D is for Disorder

“You are so OCD!” is a fairly common phrase these days. When I hear someone use it — though I cringe a little inside — I rarely have the feeling that this is a deliberate attempt to make light of obsessive compulsive disorder (OCD). Quite the opposite; I typically get the impression that someone is trying to relate to someone struggling with OCD.      

I think some of the confusion has to do with the terms themselves. Obsessive refers to a personality trait describing someone who thinks and worries a lot. Compulsive is also a personality trait, indicating someone who is hyper-organized, detail-oriented, and a perfectionist. In other words, what I think people really intend to say is, “You are being obsessive” or “You are being compulsive.”       

Why be so picky about the D? When we add the D — or disorder — to the end of a personality trait (obsessive, compulsive) or mood state (anxiety) it is meant to indicate something very important: intensity and impairment.

For many, OCD is a time consuming, debilitating disorder resulting in lost jobs, relationships and important life opportunities. When it comes to trying to understand OCD or relate to it in some way, people make the mistake of looking only at the compulsions (I’ve checked my locks several times before, too. What’s the big deal?) However, to focus on compulsions is to miss the real story.

Imagine a time in your life where you felt intense, excruciating anxiety, thoughts and feelings swirling around your head about maybe getting sick, losing a loved one, or worrying about your own personal safety. We all have bouts of this type of anxiety from time to time. Now imagine that you couldn’t turn it off.

To truly understand why someone with OCD does what they do, you have to connect with that part of you that experienced a feeling so intense that you would be willing to do just about anything to get rid of it. Then you will begin to understand what it might be like to have OCD.    

Let’s look at another D for a moment. Body Dysmorphic Disorder (or BDD) is a preoccupation with a perceived imperfection or flaw in appearance, in other words, feeling ugly or unattractive. When you read this, however, you might be thinking the same things as with OCD. Who hasn’t felt this at sometime in their life? An outbreak of acne, adding on some extra pounds, realizing that your hairline is receding, we’ve all been there in one way or another. However, this is not the experience of a person with BDD—their brains can’t get off the thought that they are defective in some fundamental, critical way. BDD is all consuming. Estimates are that one in four individuals with BDD obtains cosmetic surgery or dental procedures. Suicide rates for individuals with BDD are approximately 45 times higher than in the general population. This isn’t about having a bad hair day.

This brings me to Denis Asselin. His son Nathaniel struggled with BDD for 13 years…then ended his life last spring. He was only 24 years old. He sought treatment, had a supportive family, a job, he was healthy. Did he commit suicide because he thought he was unattractive? No. He took his life because his brain was unrelenting, never allowing him an escape from thoughts and feelings of being less than. It wasn’t about feeling unattractive. It was about not feeling worthwhile. For a family who loved him dearly this was devastating. How could all of their love and support not sink in? Unfortunately, Nathaniel’s inner voice was just too loud and distracting.

Now, his father, Denis, has taken to the road on a journey he’s calling Walking with Nathaniel. He has embarked on a seven week, 525-mile pilgrimage from Pennsylvania to Boston visiting Nathaniel’s birth place, work place, the school he attended, and the various treatment facilities from which Nathaniel sought help. His hope is to raise awareness and funding for OCD and BDD visibility campaigns and research along the way. Denis will arrive in Boston on June 7th, where a Rally is being held downtown with an anticipated crowd of 300 plus people who will join his family, friends and members of the International OCD Foundation to welcome Denis to Boston and celebrate his tremendous journey.        

Denis and Nathaniel are just a few faces that come to mind when I overhear someone saying, “You are so OCD!” My hope going forward is that people will begin to consider the importance of the “D”—the disorder that causes so much pain for OCD patients and their loved ones.

Dr. Jeff Szymanski is the executive director of the International OCD Foundation and one of the country’s leading experts on the complex and often misdiagnosed Obsessive Compulsive Disorder.  Szymanski holds a Ph.D. in clinical psychology and is the author of The Perfectionist’s Handbook: Take Risks, Invite Criticism, and Make the Most of Your Mistakes.

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