Obsessive-compulsive rituals 'ridiculous,' says victim, yet all too disabling

By Brittny Goodsell Jones

May 8, 2008 | Ashley's everyday worry isn't if she gets to an appointment on time or if she remembered to pay the utility bill.

Her main worry is death.

This is her obsessive thought. To combat it, Ashley said she will carry out compulsions that will help her feel as if she has done all she can to avoid death. Ashley, mother of two, said her main compulsions are checking to see if the stove and oven are off, constantly locking doors and windows, and checking closets and under beds for an attacker.

And if her anxiety level goes up, she will check even more.

"Instead of checking things five times, I check it 20 times," Ashley said. "If I can check everywhere then I think I'm OK."

Ashley, who asked that her name be changed for this story, is one of three people in 100 who are affected by obsessive-compulsive disorder, according to an article on Times Online. Commonly known as OCD, this is an anxiety disorder triggered by obsessive thoughts that lead to compulsive behaviors. According to an OCD Web site, the World Health Organization lists this disorder in the top 10 disabling conditions in the world.

Mark Nafziger, staff psychologist at USU Counseling Center, said these obsessive thoughts create anxiety in a person, and the change to his or her behavior can look irrational to an observer. The compulsions that a person carries out function to reduce the anxiety that is related to the obsession, he said.

Nafziger said people who suffer from OCD may deal with a strong fear of germs or contamination. Excessive hand-washing, to the point of bleeding, is one way a person feels safe from germs. Nafziger said people who perform ritualistic actions, such as flipping a light switch on and off a certain number of times before leaving the room, is also another OCD compulsion. This compulsion ends up taking time and slowing people down.

However, Ashley's obsessive compulsiveness to check things multiple times is probably one of the most common, he said.

Ashley said she noticed her OCD when she was in third grade. She would check all the light switches in the house, she said, because she was afraid that if she didn't dim them to a low setting, something would spark, catch on fire and kill everyone in the house.

"It's obviously ridiculous," Ashley said. "It makes no sense."

Now, Ashley checks locked doors and turned-off stoves more than light switches.

"To protect our family, every night I check [these things]," Ashley said. "Even if I checked the window three minutes earlier, I have to look again and it has to be the last thing I do before I get into bed."

She sometimes ends up checking them four or five times even though she knew 30 seconds before that they were locked, Ashley said. The same goes for the oven and the stove burners.

"If they are somehow on, then they are somehow going to light my house on fire and everyone will die," she said.

Ashley also said she has obsessive thoughts about a hot pad that has somehow gotten into the oven. She said she is worried that if she actually has left a hot pad in the oven, it will ignite. Ashley still has these thoughts, even though she has never left a hot pad in the oven.

"This is completely irrational," Ashley said. "But I will check to make sure all the hot pads are in the drawer where they go."

Her husband, Brad, sometimes tries to help by convincing her that for a hot pad to be in the oven, Ashley would have had to take something hot out of the oven with her bare hands and accidentally left the hot pad behind. So, even though Ashley's thoughts are irrational, it helps for someone to explain the reality to her, she said.

"I can't outthink myself," she said. "I can't convince myself that it's not worth things about, so usually it's Brad convincing me it's not worth worrying about."

Nafziger said it is tough to live with a person suffering from OCD. To better deal with the psychological disorder, Nafziger said he recommends family members of the OCD sufferer to educate themselves about OCD and about the available treatments.

"A lot of times people feel more compassionate and patient if they really understand what is going on with the disorder," he said. "Then they can be even more helpful. The better you can understand something, then, potentially, you might deal with it better."

The two most common OCD treatments are medication and therapy, Nafziger said. According to an article in The Mirror, 60 percent of OCD sufferers show improvement when they are given medication. A common medication is anti-depressant pills since Nafziger said many OCD patients have a mild form of depression. Although there is not a 100 percent correlation between OCD and depression, Nafziger said there is a small enough amount to create a possibility of a connection.

Medication can bring the brain to a calmer level, Nafziger said. This way, obsessive thoughts are not as gripping or important to an OCD individual.

"When they do brain imaging with OCD people, they find that there are certain areas of the brain that are overactive, hyperactive," Nafziger said.

So when the medication or therapy is successful, Nafziger said the brain hyper-activity is reduced to a normal functioning state. The therapy Nafziger said is commonly used is called Exposure with Responsive Prevention. This means the OCD person would be put into a situation where he or she would be exposed to their obsessive thoughts. If the person does not act on his or her compulsions, then that person is not being rewarded for his or her compulsive behaviors and theoretically, anxiety levels will decrease.

"I meet a lot more people [at the counseling center] that have the obsessive part of the disorder stronger than the compulsive part," he said. ‘So obviously, the ones that don't have many behavioral compulsions are going to be harder to work with using this kind of model."

Ashley said she went to therapy for OCD when she was in fourth grade. Her parents mistakenly took her to an adult therapist instead of a child therapist, she said. But Ashley said she still remember what the adult therapist said during the first visit.

"She told me something that helped me out the most," Ashley said. "She told me to think of my favorite color, which was pink with sparkles, and breathe in the pink sparkly air and blow out the black air, which was all the OCD stuff."

Although this seems to help, Ashley said her OCD is a daily occurrence and never goes away.

Nafziger said this is normal since OCD is one of the more difficult anxiety disorders to ever fully cure. Depending on how severe each case is, Nafziger said it is possible for improvements to be seen. Some OCD sufferers can even get to a place where they function rather normally, he said.

However, some don't. Caroline Douglas, registered nurse, said this was the case with a particular OCD patient. The patient was obsessive compulsive about organizing all personal items in rainbow-colored order. If one of the objects, such as a binder or a hair elastic, got out of its rainbow order, the girl would begin to vomit uncontrollably, Douglas said. Because of the severity of the case, Douglas said this patient now lives in a mental hospital.

Although most OCD sufferers are not as extreme, Nafziger said everyone has a bit of OCD in their lives.

"I think OCD and anxiety, they all exist on a continuum," he said. "Anyone is probably experienced something they can't get out of their head, a song maybe, so I would say that having a little bit of obsessive thought pattern is pretty normal."

In the meantime, Ashley said she goes about her activities as normal as she can. During the day is better, she said, because she can rationalize easier that her thinking is "crazy." But in the evening, when it gets dark, Ashley said she loses her ability to say everything is OK in terms of her OCD.

"I could tell someone else suffering from OCD that they are OK but I can't talk myself out of it," she said. "That's the prison of it. You can rationalize with other people who are worrying about stupid things but you can't tell yourself that or convince yourself."

"If people haven't experienced it then you can't understand it - it doesn't make any sense to a rational person," Ashley said.

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