Obsessive Compulsive Disorder: Six vignettes

Many of my clients ask questions about Obsessive Compulsive Disorder (OCD),  so I thought it would be valuable to post some real-life examples of what OCD can look like.

Most psychologists didn’t receive training in how to treat OCD in graduate school

One reason might be that OCD can masquerade as Generalized Anxiety Disorder (read: anxiety), so many psychologists, including those responsible for training students, may recognize how pervasive OCD is, and the need to for effective diagnosis and treatment.

A second reason might be that many people with OCD don’t seek help because they may have confided in someone and been so negatively received that they learned to take their suffering underground.

A third reason might be that the symptoms of OCD can prevent people from seeking help. For example, you can’t attend an appointment with a psychologist, regardless of how badly you want help, if you are unable to leave your house.

A fourth reason might be that people with OCD don’t know they can get help because good information about OCD is not readily available.

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I thought, in my first blog post on this topic, that it would be helpful to first define Obsessions and Compulsions, and to then present six vignettes, drawn from real life, that begin to illustrate the range of obsessions and compulsions that people can experience.

Definition of Obsessions and Compulsions

Obsessions are defined as “recurrent and persistent thoughts, feelings, beliefs or urges that are experienced as intrusive and inappropriate and that cause marked anxiety.”

Compulsions are defined as “repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly,” to decrease anxiety.

I suspect a client may have OCD when (1) I have been treating the person for anxiety, but they haven’t improved, and (2) the person confirms they are spending more than an hour a day focused on thoughts or behaviours associated with their anxiety.

Six vignettes that illustrate what OCD can look like

I have outlined six vignettes to illustrate what the symptoms of OCD can look like before a person receives effective treatment. I have included only a partial list of obsessions or compulsions in each example, but please be aware that the number will normally be at least 30, and sometimes more than 100, in my experience.

Identifying details have been altered in the stories that follow to protect privacy.

Vignette 1: Arranging physical items

A colleague was waiting in the check-out line at a local hardware store when he noticed what he believed to be OCD-like behaviour in the cashier. He had placed all his items on the counter and the cashier had moved them, even though she was serving another customer.

Curious, he moved his items back to where he had put them originally. Again, the cashier stopped what she was doing and moved all his items back to where she had placed them the first time.

When it was my colleague’s turn to be served, he said to the cashier, “I noticed that you moved all my items from where I had put them. I’m curious. Could you not stop yourself from moving them?”

She replied, “No. I had to move them.”

He asked, “Is this a problem for you?”

She replied, “Yes. It’s an awful problem. I can’t help myself.”

My colleague told the cashier he is a psychologist and that she could receive help for this problem if she wanted it. She was surprised and expressed her gratitude, saying she hadn’t know that help was available. He gave her the phone number for Access Mental Health in Calgary before he left.

Not many people would have recognized the cashier’s behaviour as compulsions.

Vignette 2: Playing with letters in words

Peter contacted me at my private practice and told me he has OCD. He said his OCD was well managed and that he wanted to work on other issues. When he arrived at my office, however, I discovered that his obsessions and compulsions were not well managed.

Here is a partial list of Peter’s obsessions and compulsions when we met.

1. He couldn’t say a word with the letter “d” in it.
2. He couldn’t write a word with the letter “d” in it.

It took Peter more than an hour a day to express himself verbally and in writing because of these obsessions and compulsions. These thoughts and behaviours would have gone completely unrecognized if he had not been willing to discuss them.

Vignette 3: Rules, rules, rules

Leonard told me he was tired of cleaning the house from 11 pm until 1 am several days a week. He said his wife would say she couldn’t tolerate the level of dirt in the house and would demand that they clean together.

Here is a partial list of Leonard’s wife’s obsessions and compulsions.

1. She would iron two work shirts, and only two work shirts, at a time.
2. She wouldn’t allow Leonard to touch ornaments in the living room because he didn’t put them back where they belonged.
3. She ate dry cereal in bed every night.

Leonard asked his wife to stop eating in bed because he was tired of sleeping on crumbs. He moved into the guest room for several weeks before she was able to stop.

Leonard came to see me about a personal issue. It was only over time that I suspected his wife might have OCD and asked some questions.

Vignette 4: Monitoring finances

Sheryl shared she was obsessed about being able to make the mortgage payment each month, even though she hadn’t missed a payment in ten years.

Here is a partial list of Sheryl’s obsessions and compulsions that she shared.

1. She looked at the bank balance every day and knew where every penny went.
2. She closely watched the balance on the family credit card.
3. She worried the company she worked for would fail and she would lose her job.
4. She worried that her husband would lose his job.
5. She worried that the family’s rainy-day savings were not enough.

Sheryl’s struggles might have gone completely unrecognized because they could have been diagnosed, inaccurately, as anxiety.

Vignette 5: Tapping and counting

Jacob had to tap his daughter’s headboard six times after he tucked her into bed each night.

Here is a partial list of Jacob’s obsessions and compulsions that he shared with me.

1. He had to tap his daughter’s bedroom door six times before he left her room.
2. He had to tap the front door six times when he entered or left the house.

You might suspect that you would be able to see these behaviours if you knew Jacob. You would be wrong, however, because Jacob was skilled at hiding them.

Vignette 6: Scanning for illness

Mark was concerned whenever he saw a new blemish or bruise on his skin. He had the same concern if he saw a new blemish or bruise on either of his sons.

Here is a partial list of Mark’s obsessions and compulsions.

1. Mark constantly read about what diseases blemishes or bruises might indicate on medical websites.
2. He would bring possible diagnoses to his physician and to his sons’ pediatrician and ask for tests to rule out cancer and Multiple Sclerosis.
3. He was unable to talk to his neighbours after the wife developed breast cancer and went into treatment.

You might anticipate that either the physician or the pediatrician would raise the possibility of OCD because of his repeated requests for testing, but this never happened.

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I hope these vignettes, taken from real life examples of people experiencing symptoms of OCD, have helped to illustrate the concept of obsessions and compulsions for you.

— Dr. Patricia Turner, Registered Psychologist, Calgary, Alberta