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OCD: It's Not Just Washing Your Hands

Can we change the perception?

I was frustrated this week when a heard from a patient that was denied coverage for service by their insurance company for their OCD. The patient said that they were told, "Well, you are not washing your hands or checking things over and over, so it seems that you really do not have OCD."

It is statements like this that just irritate me, as the reviewers are supposed to be educated professionals who are wise to the ways of anxiety disorders and OCD. This is not always the case though, it seems, so I wanted to take this time to educate people about OCD.

Obsessions are intrusive thoughts, images, or impulses that are anxiety provoking and unwanted. Compulsions are acts (mental or physical) that are performed to neutralize an Obsession. Relief is received when the Compulsion is completed in the way that OCD feels is "Just Right." which is why it might take numerous times to do something.

The themes of OCD

Contamination: This could be a fear of something that could contaminate you, or that you might be a person who contaminates others.

Responsibility for Harm: This often leads to checking, as checking things is a way to be sure that nothing is wrong, such as a door being unlocked, which could let in someone who might attack the family and steal a dog, etc.

Notice, these first two are the ones that people often associate with OCD and therefore think that these are the only ways that OCD manifests itself. This is wrong, as there are other themes found in OCD, such as:

Symmetry/Exactness: People with OCD may be uncomfortable with things not being at 90-degree angles, or they may want to have only even numbers of things or listen to the radio on an odd value volume.

You may see this theme and think, "Oh yeah, I forgot that one, but that is totally OCD too."

OK, so how about this theme:

Unacceptable Thought OCD: People with this type of OCD may fear that they have done something horribly wrong or they will do something awful. Their thought may be along the lines of, "Was that a bump or did I just run someone over?" or, "Did I do something that will lead to someone accusing me of molesting a child?" or "If there is a knife in the room, I might use it to stab someone."

When this type of OCD occurs, there is a great deal of mental ritualizing, trying to figure things out, reviewing events over and over, or seeking reassurance constantly. Of course, there is never enough reassurance or research to do.

Another theme that I have seen a lot:

Existential OCD: This type of OCD, which is not really a theme often seen in research studies or in assessment tools, involves thinking and then thinking about the thinking, and then thinking some more about that thinking. In fact, so much time is spent thinking about things that almost nothing actually happens. These individuals are stuck in their heads and can find it hard to hold a job or even have relationships.

Finally, a theme that can be easily related to by many:

Perfectionism: Individuals with this theme in their OCD find that it is either perfect or it is a fail. Since OCD never allows one to actually see anything that they do is perfect, then failure is all there is. Therefore, OCD just punishes you constantly for failing.

No matter what the theme of OCD is, OCD can amazingly interfere in people's lives. Luckily, there are many people who do know about OCD and its many themes. Make sure that you get them to talk to your insurance reviewers and push for your treatment to get covered. OCD is not just washing hands or checking things. OCD is so much more than that.

If you have OCD, and you want to meet others with OCD, consider going to the International OCD Foundation conference at the end of July. You will meet people with all of the different types of OCD, and you might finally realize that you are not the only person who is challenged by this disorder.