by Sarah ChanaRadcliffe.
m.Ed.,C.Psych.Assoc.

Each of us can be a bit obsessive at times. Certainly it’s common to think about things over and over again. For example, someone in the middle of purchasing a new house may not be able to get the matter out of his mind for days on end. He’s thinking about every detail, even when he’s at work and even in his dreams! He’s temporarily out of balance, his mind seemingly taken over by this major life event — he’s “obsessed.”

And who isn’t obsessed with the well-being of their newborn infant? It’s certainly normal to check many times a night whether the little one is still breathing, at least for a few weeks after birth. Some people continue to check on the breathing of their family members for years — a little quirky, perhaps, but still “normal.”

Another common obsession is checking several times to see if the door is really locked and the stove is really off before leaving the house or retiring for the evening. As long as this involves only one extra look (“just to be sure”), there is probably no reason for concern.

And of course there are some people who are “obsessive” about the cleanliness of their homes — and this is always pathological. (Just kidding!)

As can be seen from the above examples, obsessions are anxious thoughts. “Have I got all the numbers right on this deal?” “Is my baby alive and well?” “Did I remember to lock the door or did I leave it open to robbers?” A person experiencing these kinds of thoughts feels uncomfortable, unsettled. She wants to return to a calmer state.

Certain actions will relieve the anxiety. Adding the numbers again provides reassurance. Going to check the baby restores peace of mind. Making one more trip to the door or stove puts the mind at rest, and so on. Behaviors that calm obsessive thoughts are called “compulsions”; they are specific actions taken to make the anxiety go away.

Abnormal Obsessions and Compulsions

There are times when obsessive and compulsive behaviors move from the “normal” realm to the “abnormal” realm. This may appear as a gradual process. At first, for example, Judy realizes that the doorknobs in public washrooms probably have people’s germs on them. She elects to be cautious and open doors with a tissue rather than with her bare hand. If her anxiety remains at this, she will not have a diagnosable illness. When our obsessions and compulsions don’t cause us significant distress and don’t interfere with our school or work or our relationships, they are on the normal continuum.

However, suppose that after a while Judy decides that a tissue isn’t “strong” enough to block the passage of bacteria. She begins to carefully wash her hands whenever she comes home. Soon she is buying special soap for the purpose, and eventually she acquires a scrub brush, which she uses for increasingly long periods of time. Now she spends twenty minutes or more washing her hands every time she returns home from a public outing. Soon she washes her hands scrupulously even if she only passed a public washroom and didn’t actually use it. Eventually other anxieties (obsessions) and calming routines (compulsions) occur as well.

Several years into this kind of behavior, Judy’s life has become very constricted, with obsessions and compulsions taking up a good part of her day, interfering with her work and her relationships. Her condition is called Obsessive-Compulsive Disorder (OCD).

This diagnosis is applicable when a person’s life is disrupted by obsessions and compulsions. The person suffers from recurring, persistent thoughts or images that intrude into his awareness, causing distress. Such thoughts just won’t go away. In order to find relief from the anxiety they cause, the person develops calming routines such as checking repeatedly, hand-washing, changing clothing, or counting and recounting.

Unfortunately, the compulsions only provide very temporary relief, and eventually they become ineffective. In order to increase their effectiveness, more time may be spent on these compulsions, or they may need to be performed under special rules and conditions. At some point, normal living is interrupted, with the person spending more and more time quelling anxiety.

Obsessive-Compulsive Disorder is a biological illness. It exists within the Orthodox community as well as in the community at large. It is a disorder that is reported more often among the upper classes of society and in those of higher intelligence. Symptoms can start in childhood, but they tend to intensify in adolescence and early adulthood. They wax and wane, and they are more pronounced during periods of stress. Untreated, the condition is chronic. It will not go away, and it can become debilitating as it worsens with time.

There are excellent treatments available for OCD. When successfully treated, a person with OCD can have a significant reduction in symptoms and can lead a normal, functional, happy life.

Unfortunately, failure to avail oneself of treatment can result in complete dysfunction and the inability to have a normal life. Marriages in which there is an untreated partner with OCD frequently end in divorce or endure ongoing intense pain. In addition to these unpleasant realities, OCD often coexists with a particularly lethal form of depression, one that results in the highest suicide rate of all mental illnesses.

OCD is not an attitude problem or an emotional problem. It cannot be corrected by psychotherapy (talking therapy) or advice from a rabbi. It is a physical problem that responds well to a combined approach of medication and cognitive-behavioral therapy. It is most often treated in mental health settings such as hospitals and treatment centers, where specialized programs are available. Although people who have had successful treatment are sometimes able to stop their medication, others will have to continue a protocol for the rest of their life. This is similar to those who must take heart medicine in order to preserve their functioning or insulin to regulate their diabetes. Those of us who wear glasses can appreciate the concept of a condition that does not improve but rather needs constant correction in order for normal functioning to occur.

What If My Child Has OCD?

The earlier we recognize and treat Obsessive-Compulsive Disorder, the better. If you see that your child has some of the kinds of behaviors described above, take him to a competent psychologist or psychiatrist for a proper assessment. It is essential to use a professional who has expertise in this disorder, not a general practitioner. OCD can be difficult to diagnose. You will certainly not be able to diagnose your child on your own.

The assessment may show that your child does not have OCD but has some other sort of disorder. Various conditions are closely related to, and coexistent with, Obsessive-Compulsive Disorder, including Tourette’s Syndrome, Attention Deficit Hyperactivity Disorder, and depression. It may also turn out that your child has no disorder at all, but is just a perfectionist or normally obsessive. However, it is important to find out, because failure to treat a child with true OCD is a form of parental negligence. Some people prefer not to look for problems; however, we cannot put our head in the sand while our child suffers. Just as not going to the doctor for our annual checkup does not stop us from becoming ill, not going to the psychiatrist does not prevent OCD! If a child has it, he has it, and he needs treatment. There are individuals who do not want their child to take medication for fear that his or her chance for a good shidduch will be harmed. True, nobody can tell that a person is taking medication for OCD, since there are no visible side effects. But the fact that a young man or woman has been treated for OCD is relevant when it comes to marriage and eventually must be disclosed.

This presents an interesting dilemma: If the child goes for treatment, she will be a much more suitable mate. But it is true that some parents will not consider a person with OCD as a match for their own son or daughter. And so parents can pretend their child has no problem. The child may end up with a larger field of potential shidduchim, but at what cost? What kind of husband or wife will that untreated child make? How many innocent family members will suffer?

The decision to medicate will depend on the nature and severity of the child’s condition. However, it is up to you, the parent, to address the issue and seek all the appropriate advice. Today people are becoming increasingly aware of the physical nature of many conditions that, at first glance, seem to be psychologically induced. As this awareness spreads, people are prepared to treat their children with required medications. Although we are never happy to find that our child is ill, our upset and disappointment must not stop us from helping him get effective treatment. As our knowledge increases and our fear decreases, we will be able to help all our children enjoy a life of quality.

Sarah Chana Radcliffe is a psychological associate in private practice. She is a registered member of the College of Psychologists of Ontario.