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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Obsessive Compulsive Disorder, Plagued by Doubt

Allan N. Schwartz, LCSW, Ph.D. Updated: Apr 1st 2008

 Do you know anyone who cannot make a decision because they are always doubtful? Are you married to someone who is frozen in place because they cannot decide what house to buy and in what neighborhood? If this sounds like you, your spouse or someone you know then the problem could be Obsessive-Compulsive Disorder(OCD).

Some definitions:

According to the Diagnostic and Statistic Manual Volume 4(DSM 1V), "obsessions are persistent ideas, thoughts, impulses or images that are experienced as intrusive and inappropriate." These thoughts cause enormous discomfort and anxiety to the individual experiencing them. Therefore, persons experiencing obsession are aware of what they are, try to suppress them and experience increased anxiety because of their inability to stop them. It is akin to having a song you recently heard go through your head repeatedly despite the fact that you want it to stop.

Compulsions are repetitive behaviors or mental acts whose purpose is to reduce anxiety but end in increasing anxiety and frustration. Here too, the individual is aware that the behaviors are inappropriate and useless, yet they cannot be stopped because of the felt strength of the need to perform them. Examples of compulsions are such things as repeatedly: hand washing, checking (to see if windows are shut, doors closed and locked, etc.), turning off the stove and, counting numbers, words, prayers and etc. Often compulsions accompany obsessions as with children who sing: "step on a line, break your mother's spine," as they skip along a side walk avoiding cracks. In fact, childhood is a time when children normally experience obsessions and compulsions as in this example. The adult is someone who continues to experience these long after what was stage appropriate during childhood.

Doubt:

One of the driving forces of the compulsions is chronic doubt. Doors, windows, locks and other things must be checked repeatedly because of the fear that something has been overlooked despite repeated efforts.

Many patients have provided me with examples of these doubts. One example described to me was a twenty five year old man who, each time he drove into his parking space at work, would feel a compulsion to check the car windows and doors repeatedly. Then, as he walked away from his vehicle, he was plagued by a gnawing doubt that a window or door was left open. Regardless of how he tried to reassure himself that all was safe and secure,he would have to return to his car again. There were times when, despite having arrived at work early, he made himself late because of the need to repeat this ritual.

People with OCD do not find any of this to be comical. In fact, it causes them considerable emotional pain because they cannot stop what they know is absurd. Very often, they attempt to keep these rituals secret for fear of being embarrassed and humiliated. Once married, these individuals often attempt to enlist family members in performing the same rituals, such as checking windows, doors and stoves. There was one person who had an absolute need to have his wife shut the television off only when it is dialed to channel four. The thought that the television might be on any other channel, despite its being turned off, was intolerable.

Severity:

OCD is always experienced as distressing and often interferes, to one degree or another, with functioning in work and social life. However, there are degrees to which these symptoms interfere.

For instance, there are individuals whose symptoms are so very severe that they cannot leave the house. This is due to the fact that there are too many rituals that must be performed and the anxiety about leaving home can become so severe that the individual must remain at home.

I have seen examples of OCD hand washing that is so severe that the hands become reddened and severely chapped.

Then, too, obsessions can become so distracting that work performance suffers either at school or the work place.

It is also common to have this disorder associated with Major Depression and Phobias of all types.

One of the most common obsessions connected with OCD are hypochondriases. In this case, there is a chronic preoccupation with worries about health and exposure to infection and disease. I have seen many OCD patients who were unable to stop worrying that something might have caused them to develop some dread disease. In most cases they were aware that their fears were unfounded. However, in the worst cases, there can be little insight and the complete failure to dismiss these health worries.

A Common Factor:

Most of those with OCD and associated features believe they are responsible for the health and well being of others. Their obsessions contain fears that if they do not perform their rituals death or injuries can occur to loved ones.

Somewhat less common but very real in many cases of OCD is the presence of Tourette's Disorder. Tourettes is marked by constant involuntary movements, twitches, and sounds over which the individual has no control. It is estimated that some 35 to 50 percent of severe cases of OCD also have Tourettes.

Treatment:

It is important to know that, untreated, OCD can worsen so that it spreads and can become paralyzing.

Cognitive Behavioral Therapy(CBT) and Behavior Modification are usually recommended for OCD. CBT enable patient and therapist to reveal the unrealistic or automatic thoughts that increase anxiety and depression. This technique teaches the patient how to modify their thinking to become more realistic, thereby reducing the exaggerated fearful thoughts that lead to OCD. However, there are times when this is not enough. Under those circumstances, Behavior Modification is used to help a patient overcome their obsessions and compulsions. Two behavior modification techniques are "flooding" and "blocking".

Flooding is a technique whereby the therapists require the compulsive behavior be repeated by the individual over and again until they are literally sick of it. If there are several compulsions, each is treated in this way until they are all eliminated.

Blocking is a technique whereby the therapists prohibit the patient from performing the ritual behavior regardless of their desire, motivation and demand that it be done. Each compulsion is blocked until they are all eliminated.

There are many cases in which medication is combined with therapy to reduce and end the OCD. Primarily there are two categories of medications used: Anti anxiety drugs and Anti depressant drugs. Because it is believed that OCD results from a deficiency of serotonin in the brain, anti depressants such as SSRI's are used to boost serotonin brain levels and relieve the symptoms. Examples of these medications are Prozac, Zoloft and similar drugs.

Tell us about your experiences with OCD.

 

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    AHHH - - Jan 2nd 2013

    I like many of you have OCD, Doubt and Anxiety. I got engaged one year ago and I couldnt be happier, well at least I thought. I started freaking out that maybe I didnt love my fiance enough and all this other horrible things. In my heart I knew I loved him so much and that he was the most amazing man in the world to me, but as I tell my therapist, my anxious mind wouldnt let me connect to my heart. I started worrying everyday and making myself so sick to my stomach and crying every single day. It was horrible. I began taking medications which has helped a lot, but I still have those days were I am just so anxious it sucks. My fiance says I like to cause drama with myself. I have so much doubt it is ridiculous. My new recent obessesion is that I cheated on my fiance and I dont remember. No matter who I ask I always get the answer no! No you did nothing wrong. When I drink I notice that my anxiety and doubt are 100000 times worse. Even if I have someone there who is sober and can give me a play by play I still am afraid I did something wrong. For New Years Eve my fiance and I went out and I had this fear that the man I made out with for my New Years kiss was not in fact my fiance. (It was him)! I could never cheat on him, but I have allowed my anxiety and doubt to take over and make me think am I 100% sure that this in fact did happen? I think to myself well I am a horrible person and I dont deserve the amazing man that I have. I hate it. I hate feeling like this. I wish it would just go away. To make matters worse I am afraid I am hurting the realtionship with my fiance because I am always telling him my doubts and fears and I hate it. I am giving up drinking until I can get my anxiety under control. Even though I remember what I did when I was drinking, I think its best until I can get my dount away to do this. I just want to feel better.HOW CAN i MAKE THIS GO AWAY AND STOP DOUBTING MYSELF!? I am 23 and dont want my whole life to be doubted.

    I strongly suspect i have OCD - P.E.A. - Oct 27th 2012

    I"m in my fifties now and have come to realize of the last few years that something is not right with my thought processes.  It's been part of my life since my earliest childhood memories, so i didn't realize it wasn't 'normal' to think and feel this way.

    It seems silly to say it and i've never talked about it to anyone, out of embarassment.  But i'm obsessed with forgetting things.  I constantly doubt my memory, worry that i've forgotten something important etc.  Even when watching movies, reading a book etc i get afraid that i've forgotten something important about the plot or a character in the story.  Or that i will forget.

    Much of the time i'm fine but i seem to go through bouts of this fear and self doubt about my memory.  A few times a day.  The rest of the time, i would say i'm perfectly normal and happy.  These bouts are almost like attacks.

    The ironic thing is, i have a very good memory.  And i know i do.  I sometimes suprise myself with the little things i recall or trivial tasks i recall i wanted to perform.  Yet in spite of this awareness, my fear of forgetting things and doubting my memory when i recall them persists.

    And making lists of important tasks i need perform is not the solution.  I already leave reminders for important things.  The things i'm afraid i've forgoten are trivial things but for some reason are of enormous importance to me, so much so i'm very afraid i have forgotten something about them, or will forget etc

    Carl's blog is here. - - Dec 25th 2010

    http://managemesystems.com/

    ocd - kirsten wood - Mar 30th 2010

    hey i have ocd. the logos on everything have to be facing me, exsample if i have a smoke the lighter has to be facing me. and the ciggs pack nothing upside down. it freaks me out. if i dont put it upside down then i dont really care too much unless i have have to use it. its worrys me to see things not the right way up! i really need some help or and addvise

    ocd and a mistake!!! - zed - Feb 27th 2010

    I have suffered from pure O mainly, with my compulsion i guess asking for re assurance if I didnt like an intrusive thought, and then i would move on... probably a mild case, yet at the initial time when i did not know what ocd was, it was very confusing, scary, and I felt there was no one else in the world goping through this....I have always tried to be "perfect" in every way, best husband, best sports person, fitness proffesional, trying to prove to myself that hey, I am a good guy with good qualities.

    I have been with my wife for nearly 20 years, i am 35 now, we have a beautiful child, she was a model and beautiful girl in every way, sound principals and nature,and were very much in love, she is always there for me, and I for her, good communication, hardly ever argued, you could say we made the best team. her boss who had a fixation on her for 7 years I later found out, at a work function got my wife very drunk ( she doesn't usually drink) and took advantage of that situation in the worst way... and she came to me pretty much straight away and told me what happened.., having everything, i now had NOTHING, I had lost my besy friend, my partner of nearly 20 years,the innocence had gone, I was no longer the only person in this world that had been with my beautiful wife. She was shattered too, didn't know how the hell, he managed to 1. get her to drink, 2. manipulate her against her will ( she was pretty much unconscious, not being a drinker) 3. go against her strong morals.

     I look at the situation as a boss, who used his position of trust (she thought he would look after her at the function being her "friend"), to manipulate an innocent person, ( i thought she should have looked outside the square at his motives, and seen what he was really doing). I realise that people can make mistakes, but I just can not get over this, I swing in my moods constantly, I have gone from a very confident person, to one that is unsure about many things, I rushed out to try and get revenge with the opposite sex, but there was just too much emotion and things didn't work to the usual standard...which almost killed me. I am constantly going over how I am going to take revenge against that arsehole who changed my family, and i am trying not to go to jail over this... it has been nearly  3 years, and my wife has mostly been there for me, except when she found out about my revenge acts ( which I hate, because I would never ever have gone and done that, I tried to be the best husband, and always knocked back advances in the past, I am a personal trainer and part time male model, and got tested quiet a lot)( I have lowered my standards and feel ashamed)

    my question is how do I move on from this when I can not get everything out of my head??? constantly now, intrusive thoughts of exagerated images that haunt me, the whoile incedent lasted seconds apparently, but in my head it is made into hours, and this and that and this etc etc causing my emotions to spiral, I hate it, I try and smile, but inside I am seething, and i just want to raise my family in peace and happiness for which I stood for, not have these years taken for good that can never be replaced.

    I have never taken anti deppresants as I didn't want to be on them, I could beat this ocd myself, and had it under control for 12 years, since this I have seen a psychologist, and I can see what i have to do, I understand it, I mean I can give advice to my  personal training clients about these matters and I do, but I just cant seem to put it into practice because of the underlying bitterness, anger, shock, sadness, disbeleif...do you know anyone who makes  time machine's?? lol....

    OCD throughout my life. - Lance Okones - Dec 17th 2009

    I began experiencing symptoms of OCD in 1986.  My job at the time was satisfying and I did very well but when the symptoms to check and over analize my work became to much I couldn't even function at it.  I was treated in the 90's and began taking LUVOX and I noticed that with the decrease in anxiety I also had a decrease in irritability.  I still have some obessive patterns in my thinking and I'm beginning to desire to correct this.  The medication has worked wonders but I want to learn how to recognize OCD thoughts and behaviors and stop acting them out.  My behaviors are relatively small I think but I would like to be rid of them.  Maybe,one day, even get off the meds.  We'll see.  It's definitely interesting to hear of people who've suffered the same things I have.  For so many years I thought was weird or crazy and alone.  Lance in Iowa

    GReat Blog...Now what is Carl's blog address? - Tanya - Apr 23rd 2009

    Hi to all. This information has helped me understand and match my symptoms and behavior. I read what Carl had to say, and found his reply interesting. He said that he too had a blog and that he was in the process of writing a book. Can someone please post the address of his blog. I would like to cure myself without medication as Carl did (although he underwent a low dose of Prozac).  Than you. I'll be checking up on this blog for the update.

    The true source of obsessions ... - Carl - Nov 15th 2008

    What a great blog!

    5 years ago I was diagnosed with 'complex OCD'.  My problem started in my late teens after I became a young father and my partner told me several times she wanted to end the relationship.  All I could think about was losing my child and I became very anxious.

    We got married and had 3 more children but due to her never 'settling' down I was constantly worried about bad things happening to the children if I weren't around.

    At age 21 I read an article in the newspaper about something happening to a young boy that I found so horrific I couldn't get the imagery out of my head and that kick-started my obsessions - as you rightly point out it just kept building from there. 

    I divorced my ex 15 years ago (did my best to stay in touch with the children until they reached adulthood) and 5 years ago went to my doctor and explained my symptoms to them.  I'd done a lot of research on healing anxiety disorders but nothing actually gave me a plan on what to 'do' - so I started to develop my own approach.

    My doctor sent me to see a psychiatrist who told me I had a complex form of OCD - he also told me I was suffering from severe depression - which I didn't know about at the time but boy did I learn about it later - and wanted to put me on a high dose of Prozac.  

    I told my psychiatrist I had a vague plan forming in my head and felt I knew what I had to do, and my condition was going to hurt more than it already was doing, but I needed to be able to study myself while I went through it and didn't want the Prozac to get in the way of my 'seeing the process'.  He agreed to support me in this and I went on a low dose of Prozac.  I also signed up with a person-centred counsellor (I asked for a Cognitive Behavioural Therapist but couldn't seem to get access to one).

    I put my plan into action and within a year had healed multiple phobias (I was terrified of pens; lampposts; street bollards; shovels etc); I eliminated 27 obsessions (I counted them as I removed them); rage attacks that emerged unexpectedly and finally that depression.  I used the same general approach for every emotion although I did have some minor techniques that worked better with one emotion than it would with another.

    Within one year I was off the Prozac and the visits to the psychiatrist were stopped.  I still have emotional issues to work on occasionally and for that reason I've maintained the relationship with the counsellor - even if I won the Lottery I'd still see her.

    I've now set up a blog (not specifically about anxiety disorders but it is about the approach I used) and I'm putting together a book.

    Here's something I discovered, and which I think may help anyone wanting to heal to focus on the 'right' place within themselves when they are ready to heal:

    anxiety disorders, of which OCD, obsessions, panic attacks and phobias are all examples, are not evidence that something has gone wrong in the brain.  In fact what's happening is the brain is doing too good a job of stopping trapped emotional energy from leaving the body and that's what the problem is.

    Those images and rituals are a desperate attempt by the brain to create doorways to release trapped emotional energy from the body.  See those images, fears and so on as doorways through which the energy must flow and let the emotion flow (and don't do the external actions) and over time you get the body emptying it's emotional reserve; trapped emotions evaporate and the 'issues' in your head disappear as a side affect.

    The source of the problem is trapped emotional energy stored in the body - the body is a battery and when it's over-charged the energies concerned fight like trapped snakes for release.  You've got to slowly let them out - too quick and you become overwhelmed; too unwillingly and they just stay trapped.

    Focus on continually going into the pain that presents itself from the body, seeing the issues in your mind as the doorways through which the pain can escape, and you can eventually cure all anxiety disorders.  

    As a side affect you also see quite a few belief systems change and develop a deeper understanding of how people work.

    The way we see the problem is key to getting the brain to allow the trapped emotions within to escape into the 'nothingness'. 

    It's all about letting a trapped emotional cycle complete its job - and you can learn to do this without doing a thing in the outside world other than set aside some personal space and take proper care of yourself.

    Regards.

    Carl

    OCD, Stephanie - Allan N Schwartz - Sep 25th 2008

    Hi Stephanie,

    Medication alone will not solve your OCD problem. You need to see a psychotherapist trained in the use of Cognitivie-Behavioral Therapy (CBT). Only the combination of both works. I would suggest a Clinical Psychologist who is trained in and uses CBT.

    Let me assure you that you have a common form of OCD despite the fact that you do not think so.

    Dr. Schwartz

    OCD - Stephanie - Sep 25th 2008

    I have always been a happy, fun, determined person. However, recently I was diagnosed with OCD which was extremely diffiut to accept and understand. I deal with a type of OCD that I am not sure too many face. I constantly worry that my husband will cheat on me. Once my husband and I met with a councelor and discussed what was going on he quickly remarked, " you have a severe case of OCD." two points added to my self esteem....j/k. I have met with many other doctors who all say the same thing so here I am.  Crrently I am on medication, which I have just recently started and have truly not seen or felt any difference.

    Before I was actually "diagnsed" I would constantly check his things and accuse him until his was blue in the face. My mind would send me an insurmountable amount of irrational thoughts and literally the effect was paralyzing. My husband is so supportive but many times I have brought him to tears which kills me. When I say I would check and accuse him it wasn't a once-a-day ritual, it was constantly uncontrollable. I feel like a monster putting him through this because  truly I know that he would never do anything to hurt me, but honestly my mind refuses to let me think so. He is the most loving loyal husband anyone could ask or and he constantly is having to reassure me that those thoughts are irrational. We are a team but I worry that this disease I have is going to end our marriage sooner or later.

     I mostly have bad days and I truly want to change but it is almost impossible. I am so incredibly frustrated with these crazy thoughts that I obsess until I'm sick to my stomach. I not only have worries about infidelity but other random thoughts pop in as well. I feel like I'm not who I usd to be. My confidence has dropped dramatically and life really doesn't have the spark it once had. I am not interested in  many of the fun activities and hobbies I once was. My OCD literally sucks everything out of me....if you have any suggestions as to how to better cope with my type of OCD it would be greatly appreciated. THank you :)

     

    --Stephanie

    Recently Diagnosed With OCD - Laura - Apr 12th 2008

    Let me tell you, it was no surprise that my psychiatrist diagnosed me with OCD recently. Yet, still, it made me feel awful.

    Although most of my life was quite normal and happy, slowly and slowly I became and obsessive-compulsive. I really think this all swirled into action after I became a mother. Yeah, sure, kids are great. But there's a lot of crap, barph, cuts, laundry and other things that ONLY MOM is expected to clean up.

    Sometimes, I wonder whatever happened to the worry-free, chemially balanced, happy me. In many ways, I am/was a well-rounded person. Creative, intelligent, together, and simple. I love dancing, reading, writing and drawing. Baking cookies, or anything delicious is also one of my favorite things to do.

    OCD has turned me into a regimented, counting, doubtful, repetitive, paranoid, mean, anxious, frustrated, sensitive, crybaby of a person. This leaves me no time or energy to do what I love to do. No time to enjoy the precious moments of my life...that are ticking away...while I wash my hands over and over and over and over and over....or shower for ten minutes, twenty minutes, thirty minutes, forty minutes, fifty minutes......

    With kids, all that happens three time a day. That's alot of time, water, and my energy. Sometimes, I feel so washed-up..inside...and out.

    I am glad to see more articles about OCD. It can happen to anyone. Educated or not. Successful or not.

    But let me tell you, I wouldn't wish it for my own enemy,

    Laura

    PS Serotonin is a key hormone that people with OCD need. I just wish there was candy injected with Serotonin so I will be able to take my medication. I am so lousey with that. Now, if I don't take my medicine regularly, I may really mess myself up. And, I don't want to do that cause things are already messed up.

    PPS I would never EVER let OCD get the best of me. I will fight it till my last breath. I will also write a book about my experiences to let people with OCD know that they are sane individuals who somehow got a shortage of serotonin along their life of giving and giving to others. It is a mind game that we have to win. Not a disease. If you are doubtful that something is contaminated, then leave it. Surely if you knew it was unclean, knowing your  OCD-self, you would stop at nothing to clean it up. Just give yourself the benefit of the doubt. Simplify life.

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