By: Kasha Martin and Natalie Bunner, LCSW-BACS
Remember Alyssa*? She was our case study in Part 1 of this series who struggled with obsessional thoughts around school which led to compulsive behaviors. She has Obsessive Compulsive Disorder, or OCD. Due to the school-related stressors she experienced, Alyssa began to exhibit compulsive behaviors which included hair pulling, or trichotillomania. Today, we will explore the reality of the “C” in OCD – compulsions – what triggers them and how they may present. But, before we do, let’s have a side bar….
Trichotillomania…What is That??
Perhaps you have heard of trichotillomania before; in fact, you may have even heard of it in the context of OCD. Many people assume that it is simply a symptom of OCD. It is important to note that while hair pulling can be a compulsive behavior associated with OCD, it is not always related to OCD. Trichotillomania is a stand-alone diagnosis where the compulsion to pull one’s hair or skin is the primary expression of the disorder. Meanwhile, the compulsions seen in OCD are usually related to obsessional thinking and can included many actions one may take to assuage them.
Compulsions: Triggers and Presentation
Compulsions are repetitive actions that people with OCD have in response to an obsession. Compulsions can be physical or mental. They are rarely rational or logical in action; they are performed out of an overwhelming need to react to the anxiety induced by obsessional thoughts. We know that obsessive thinking is usually the primary trigger for compulsive behaviors. As a quick recap, the focus of obsessive thoughts may be:
- A fear of being contaminated by germs, viruses, body fluids, or chemicals
- Fear of losing control of your body, thoughts or behavior with ruminations about how our lack of control could hurt others, accidentally or on purpose
- Undesired sexual thoughts, acute or chronic, that may include thoughts, or images that are disturbing
- Moral obsessions, particularly fear of not being “holy” or ethical enough
- Preoccupation with order, design and having things occur in very specific ways
Compulsive behaviors are usually chronic and intrusive. Once the mental connection is made between the thought and action, it is extremely difficult to dissuade the behavior. Compulsive behaviors might include:
- Washing hands excessively or excessively cleaning objects to eliminate perceived contamination
- Checking things repeatedly for reassurance
- Excessive religiosity or zealotry
- Chronic counting, tapping or use of certain colors to ward off anxiety
- Rigidly following routines regardless of their effectiveness
- Hoarding behaviors from fear of loss
Ways to Manage OCD Compulsions
Now that we have identified signs and symptoms of OCD, what can we do to manage them? First, be willing to learn. With education, parents can help their children understand themselves better and build confidence in their ability to cope with OCD-related challenges. Next, use your resources. Consider what your child will need to effectively manage their symptoms and connect with those who can help you and your child. Their pediatrician, therapist, psychiatrist, school counselor are just a few people who can help you get the assistance you need to help. Remember, with the right interventions, your child can live a productive and fulfilling life. There is HOPE!
*Alyssa is a fictional character created to convey a person with OCD.