Obsessive Compulsive Disorder (OCD) is a painful, debilitating and embarrassing psychological condition. Howard Hughes is a famous sufferer of OCD, and because he had the means to indulge his compulsive habits, they grew in strength, expanded in scope to an extreme degree and turned his life into a living hell.
Some of Hughes's compulsions included calling for flight information 33 times after getting the correct information the first time (he needed a multiple of three); for fear of germs he used special china for certain unseemly friends only once before being destroyed. These OCD symptoms grew to the point where at the end of his life he lived in an apartment designed to eliminate germs, with blackout curtains (because he thought the sun could transmit germs) and assistants bringing his precisely measured food with gloves and tissues covering their faces.
But Hughes is not the only one to suffer these symptoms. It is estimated that about one person in forty has had to deal with this condition to varying degrees. Unlike depression or anxiety, because it seems so strange to the person suffering from it, it is likely to be kept a secret. And secrets are like Petri dishes for psychological troubles.
If you have an urge to count, to wash your hands continually, to constantly check to see that the stove is off or the door is locked; if you feel compelled to do certain rituals in order to fend off some imagined disaster; if you feel an intense pull to think some thought or perform some ritual, to the point where it can be unbearable not to do it and it is hindering your ability to function well, there is something that you can do to overcome that.
There was no treatment for OCD in Hughes's time. There are medications that are used to treat it today but, as I talked about in Psychiatry's Hammer, there are good reasons to be very cautious about using such medications and they are not a cure; they just temporarily relieve the symptoms.
Fortunately, psychology is not just about medication. Jeffrey Schwartz of UCLA School of Medicine, and author of Brain Lock, has done some fantastic work on a cognitive behavioral approach to treating OCD and what he's found is that those suffering OCD do indeed have a difference in their brain – specifically, an overactivity in the orbital frontal cortex and a problem with the caudate nucleus.
But it is fascinating and hopeful that through the use of mindful awareness people with OCD have been able to learn to change their brain, allowing them to focus their attention on things that are adaptive and functional, rather than the disturbing obsessions and compulsions that they are drawn to perform as symptoms of this condition.
If you or somebody you know suffers from OCD, I encourage you to read Brain Lock and get the kind of help you need to overcome it. The more you indulge these habits, the stronger they become. The more you counter them with some of the actions I will outline below, the more you train your brain away from them, the weaker they become and the more free you will be from the tyranny of these symptoms.
(If it's appropriate for you, I am available to help you through this process as a coach, which is a very different relationship than as a therapist (see A Market Alternative to Psychotherapy). The process I am describing in this article is something that can be self-administered but it can be very helpful to have somebody in your corner, helping you to stay on track.)
The first distinction to make is between the form and the content of your OCD behavior. The content can be as different as driving home from work in the middle of the day to check that the water isn't running to feeling that you have to perform some ritual such as turning around three times or else something very bad will happen.
But the form that each of these takes is a feeling of worry that intrudes on your mind repeatedly, and that worry is fueled by a hyperactive orbital frontal cortex.
In other words, all the time you spend trying to figure out why you are so obsessed with washing your hands – was there some trauma that made you feel "dirty" – is completely irrelevant. It's like hitting yourself in the head with a mallet, and trying to figure out why this particular brand of mallet is so important to you. It's beside the point; the point is to stop hitting yourself in the head… with that mallet, or with anything else!
This is not magic (and neither are the rituals). It takes concentrated, focused work over time. You are changing your brain with your conscious mind, and that takes willpower and perseverance. That's one reason why it's good to have help with it, to keep you on track.
That said, here are Schwartz's four steps to overcoming OCD (from Brain Lock):
1. Re-label: Call your obsessive thought or compulsive urge what it is: an obsessive thought or a compulsive urge. That thought or urge is caused by the overactivity in your orbital frontal cortex. The problem isn't that you feel that your hands are dirty or have to count to three or something bad will happen; the problem is that your brain is sending you false messages, and the feelings from those messages are not legitimate.
Don't try to stop the thoughts or urges; that can be the worst thing to do because doing so intensifies them so that they become overwhelming. What matters is that you control your responses to the thoughts and urges; that you resist them. Just as you can have a feeling and not act on it, you can feel the obsessive/compulsive thoughts and urges and not act on them.
2. Re-attribute: These urges and thoughts come from a biochemical process in your brain. They do not come from a need to "get the feeling right," or because there is any actual connection between performing a ritual and avoiding some horrible event.
Saying something like, "This is not me; it's my OCD," clarifies this mistaken idea, attributing the urges and thoughts to their actual cause – inaccurate messages in your brain. Understanding this and reminding yourself of it can help you to have the perspective you need to resist the thoughts and urges.
3. Re-focus: This is the hard work part. In this step you actively redirect your attention to something other than your OCD urges and thoughts.
The feelings will continue to bother you for a time, but in the meantime you consciously, manually, deliberately refocus your attention, and do not respond to the compulsive behavior or obsessive thought – preferably for about 15 minutes but a shorter time to begin with is fine. While you actively avoid the behavior, you also shift to doing a different behavior that is somewhat enjoyable and engaging. After the 15 minutes has passed, revisit the urge and see if there's been any change in intensity. Write down any change that you notice; it will give you motivation to keep at it.
The main thing is that you don't do what your OCD is telling you to do. You will not achieve this perfectly; you will have many instances of going off-track. That's normal and human. Just accept this and keep at it over time – probably several months.
4. Revalue: Having practiced the first three steps, the OCD thoughts and urges will become less and less compelling to the point where you will find that they are not worth listening to. You stop accepting the necessity of acting on those thoughts and urges, and you stop being ruled by them.
This is just a brief summary of the process, but it may be enough for you to start working with your obsessive thoughts and compulsive urges. It is well worth the hard work that it takes to do this, especially if you consider the time and energy you spend complying with the feelings of the obsessive thoughts and compulsive behaviors.
The strength that you will gain from practicing these new habits will serve you well beyond the psychological freedom that you gain; you will have learned how to change your brain with your mind.