I have treated OCD for over 20 years, and for the last 10, more than 80% of all the clients (a term I prefer to "patients") have had a primary presenting diagnosis of OCD. Clients with OCD that I have treated over the decades probably number over a thousand, and I have probably clocked over twenty thousand therapy hours treating the disorder. As a result, I have a lot to share about OCD and its treatment, and am excited about the opportunity to do so with you through this venue.
As I write my first blog entry for Psychology Today, I find that there are several regularly scheduled TV shows that focus on the psychiatric disorder we call OCD. Several major motion pictures have featured the disorder ("The Aviator" starring Leonardo DiCaprio and "As Good As It Gets" starring Jack Nicholson, to name two), as well as multiple independent films ("OC87" is one of the more recent productions). There are several other films presently in some phase of production ("Machine Man" stands out as looking particularly promising, but there are many others), and of course there are many, many books that have been authored on the subject, both those geared towards consumers as well as those written specifically for the professionals who treat the disorder. Rarely a week goes by where there is not an OCD-focused interview on a nationally broadcast radio station, or an OCD-focused article in a national magazine, not to mention the many local stations and local newspapers that feature the disorder in their stories.
Even more notable is the entrance of the disorder into our casual conversations. While horribly misused, the expression, "Don't be so OCD!" is often heard in verbal interchanges, most commonly among adolescents (and I can verify this from the reports provided to me by the two teenagers who live in my home). Unlike bipolar disorder, depression, schizophrenia, and most of the other psychiatric diagnoses defined in the DSM IV, OCD seems to illicit a strange fascination, a curiosity, and, ironically, an almost obsessive pre-occupation by the general population and the popular media.
I propose the clinical question– "What's up with that?"
I think there is a pretty clear answer. Obsessive-compulsive disorder is relatively simple and easy to describe in clinical terms, but it is extremely difficult to fully understand. Once
presented with information about this psychiatric disorder, many are left with the questions, "Okay, I get what happens, but how can that be?"
"How does that make sense?"
"Why are people thinking and doing those crazy things?"
"How can a person who seems completely normal and competent in so many areas of his or her life waste so much time engaged in the most ridiculous, nonsensical behaviors?"
"How can it be possible that someone who is a successful marriage partner, parent, professional, or all three, is unable to touch something that everyone else has no problem touching?"
"Why would someone with a higher than average IQ find the need to read the same passage in a book over and over again?"
"How can it be that someone who never acted out aggressively, and has a good relationship with her mother, finds that she dare not go into the kitchen because there are knives there, and she fears that she might impulsively grab a knife and attack her mother?"
"How can someone who can quickly and decisively research and purchase a car or giant flat-screen TV spend hours struggling with the question of which pair of socks is the one that is ‘just right' to wear that day?"
People with apparently excellent and sound judgment, people who are responsible, decisive, and spontaneous in most aspects of their lives, will often become completely unable to demonstrate these qualities and strengths when faced with the most mundane of tasks and activities. It does not logically follow. It is counter-intuitive. It is a contradiction.
It is these contradictions in OCD that first drew me into working with this disorder. People diagnosed with OCD can be completely lucid but can appear completely psychotic. Their thought processes about the rituals that they need to perform sound outrageously foreign to
most people yet at the same time, somehow hauntingly familiar. Rarely do I tell someone what specialty area I practice in without a resulting comment about an in-law or sibling who could use my services.
And here is where the fascination lies. For those of us who don't have OCD, we still see ourselves in the very disorder that we also find incomprehensible. It doesn't make sense to us, but yet we can relate to the experience, and can empathize with those who suffer with the disorder.
My intention with this blog is to help clarify the mystery of OCD, to those that have it, to those that live, love, and or work with those that have it, to those that clinically treat those that have it, and to the general population who want to better understand it. Because so much is already written about the disorder, I will try to focus on the more subtle aspects of OCD and its treatment, so as to make it worth your time to pay me a visit here. I look forward to the challenge.
–Allen H. Weg, EdD