired to scan the horizon for danger. One of the first questions the brain asks when it’s in a new situation is, “Am I safe? Am I going to die?” If the situation is deemed unsafe, the danger alarm goes off. Without conscious thought, our bodies get ready to spring into action. Our hearts start racing and breathing gets shallow.

 Brains wired for OCD have very sensitive danger alarms that are set off by specific categories of unwanted thoughts or images or urges. These can include a fear of contamination, a need for symmetry and order, the need to do things just right, urges to harm, questions about being a bad or immoral person, taboo sexual thoughts, or the rightness of relationships.

We implement one of four responses once the danger alarm goes off: fight, flight, freeze or fawn.

 Some creatures choose to fight. They turn and face the aggressor.  They say there’s nothing more dangerous than a mother bear protecting her cubs.

 Some creatures choose flight. When people in public places hear gunshots, their natural response is to flee. 

 Sometimes freezing is a creature’s best response. This helps you become invisible to the person threatening your life. 

 There’s a fourth option you may not have been taught about in high school biology. That’s fawning. In the fawn response, you immediately turn to please the aggressor and avoid conflict. This is the option some kids reach for if they are threatened by a bully. This is often the response our kids use when they try to please their OCD monster.

 It would be great if our brains could tell the difference between a real circumstance and an illusion, but it does not. If you're afraid of snakes, and a friends says, “Look at my plastic snake” you will have a strong visceral and emotional response, even thought you know the snake is plastic.

 While the words fear and anxiety are used interchangeably, they are not.

 Fear is a response to a current situation. You see, hear, feel, smell or taste something that could be dangerous.

 Anxiety is a response to a thought that we could be in danger in the future, even though we are not in danger in the present moment.  The situation is imagined. The brain cannot tell the difference between something that’s imagined and something that’s real. If you have a fear of flying, you are white-knuckled on the plane. However, your heart can start racing at the thought of getting on a plane.

 If you were walking with your child back to your car at night, and you saw someone approach you wielding a knife, you would experience fear. 

 If you’re up at night worried about what the future holds for your child with OCD, you may experience anxiety.

 The most common unpleasant feeling with OCD is anxiety. They are not dealing with the here and now; the trigger for the obsessive thought may be in the here and now, but the  consequences are usually in the future.

 Here’s why it’s important to distinguish between fear and anxiety. Fear is programmed into our brain. However, anxiety is triggered by a thought, and you get to choose the thought that you believe. 

 When my patients were told they had an abnormal mammogram, often the first thought is, “What if this is cancer? What if I die?”

 Now imagine that you believe that thinking bad numbers or accidentally cheating on a test could cause someone you love to have cancer? That is the experience of our kids with OCD. Their misfiring brains offer them lies they choose to believe.

 A little anxiety is good. It gets us out of bed in the morning. However, at a certain point, adding more anxiety impairs performance.

 There are many examples that illustrate the idea that more of a good thing is not always better. In fact, it can be dangerous. 

 When I was in college, I was the eyes for a blind graduate student in experimental physicians names Kent Cullers. If you saw the movie Contact, you were introduced to him. I once asked him how he lost his vision.  He told me the was born prematurely in the 1950. At that time premies had a high risk of dying. Pediatricians knew that babies who were given oxygen had a better chance of survival. If a little is good, more must be better, they thought. So Kent was placed in an incubator with 100% oxygen. It turns out that this level of oxygen is kills retinal cells. 

If you have ever undergone a surgical procedure, you know that the right dose of opioids helps you recover. However when those same opioids are stolen and sold on the street, overdoses  can be fatal.

Our kids with OCD can go to 10/10 anxiety in nanoseconds. This can be excruciating for them. My son says it’s like having a heart attack. 

When you have a headache or toothache, you just want to make it stop. You might take aspirin or take time off of work to see the dentist, Again, that’s a normal part of the human experience. 

You have ways of calming yourself when you have fear or anxiety. You might take deep breaths. You might go online and do some research. You might reach out to a friend or pray.

Compulsions are the activities that bring anxiety or fear back to baseline and restore equilibrium.  For our kids with OCD, this might include washing and cleaning, checking and repeating, arranging objects, apologizing and asking forgiveness. 

So, what is OCD? It’s a cycle of obsessions and compulsions that get in the way of living. People with OCD might avoid activities that trigger obsessions. They can invest hours each day performing compulsions. They might experience collateral damage of shame and embarrassment and have the sense that they’re in it alone.

Yes, OCD is real!

 How is OCD Diagnosed?

 The next question is this: how is OCD diagnosed? 

 If you go to the doctors for pretty much any health concern, the doctor begins by listening to your story. Then you will get a lab test or an xray or a biopsy to confirm the diagnosis.  

 So, what diagnostic test confirms the diagnosis of OCD? There is none that is currently considered the standard of care.

 Right now, most people get the diagnosis of OCD based on a history, and a history is a crude diagnostic tool. It’s easy to understand how and why kids would believe that they’re just like anyone else who has unwanted thoughts or superstitions or rituals to make things go in their direction.

 My own son was diagnosed with OCD on the basis of an imaging study of his brain. I knew something in my son’s brain was not right, and at the time I suspected that he might have an atypical form of ADHD. After all he had an attention problem. Quite honestly I was shocked at the diagnosis of OCD. It never crossed my mind. However, once I looked at his behavior through the lens of OCD, things started making sense. 

 Let me just be clear. I am not suggesting that your child needs an imaging test. We are just beginning to correlate brain scans with observed behaviors. However, i project that as we collect more data, we will use imaging studies to diagnose OCD and ADHD just as imaging is  used with medical conditions like brain tumors or strokes.

 However, this leads to a bigger question. Why be concerned about a diagnosis at all? A diagnosis is just a collections of words. Why is it important? 

Why is a Diagnosis Important?

 First, a diagnosis helps you understand why certain things are happening. Once my son got the diagnosis, things started making sense. Often the simple ability to understand is therapeutic.  A diagnosis can help project what the future might look like.

 Second, a diagnosis guides treatment. Heartburn is treated differently if it’s caused by acid reflux in the esophagus than from insufficient oxygen flow to the heart. 

 Third, you can get to the result you want more quickly, whether it’s being cancer-free or getting rid of the pain of reflux. Once your child has the diagnosis of OCD it’s much easier to find the right help to put them in a situation in which OCD no longer holds them hostage.

 Let’s get back to our initial question. Is OCD real? Yes it is. There is a correlation between the challenges people with OCD face and brain scans.

 Does my friend Alan with the organized socks have OCD?  I don’t know. As I dug through my sock drawer this morning, I saw the appeal Alan’s system of sock management.

 Does organizational consultant Marie Kondo have OCD? I don’t know. Her huge popularity taps into the desire to create physical spaces that bring joy.

 Just because someone is organized does not mean that they carry the brain baggage of OCD. 

 Some people with OCD aren’t organized at all. Their obsessions may be about whether they’re good people, or whether they might harm others.

 However, let’s keep our focus on what’s most important. As parents we want to offer our children the tools and resources to launch into a successful adult life.

 If our kids had reading problems we would do what we needed to do to help them read. If they had visual impairment, we would get them glasses. 

 Kent Cullers was completely blind. AND he wanted to be an experimental physicist when he grew up. He learned braille. He found ways of getting around the barriers so that he made his dreams come true.

 This is what you want for your child. You want to help them make their dreams come true. 

 Yes, poorly managed OCD can potentially be a barrier to your child’s success. However, your children can learn how to manage their brains so that they, too can make their dreams come true.

What if Someone Doesn’t Think OCD is Real? 

 Undoubtedly there are people who think that OCD is a fad. This is usually because they do not have direct experience with it. If OCD has entered your child’s life, I think you would have not doubts that it’s real.

 What do you do the you see a Facebook post that shows a picture of an organized kitchen cabinet and someone says, “That’s so OCD.”?  You can decide if you want to go to battle to clarify what it means to have OCD.

 If your family members or friends wonder if OCD is real, educate them. Share this podcast.

 And if your child wonders if OCD is real or not, you can say, “I can understand why you question the diagnosis. Yes, everything that you are experiencing is part of the human condition. Yes, people have unwanted thoughts. Yes people do things to many their anxiety. And everyone has brain baggage. Instead of focussing on the label, let’s talk about what’s most important. That’s developing the skills and tools so that you’re in charge of your brain rather than your brain being  in charge of you. You want the freedom to get out and do the things you love to do. I want you to dream big and make those dreams come true. I trust you will get there, and I’m here to support you.”

 What do you think? Leave a comment below. Please feel welcome to leave a review. Share this with the people in your life supporting your child. 

Your Next Steps

 Do you have a specific parenting challenge? Please feel welcome to schedule a 15-minute complimentary consultation. You have the power to be a force for healing in your child’s life. You can be an OCD Power Parent and we’re here to show you how.

 Do you learn best by listening? Click here to listen to the podcast about this topic.

© 2022.  Dr. Vicki Rackner. You may reproduce this blog post with attribution.