“I touched something and I will contaminate myself, I have to wash myself or something will happen to someone in my family”, “I didn’t close the gas well, I could cause a fire”. These thoughts and others are what can invade the mind of a person with OCD, a mental health disorder that generates “intrusive” thoughts. It is the obsessions that give rise to anxiety.
He explains it to EFESalut the researcher at the Biomedical Research Institute of Bellvitge (IDIBELL) Carles Soriano. And from this strong obsession, a compulsion originates with the aim of curbing this anxiety.
“They think that the consequences of contamination are very serious. In addition, the compulsion is a repetitive behavior that does not stop, it never ends, people with this obsession can even wash their hands until they bleed”, adds Soriano about this disorder.
The person, for example, who is afraid of leaving the gas key on will check that it is tightly closed again and again. He will go, he will come back, he will go he will come back, he will always have doubts…
“She gets stuck in a loop on a concern, she has no way of solving it. OCD is the disease of doubt, there is always a doubt. it can become an incapacitating horror”, he points out the clinical psychologist Rafael Santandreu in EFESalut.
OCD, manias, other disorders…
The most well-known OCDs in order of frequency are precisely that of cleaning: the person cleans and cleans because he has the threatening doubt of whether he will have been infected by touching some surface. But also hypochondria and order, according to Santandreu.
In reality, both experts agree, there must be millions because sufferers can “get into OCD with anything”.
And there are also different degrees of OCD, from a milder disorder to a much stronger and present one.
Santandreu points out that people often confuse a slightly superstitious behavior or a mania with OCD when “it has nothing to do with it”.
“I’ve been asked ten million times if what Rafa Nadal does when he hits is a touch, and it’s not”, points out this expert. The difference is that “you can have small rituals, manias but they don’t cause you great anxiety if you don’t do them, on the other hand in OCD, they do”.
With OCD disorder, if the person does not compulsion the anxiety is unbearable.
Nor does a perfectionist have to have OCD. “The difference is absolute, because the perfectionist does not have an irrational doubt-threat all the time, this is the difference,” Santandreu insists.
And a person who is anxious or worries a lot about things doesn’t have OCD either. In the case of obsessive compulsive disorder, the preoccupation with which he gets stuck is always the same. It can even be like this for several years and then change to another one.
“When a person is simply worried, they worry about anything, with many different things that vary throughout the day”, concludes Santandreu.
What happens in an OCD brain?
Researchers know very little about what goes on in an OCD brain.
The brain can be divided into two large parts: the cortex that is on the outside and the structures that are on the inside, the so-called subcortical, details Soriano.
Within the latter there are very specific ones known as striatal nuclei, involved in various neurological pathologies such as Parkinson’s, for example. These nuclei are very varied, continues the IDIBELL researcher, and they participate in many behaviors: there is a nucleus that participates in the motor subject, another in memory, among others.
In OCD, the connection between the striatal nuclei and the cortex, especially the frontal cortex, is disrupted.
“There is a hyperexcitation of this connectivity between the striatum and the cortex and depending on which part of the striatum is altered, whether it is more related to motor issues or memory or reinforcement issues, the symptoms of OCD they could differ a little”, emphasizes Soriano.
How is it treated?
It is usually treated with pharmacological, psychological therapy, either separately or both in combination. In more extreme cases with surgery.
“Many people solve OCD with psychological therapy alone, but there are people who support themselves with psychotropic drugs, which are usually a type of antidepressant that reduces the symptomatology, in some small cases it eliminates it altogether, but as long as you take them, of course”, explains Santandreu, who in addition to writing a book about this disorder – Without fear – has written the foreword to Jeffrey Schwartz’s book “Unblock your brain”.
For his part, the IDIBELL researcher points out that all the international guidelines recommend that the first strategy for dealing with OCD is psychological.
And among the psychological therapies that work best are the so-called behavioral therapies.
“They are exposed to the situation that causes them obsessions, as for example we will prevent you from ordering things or from explaining. It’s about the person experiencing that discomfort and letting time pass and that anxiety not really being associated with the negative consequences they think will happen.”
In this way, the association breaks between not having done the compulsion and the supposed negative consequence.
And in children?
OCD can also appear in childhood. You can start with some stressful factor or with some developmental change, for example, girls with menarche, when they start puberty. “It is a critical point”. For children it can start a little earlier, around the age of eight or nine.
Then there is another peak for the onset of OCD, which is usually in early adulthood. “It is relatively rare for people to start OCD later, because there are people diagnosed later but because they have not gone to a psychologist or psychiatrist before,” adds Soriano.
The expert explains that all children go through a normal period of development in which they manifest obsessive symptoms, such as not stepping on the white lines of the zebra crossing or touching all the posts on a fence.
In principle this is not worrying, moreover, it disappears with time. “There is also no need to cause alarm and for parents to take them to the pediatrician when they see these symptoms. Most parents are aware when this behavior is disrupting the normal life of the family or the academic performance of the child”, clarifies the IDIBELL researcher.
“I didn’t know what was happening to me”
Miguel – fictitious name – is 39 years old. He is a journalist. He was diagnosed with OCD in 2012, as he tells EFESalut. Since childhood he has always been very obsessive. “He was a schoolboy and mentally he always had to say father was our perfect, but he didn’t attach importance to this behavior.”
Thus, until adulthood, when breaking up with a partner, “an intrusive thought” began: “What if I have been infected with HIV?”.
“At first I said, how silly, but the thought was still there. It’s as if they were knocking on the door all the time, ‘pumpumpum’, and you don’t want to pay attention and in the end you let it happen and you get all muddled”, remembers Miguel.
After compulsively searching for information, he began to take HIV tests, he was not satisfied with the negative result that came out again and again. It got to be done up to four and five a week. “You enter an endless loop, every time you take a test it’s another compulsion, you’re feeding the OCD ball,” he says.
And another intrusive idea started that was the one that sank him, displaced that of HIV. And if he was able to attack his mother? “I started to think what if I’m a psychopath?”. Miguel avoided being alone with her just because of that thought.
“I didn’t know what was happening to me and I had depression because it wasn’t me. I am a cheerful, happy, extroverted person…”, says Miguel. At that moment he decided to go to the psychiatrist, who gave a name and surname to what was happening to him: OCD.
From here he started therapy and getting better. He hasn’t explained it to everyone around him. Some close friends, parents and the boss know. In fact, although he is about to take the step, he prefers to speak under a fictitious name because he considers that the disorder stigmatizes.
“I’ve had some pretty good times but overall I’d say pretty much 95% of the days since I was diagnosed I have intrusive thoughts. It is a titanic struggle, you need a lot of willpower and to lose your fears. For me, the key word for OCD is exaggerated fear”, he acknowledges.
Miguel has better and worse times, but the meetings he has on Saturdays at the TOC Madrid association have also helped him a lot: “You expose points of view, you see other people’s problems, you see that they have an obsession that you have already had and you can give them guidelines, it’s very enriching”.