OCD: Obsessive Type and Scrupulosity

A few years ago I had the privilege of speaking to an expert in Obsessive Compulsive Disorder. I was informed that there are sub-types of OCD that the Diagnostic Manual did not address at the time. The two types that really stuck out to me were the "Obsessive Type" and "Scrupulosity."

In order to understand either, let's talk briefly about OCD. OCD is an anxiety disorder that has a few distinct symptoms: anxiousness (emotional, cognitive, and physical); and compulsion (can include rituals, outward and inward behaviors to decrease the anxiousness). There must be both of these symptoms in order to have a diagnosis. Anxiety is obsessive and continuous worry that has little or no foundation or reason to it (i.e. stressing over finances because you're broke does not count). It is worrying about things that may not be true or rational. However, to the person with OCD, it feels real in every sense and evidence is often sought to support the obsessive thoughts and worries. When the anxiousness increases, the individual can get stuck in an anxious thinking loop; then, the desire to decrease the anxiety begins and the individual engages in compulsive behaviors. We have all heard of the obsessive hand-washing, counting, touching objects, etc. compulsions; however, with the other two types, the compulsions may be different. The "Obsessive Type" is when the anxious thinking is tied to the compulsion. The individual gets stuck in a "thought loop" where they feel compelled to continue thinking about the anxious thoughts in order to control them or to change them--or perhaps to come to a new conclusion. The thoughts feed on themselves and the compulsion to think more and to analyze more feeds anxiousness. It results in heightened anxiety and can even lead to depression.

Scrupulosity is an interesting type as it can be a part of perfectionistic patterns of behavior and to spiritual and/or religious beliefs. For example, an individual can believe that if they do not pray enough or long enough or a specific amount of time, then God will smite them or harm someone else or will not bless them. This can lead to trying to live "perfectly" without flaw or fault, which ultimately can lead to disappointment, depression, and disillusionment with beliefs of who God is.

Now, the main issue is how to deal with OCD in all of its complexities. First off, if you struggle with it, remember that it is a diagnosis and not a label. It's interesting how people will say "I'm OCD" as if it is a name or an identifying feature. Typically speaking, obsessive thinking and compulsions actually have more to do with biological processes in the brain than the person or their personality. Secondly, when an individual is engaging in the obsessive and compulsive thinking and behaviors, it means that the brain is "stuck" in the loop and needs to be redirected. The expert I spoke to indicated that the brain can only focus on one thing at a time. Therefore, focusing on something else (such as reciting a long poem from memory) will pull the brain out of the loop. This may need to be done more than once, and that's okay! After the individual is out of the loop, then they can begin to think rationally through the process that has just occurred. Cognitive Behavioral Therapy can be a big help at this point, as well. OCD requires management and maintenance. The goal of treatment is to decrease the symptoms over time, but this requires consistent work on the individual.

If any of my three readers are interested in more information, feel free to leave a comment.

Jamison Law

The Psychology of Brer Rabbit: Psychological Resiliency

I know for all four of my readers out there, it is obvious that I have an affinity for many things, Disney. Much of that has to do with its capacity to remind me of childhood, and for the positive memories I have with family and friends. I grew up watching old Disney cartoons on Sunday evenings with my siblings. They were good times and I remember them fondly and hope to give my children similar memories. Today, I was reviewing the old movie, "Songs of the South" made by Disney. It has been years since it was shown on TV. Despite the reasons for its discontinuation, I find the story of Brer Rabbit to be helpful. You have the main character, Brer Rabbit who was born and bred in a briar patch. When he got to the point where he didn't like it anymore, he left his home and went off to explore the world for himself. He eventually finds himself caught in the middle of a "Tar Baby," or a trap set for him by Brer Fox and Brer Bear. Brer Fox hopes to make a quick meal of him and Brer Bear wants to "knock his head clean off." Though it appears that he is about to meet a gruesome ending, Brer Rabbit convinces the Fox to throw him back into the briar patch where he was born. Though it is a harsh environment, he is familiar with it and able to handle it. We can look at this in a metaphorical sense. Many people are born into situations that may not be exactly optimal. Life gave them their own "briar patch" to be raised in. However, research demonstrates that life's difficulties can result in a type of psychological hardiness that would not be present if the person had not been otherwise exposed to hardships. That is not meant to say that some difficulties are harder than others, because they are. Simply put, many of life's challenges can become the stepping stones by which we can survive later difficulties. If you buy into Victor Frankl's ideas in "Man's Search for Meaning," he said that it does not matter what we ask of life, but rather what life asks of us. At times, life gives us things that are challenging as if to ask us "what are you going to do with that, now?" We can use our prior experiences, whether they were easy or difficult to work through our own personal "Tar Babies." Therefore, when in difficult situations, it can be beneficial to think through prior struggles and come up with a plan with reasonable steps to work through it. And, if there are no steps, then leave it alone and see if things will resolve themselves. Of course, if you don't know the answer, that's when you turn to others such as family, a friend, a counselor, and/or your spiritual beliefs to work through them. Dr Law