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When OCD Is a Hostage Situation

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In my everyday clinical practice as an obsessive compulsive disorder (OCD) specialist of over 20 years, I hear many personal stories of people with OCD. As I strive to get a true and deep understanding of what it is really like to have OCD, I come to realize that the OCD experience resembles a hostage situation where the captor and the captive are the same person: the person who has OCD. When the disorder has weaved its web, it takes away all freedom and it turns a free person into a hostage! But what methods does OCD use to turn a free person into a hostage of his own self and keep him in captivity?

Let us take things from the beginning. OCD is a neuropsychiatric disorder that is characterized by obsessions and compulsions. It is a chronic, incredibly cruel disorder that affects around 1 percent of the general population. It could present at any time during childhood or adulthood in both men and women with a genetic predisposition. Stressful life events (e.g., illness, death of a loved one, unemployment, pregnancy, birth of a child) can precipitate its onset in vulnerable individuals.

From what I’ve seen so far, the onset of the disorder is seldom perceived by the person as a problem in the beginning, as it sneaks its way into his life unnoticed using covered means. It is not even unusual for the person to feel safer at first. This is because the disorder has already started to whisper thoughts such as: “Be careful! You better be safe than sorry!” Needless to say, the person gradually starts to pay attention to things he never used to and takes extra precautions. He feels safer as a result. He may even start to think how careless and frivolous he has been in the past and recount all the possible risks he has potentially exposed himself to! So where is the problem? So far there doesn’t seem to be anything absurd about OCD! Wouldn’t you agree? OCD only seems to urge the person to be more careful of, so-called, real dangers. Well, it would appear so! The truth is that this isn’t what OCD really does. What it really does, is that it outsmarts its captives making them feel that it protects them from real dangers when in fact it doesn’t. So how does it do it, really?

Doubt is the key ploy that OCD employs to keep a person in captivity. Once OCD spots a potential person in a vulnerable state, it starts to poison the person with an unyielding sense of doubt, making him feel that he is in a real danger unless he does something to protect himself:“What if I didn’t turn the cooker off properly or what if I didn’t take the plug off and the iron catches fire? What if I didn’t wash the salad thoroughly and my family gets seriously ill? What if I hit that pregnant woman unknowingly as I was going past her and harmed her unborn child? what if…? what if…?”

These are all common thoughts (or obsessions) of OCD captives who are tortured by this unremitting sense of doubt with regards to their own safety and the safety of others. The only way to get rid of this sense of doubt and imminent danger is to give into OCD and do as it dictates (for instance, keep checking the cooker is turned off properly or the plug is off, keep washing the salad until it feels OK, go back and check the pregnant woman is OK, etc.), or else the risks seem real and definite. But how does OCD manage to make its captive lose his perspective on real danger?

Once OCD sneaks its way into his life, it starts to undermine its captive’s confidence with regards to his judgment of danger. The captive no longer feels certain as to what a real danger is, so he begins to doubt his own judgment. And with the lack of certainty that characterizes our everyday experience about almost anything (How can one be 100 percent certain he has washed the salad properly?), it is really very straightforward for OCD to argue its case.

So that’s it — the person has been caught in its web. If he cannot be 100 percent certain he better do what OCD says. There doesn’t seem to be a surer option and certainty is what someone who has OCD desperately needs. Hence he takes extra safety measures, avoids potentially dangerous situations and does all these (un-)necessary rituals and compulsions according to OCD’s strict rules. It is only then that he can feel safe and secure.

But wait a minute! OCD gives him good advice about what to do to feel safe! Priceless, wouldn’t you think? Wrong! Unfortunately, the next moment when the person feels a torturing sense of doubt and an impending fear of danger is never far away, setting the vicious wheel of OCD back in motion. The die is cast! The person is now a hostage of his own self. There is no easy way out. The more he gives into OCD, the deeper the sense of doubt and insecurity; the more the safety measures, the avoidance and the compulsions become. OCD weaves its web around its captive slowly and steadily. Its domination on the person is becoming pervasive. That sense of safety is not only short-lived, but it comes at a steep price.

The good news is that, Exposure and Response Prevention, or ERP in short, is a psychological method that is particularly effective in treating people with OCD. Its effectiveness lies in the fact that it enables the person to unmask OCD and reveal its true face. It consists of two equally important parts. The first part is therapist-assisted gradual exposure to all avoided situations. The person gradually starts to expose himself to all previously avoided situations without the use of any safety measures. The second part is response prevention. During exposure, the person learns to resist giving into the compulsions and the rituals that OCD dictates, in other words he prevents all OCD responses.

This is arguably a rather difficult method as the amount of anxiety and distress that the person has to tolerate during ERP is usually very high. But should he manage to endure what it takes and meet us at the other side, the benefits he is going to reap are worth every bit of effort. He can get his freedom and his life back! And this is a price worth paying, wouldn’t you agree?

Originally published: September 16, 2016
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