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Bruno

Obsessive-Compulsive Disorder

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Dr. Rosman,

As far as I know, people who have Obsessive-Compulsive disorder (OCD) have intrusive thoughts that only go away when certain rituals are performed (like washing hands, counting odd numbers, etc.). Even if a person knows that the thoughts and the rituals are completely irrational, one cannot stop them.

Is OCD of biological origin? If yes, how can it be treated? If not, can a proper philosophy help?

Thanks in advance.

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Dr. Rosman,

As far as I know, people who have Obsessive-Compulsive disorder (OCD) have intrusive thoughts that only go away when certain rituals are performed (like washing hands, counting odd numbers, etc.). Even if a person knows that the thoughts and the rituals are completely irrational, one cannot stop them.

Is OCD of biological origin? If yes, how can it be treated? If not, can a proper philosophy help?

Thanks in advance.

Dear Bruno,

Obsessive-Compulsive Disorder is a non-psychotic disorder, characterized by one or both of two key sets of symptoms: obsessive thoughts, which are unwanted, intrusive thoughts that seem to pop themselves into one's head (for example, the thought that one is going to become an axe murderer); or else, compulsive rituals, which are ritualistic behaviors that are repeated over and over, in order to relieve anxiety. The obsessive thoughts do not necessarily go away by performing the rituals; but if the person does not perform the rituals, they feel tremendous anxiety. The person ALWAYS knows that the thoughts and rituals are irrational. This is what distinguishes OCD from a psychosis.

OCD is classified currently as one of the anxiety disorders, although there is some recent thinking that it may be a little different in nature. I think that there is mounting evidence that the anxiety disorders as a whole have some biological basis to them, in the sense that some people are more susceptible than others to experiencing particular expressions or forms of anxiety, given the same biological triggers (for example, injecting sodium lactate into some people will trigger panic, whereas in others, it will not).

The two key treatments for OCD are medications plus cognitive-behavioral therapy. In my experience, it is EXTREMELY hard for someone with moderate or severe OCD to get better without the help of medications to ameliorate their anxiety and symptoms.

A correct philosophy can always help someone. In the case of OCD, it is not so simple, however, because people with this condition already know that their symptoms are irrational. They just can't seem to shake them, despite their lives being crippled. Applying the proper philosophy in this case is not a matter of convincing them that they should not give in to their symptoms. Applying the proper philosophy involves helping them to shift their mental focus from obsessive thinking to productive action, or from compulsive action to non-compulsive action. This can be very hard to do.

A great real-life example of OCD was portrayed in the movie The Aviator.

Jonathan Rosman

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I used to suffer from what one doctor called "generalized anxiety" and what many would call OCD. I had severe hypochondria and used to engage in a number of rituals (the rationality of which varied) to prevent [often unspecified] "germs" from "getting on me." This could be as mild as refusing to touch door handles with my bare hands, to moderate examples like overusing antibacterial lotion, to extreme problems like obsessing during waking hours over bizarre scenarios in which I might have contracted some fatal (or permanent but non-life-threatening) illness through casual contact with othe people and objects.

I knew, even as it was explained to me, that my fears were irrational, and I knew the explanations were themselves perfectly reasonable. This did not change anything about how I used to obsess and worry and be afraid.

One day... it went away. I made a conscious decision to touch a doorhandle with my bare hand -- and I went from there. I attribute my release from hypochondria and related obsessions to training in the martial arts, to becoming more confident and more assertive. I honestly do not know to what else I could attribute the abrupt cessation of my obsessions. Is there some precedent for this type of "cure?" Does my experience stop short of actual OCD?

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I used to suffer from what one doctor called "generalized anxiety" and what many would call OCD.  I had severe hypochondria and used to engage in a number of rituals (the rationality of which varied) to prevent [often unspecified] "germs" from "getting on me."  This could be as mild as refusing to touch door handles with my bare hands, to moderate examples like overusing antibacterial lotion, to extreme problems like obsessing during waking hours over bizarre scenarios in which I might have contracted some fatal (or permanent but non-life-threatening) illness through casual contact with othe people and objects.

I knew, even as it was explained to me, that my fears were irrational, and I knew the explanations were themselves perfectly reasonable.  This did not change anything about how I used to obsess and worry and be afraid.

One day... it went away.  I made a conscious decision to touch a doorhandle with my bare hand -- and I went from there.  I attribute my release from hypochondria and related obsessions to training in the martial arts, to becoming more confident and more assertive.  I honestly do not know to what else I could attribute the abrupt cessation of my obsessions.  Is there some precedent for this type of "cure?"  Does my experience stop short of actual OCD?

Dear Phil,

Good for you! The symptoms you describe are very typical of OCD. However, your decision to touch a door handle was obviously not made in a vacuum, without a lot of preparation. It sounds like you worked very hard to increase your self-esteem, and the way in which you did that, by the use of martial arts, would have been very helpful, because it focuses on body action and movement, which are necessary elements to get out of the mental mode of obsessive rumination. You also confronted your contamination fears, which is a necessary behavioral step to take. Would you agree that you would not have been able to overcome your germ phobia without first working on your self-confidence?

Jonathan Rosman

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I did not consider it in those terms before, but yes, I think I would have to agree.

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