127
says over and over "I am going to die soon." But the tormented person
doesn't know anything about the internal struggle between good and
evil. Yet, he/she might be able to reason it out or guess at the cause
(or go for therapy). If the troubled person could grasp some of the
moral war inside, he/she might be motivated and able, using the
adult's rational mind, to resolve some of the child-like anger and, thus,
stop the obsession.
The word "compulsive" is also used to describe normal-but-unusual
behavior, such as keeping your desk or drawers very clean and
orderly, dressing meticulously, doing extremely precise work, etc.
Many of these traits are valuable and contribute to success and self-
esteem; they are not a disorder, although some become unpleasantly
compelling and a waste of time. On the other hand, obsessive-
compulsive disorders are very disruptive of living, and people are
ashamed of these habits. The most common compulsive rituals are
hand washing (2+ hours per day), counting things repeatedly,
checking (that the lights are out or the doors locked several times),
and touching (e.g. pulling one's hair or rubbing one's mouth). Any
excessive, time-consuming activity can become a serious compulsion,
such as taking an hour to brush your teeth, three hours to groom
yourself, three hours every day to clean a small apartment, or suffer
intense anxiety if everything is not kept in order. Excessive, time-
consuming obsessions may raise anxiety (thinking "a serious accident
will happen") or may reduce anxiety (praying for hours every day or
reading labels on every box and can in the house every day) by
distracting the mind from disturbing thoughts. Thus far, science
doesn't understand this disorder well, but the treatment is becoming
clearer.
Women are more inclined to be compulsive cleaners (starting
age=29 vs. men at 22). Checkers start earlier (men at 14 and women
at 21). Men are more obsessional than women. Obsessions start later
(men at 26 and women at 30). Like so many other anxiety disorders,
there seems to be a genetic factor involved. The PET scans of these
patients are different. Even more of a concern is that 35% of
obsessive-compulsive disorders are also diagnosed schizotypal
personality disorder, and when a person has both diagnoses, the
treatment success rate is rather low.
Treatment for obsessive-compulsives (and worriers): refer to Foa
and Wilson (1991) for a simple, detailed, research based, thorough
self-help plan. I'll summarize their suggestions: (1) Consider carefully
(measure!) how serious your worries, obsessive fears, and
compulsions are. (2) Use your rational thinking (and the research
findings available) to realize that your fears and rituals are totally
unrealistic, that there are better ways to handle the fears, and that
you, like thousands of other people, can overcome this problem. You
need to become determined to conquer your false beliefs; it won't be
easy; however, paradoxically, as we have already seen with certain
fears, accepting reality and not constantly "fighting against" the
obsessions and rituals are big steps.
