Obsessive-compulsive disorder is associated with anxiety disorders and affects a significant part of the French population, since approximately one person in 50 suffers from it.

It is difficult to list and describe all OCDs, because each individual who suffers from them brings their own nuances to the expression of the disease, depending on their personality, origins, fears, doubts, etc. What all OCDs have in common, however, is that this syndrome is defined by 2 essential components:

1/ Obsessions:

These are ideas, mental images, involuntary and annoying impulses that cause an unpleasant emotional state, discomfort, anxiety.

2/Compulsions:

These are actions (mental or behavioural) that are voluntary unlike obsessions, but which are felt to be obligatory to alleviate unhappiness, feel better or avoid a catastrophe.

 

We generally try to classify OCD by theme, but these categories are of course not mutually exclusive, and some people suffer from several associated themes.

The usual suspects are:

Religious, moral, superstitious themes. For example: \“if I don’t read this email 7 times, my mother will die\”, \“if I think about God in an impure place like a nightclub, I will go to Hell\”, etc.

Themes of contamination, purity, cleanliness. For example: \“If I touch the handlebars on the subway I will get Aids\” or \“If we don’t make a decontamination lock in the entrance when changing clothes then my flat will be soiled\”

Themes of precision, order, tidiness, perfection. For example: \“I must have everything in my house perfectly aligned or there will be a disaster\” or \“I must have watched this film perfectly, hearing every word, every sound, seeing every detail, or I am in danger\”.

Themes of protection from disaster or danger. For example, \“I’m afraid I’ve caused a road accident without realising it, so I keep going back to the scene\” or \“I check by putting my hand on the hotplate 57 times, otherwise I might set the house on fire\”.

\“Other\” themes, such as the need to count, to associate words, the need to accumulate and not throw anything away, the obsession with physical sensations (breathing, blinking) etc.

 

These 2 facets (obsession and compulsion) of the same disease will feed on themselves: The obsession leads to a compulsion, which will calm the obsession in the short term but make it persist in the medium term. Indeed, as the compulsion has most certainly prevented the obsession from being realised, it reinforces the belief that the compulsion is working. This is called a \“self-fulfilling belief\”.

Let’s take the example of a person who has an obsession with an impending disaster: she fears that her flat will be broken into while she is away. So before leaving, she checks 30 times that the door is locked (this is the compulsion action). When she returns, her flat will not have been broken into, and this will be validation for her that her compulsion to check has worked. As a result, the next time she goes out, she will reinforce her checking action \“since it works\”. That’s the whole point of this disease, it’s self-sustaining, and “the solution (which is the compulsion) is actually the problem. \”

Here’s an anecdote that I think illustrates this idea of self-fulfilling prophecy:

Two men are in a high-speed train, between Paris and Lille. The first one looks at his neighbour, intrigued. Indeed, the latter, at regular intervals, gets up, opens the window and throws a little white powder from a bag on the track. The man asks him,

\“Why are you throwing powder on the track?\”

The other answers: \“To chase away the elephants.\” \“Can you imagine if an elephant came on the track? The train would derail and there would be a serious accident.\”

\“But there are no elephants in the wild between Paris and Lille.\”

And the man replies: \“Well yes, of course, it’s thanks to my powder.\”

That’s the problem with OCD: as long as the man doesn’t stop throwing powder (his compulsion) he won’t realise that his fear (obsession) is unfounded and that his action is useless.

 

It is therefore a chronic disease, which will often manifest itself by a co morbidity (i.e. a disease which will be the consequence of the OCD) because it not only makes you suffer, in the long term it can cause: a depression because of exhaustion, sleep problems, addictive behaviours, dark thoughts, anxiety attacks. OCD can also have negative consequences on work (slowness, delay), family life and friends (those around you are \“hostage\” to OCD) and finances.

 

OCD often appears in a person who already has an obsessive personality, i.e. who has several of these traits: preoccupation with details and rules, perfectionism, excessive devotion to work, rigour, rigidity, control, lack of flexibility. Of course, one can have obsessive personality traits without suffering from OCD, just as one can have a worrying personality without necessarily suffering from an anxiety disorder.

 

Cognitive and behavioural therapy has been shown to be effective for OCD, particularly with Exposure and Response Prevention (ERP) techniques. You will find all the activities related to this technique in My Sherpa, in the activities on OCD.

Oftentimes, an antidepressant treatment is necessary in the beginning of care, as well as sometimes an anxiolytic or a sleeping pill.