Whether or not you remember it, there is a time in childhood when compulsive behavior is pretty normal. It’s usually in the early elementary years (about 7 or 8 years of age), when “step on a crack, you’ll break your mother’s back” actually seemed believable. This is the era of magical thinking, and since children at this age become anxious at the unwanted thought of harm to their mothers, they scrupulously avoid stepping on cracks.
Although most of us outgrow this fairly quickly, it illustrates how a compulsive act is used to ward off anxiety. If the child (or OCD-afflicted adult) does some “right” action, there is a relief of psychological tension, even if only briefly. If the action isn’t done, or done in a specific way, the tension grows to an intolerable level. The person “must” do it a certain way in order to reduce the anxiety within.
For most people with OCD, it’s not cracks in the sidewalk they feel compelled to watch for. It is usually “checking behavior” (repeatedly making sure the stove is off or a child is in his bed), “patterning” (walking through a door a certain way, tapping out a sequence with certain fingers), or some other ritual or series of rituals. The need to do these things seems irresistible, and they may so dominate a person’s day that normal living becomes impossible.
Obsessions are part of the mix, but tend to be invisible to others. We’ve all had a song that gets stuck in our mind, or a thought that persists for awhile, but a person suffering from OCD may find intrusive thoughts or ideas to be so tormenting as to make life miserable. There seems no escape from these unwanted thoughts.
OCD is treatable by a mix of psychotherapy and medication. Drugs of the “selective serotonin reuptake inhibitor” class (SSRI’s) usually provide some degree of relief. Psychotherapy then helps the person take greater control over the thoughts and compulsions by: 1) understanding their function, and sometimes identifying the triggers that set up the anxiety in the first place; and 2) encouraging greater tolerance for the anxiety without resorting to the magical actions, through relaxation techniques, hypnosis, flooding,etc. Insight-oriented therapy is generally not an effective method of help.