The dark side of OCD.

When you hear these three letters, OCD, what comes to mind? 

Perhaps you think of someone who cleans a lot, likes things a certain way, or engages in excessive hand washing. This is the OCD we generally hear about. We even see social media videos and posts that say things like, “I’m so OCD” under a picture of a super organized cupboard. The truth is if someone is saying they are “so OCD” they most likely do not have it. 

But this blog is not about the more commonly known subtypes of obsessive-compulsive disorder (OCD). Instead, it is about the ones you do not hear of, harm, sexual, and perinatal (pregnancy and postpartum). 

So what exactly is OCD? It is a mental health condition with a strong hereditary connection and possibly a serotonin chemical imbalance in the brain. Serotonin is essential for functioning.

Here is how it presents… 

*Someone with OCD has obsessions which are unwanted intrusive thoughts, urges, sensations, and/or images that come against one’s will and cause significant distress, which prompt someone to engage in compulsions.

*Compulsions are behaviors to alleviate the distress from the obsessions and generally consist of: 

1) Mental compulsions like silently saying STOP, counting or even praying when the obsessions occur; and 

2) Physical compulsions such as checking, assurance seeking, or avoiding sharp objects or driving.

Have you ever had an unusual thought and said, “Woah that was a bizarre thought and went on about your day?” Probably! “90% of people will have a ‘harm’ thought at some point in their lives.” Yet, only “2-3%” will develop OCD”. Now imagine that strange thought gets stuck on replay in your mind.  

Here are just 3 subtypes of OCD and how they may present:

Harm (aggressive/violent)

• I visualize driving my car head-on into oncoming traffic. (image)

• What if…I stab myself or someone else with this knife. (thought)

• Push that person down the elevator. (urge)

Sexual (pedophilia, incest, etc.)

• What if…I inappropriately touch a child? Did I inappropriately touch them? (thought)

• Reach out and grab that stranger's butt? (urge)

• Yell out a bad word. (urge)

Perinatal (on-set during pregnancy / postpartum period)

• What if my baby stops breathing during the night? (thought)

• I had a groinal response while changing my child’s diaper, does that mean I’m attracted to him? (sensation)

• What if I pass a germ to my child and they get sick and die? (thought)

Maybe after reading these examples, you wonder, “Yeah but how do we know if someone will or will not act on a thought or urge”? The answer is clear, if someone has an unwanted obsession and it causes them distress this is OCD. Individuals with OCD do NOT act on their obsessions.  

OCD targets what we value most in life like family. This is the reason it is so distressing! 

Let's dig into this more. Individuals with OCD are ego-dystonic.

Ego-dystonic occurs when one's thoughts, images, urges, or sensations, also known as obsessions, are unacceptable even repugnant to one’s beliefs and values. This is why they cause them significant distress and other negative emotions. These individuals have OCD.

Meanwhile, ego-syntonic occurs when one’s impulses, thoughts, and even wishes are seen as acceptable and in harmony with their beliefs and values. Therefore, no negative emotions are connected to their thoughts, urges, etc. These individuals do NOT have OCD.

OCD is treatable but first someone has to feel safe sharing what they are going through. This is why we must see these subtypes for what they are, a nightmare for the one who is experiencing them and OCD.

If you think you have OCD or know someone who does Exposure and Response Prevention therapy is the gold-standard treatment and is effective in reducing obsessions and, as a result, unwanted emotions like anxiety. If one’s symptoms are severe, it may be recommended to combine an SSRI antidepressant with therapy. Keeping in mind therapy treats the cause and antidepressants treat the symptoms. 

Meanwhile, if someone has psychosis (ego-syntonic), this is treated as a mental health emergency and they should see a doctor immediately.