By Evan Perez

5/12/2023 

English 110 

The City College of New York 

Professor Vicars

Research Essay Final Draft:

“I keep everything neat, I am so OCD.”, “I like to keep my hands clean, I’m so OCD!”, “I need to fix that crooked painting, my OCD is bugging me out.” The average person has more than likely heard similar phrases thrown around in various social settings and general media. Without ever knowing what it stands for, most people see Obsessive Compulsive disorder as a quirk or character trait, typically associated with being neat or clean. Though OCD can manifest in these activities, the basis of OCD is grim and violent. Obsessive Compulsive Disorder is a debilitating brain/anxiety disorder that is incredibly time-consuming, damaging to a sufferer’s overall health and is avoided in conversation and education. What is Obsessive Compulsive Disorder and how does it affect an individual who suffers from it? More importantly, why is OCD not talked about more, and why should it be brought to people’s attention?

According to an undergraduate research article from the University of Wisconsin-La Crosse, Obsessive Compulsive Disorder is characterized by heightened anxiety caused by repeated, unwanted thoughts identified as “obsessions”. The unwanted thoughts are also known as intrusive thoughts, “popping” into a person’s mind randomly. The heightened anxiety caused by intrusive thoughts is soothed or sedated by performing repetitive behaviors that get rid of or “fix” the thoughts, these repetitive behaviors are known as “compulsions”.

But what are unwanted thoughts? Unwanted thoughts can range from many different categories, or “themes”. These themes can get very broad or very specific. According to a health professional Mr. Frank Morelli (1), who exclusively treats OCD patients as a counselor, OCD that appears in children will experience contamination obsessions or unwanted thoughts of a contaminated surface. This is the common trope of fearing unclean surfaces obsessively and washing hands compulsively to mitigate anxiety or perhaps compulsively clean the surfaces themselves. OCD in adults, however, gets more intense. When an adult experiences OCD, they are more likely to experience what is called “bad thoughts” OCD. The themes/obsession manifest as the fear of losing control and secretly wanting to harm loved ones, the fear of enjoying sexual taboos, and the excessive focus on religious morals. With these themes comes a variety of intrusive thoughts tailored specifically toward someone’s fear, such as intrusive thoughts of harming children or thoughts of rebelling against God. Some common OCD compulsions can manifest as excessive double-checking of things, excessive counting, rumination (repetitive thinking or dwelling on thoughts or situations), and excessive prayer. 

Let’s look at a case example of contamination OCD:

“In a health class, a 13-year-old boy learns that vomiting is an involuntary response to illness. While watching the news one night, he sees a story mentioning how a boy vomited in his sleep and died. This triggers the initial obsession, where the 13-year-old boy now has an obsessive fear of vomiting and becoming ill. As a compulsive response to avoid anxiety, the boy avoids contact with anyone who may be sick, even distancing himself from his friends at school. He carries hand sanitizer every he goes and uses it constantly, causing his hands to dry and crack due to the irritation of constant cleaning. He won’t eat any food that he fears may be contaminated, causing him to avoid his favorite restaurants completely. His parents start to worry about him.” – Mr. Frank Morelli (2).

 Let’s take a look at a “bad thoughts” OCD case example:

“A 35-year-old man loses his uncle to a car accident. Two years after the incident, the man develops an obsessive fear that he will inadvertently cause harm to his family if he does not walk a certain way. He is fully aware that the idea is silly, but the thought sticks and won’t go away, not unless he performs the action. So the man begins performing elaborate compulsions that have to do with stepping in the right way, becoming time-consuming and physically cumbersome. Going outside or even walking around his own home becomes an ordeal.” – Mr.Frank Morelli (2).

The examples mentioned above are just two of thousands, if not more, of the types of OCD scenarios. These obsessions can become elaborate and the compulsions even more intricate and specific. The thing is, the sufferer is fully aware that these obsessions and compulsions are nonsensical, yet their brain has fully convinced them, no matter how bizarre or cumbersome, that these obsessions are real and that compulsion must be performed to prevent anxiety or bad events from occurring (4). Sufferers do not like to perform compulsion, they hate them. However, once the brain has convinced itself that a compulsion relieves anxiety, then it is more likely that the next time that person has another intrusive thought, the brain will resort to forcing the sufferer to perform the compulsion.

So how are obsessions and compulsions a problem? Everyone has intrusive thoughts once in a while, so how is OCD different? It is true, all humans experience intrusive thoughts of some type all the time, but most people don’t even realize that they occur. Intrusive thoughts can be anything like walking past the kitchen knives in a grocery store and thinking, “I could definitely take one of these knives and stab other people in this store.” or walking over a bridge and thinking, “It would be very easy for me to jump off this bridge and kill myself.” When most people experience these thoughts, they are easily brushed off. These thoughts occur as a result of the brain trying to protect an individual from a type of danger or negative possibility, by bringing it to a person’s attention, the person is now aware of the type of dangers in their environment. For a person that experiences OCD, when walking past a set of kitchen knives and having the intrusive thought of harming others, the brain juices up the body with anxiety, and the person may begin to wonder “Why did I have this thought? Did I enjoy this thought? Am I evil and will I lose control? What if I hurt my family?” In response to that, the brain will make the person also believe “I must stay away from all kitchen knives. I will avoid going out in public so as to not harm others. I should sit and think back on if I enjoyed that thought, I must disprove it. This is a real danger.” From here, in any parallel scenario, the person will avoid triggers, ruminate on past thoughts and what-if scenarios, and stop whatever it is they are doing to perform compulsions. Avoidance, rumination, and rituals are all forms of compulsions, providing temporary relief as a response to anxiety caused by intrusive thoughts. Avoidance is an issue as it may cause individuals to refrain from interacting with people completely, avoid doing activities they once enjoyed, and cause them to go to great lengths to avoid a trigger like taking a more time-consuming car route for example. Rumination is an issue as it forces the individual to focus on the problem at hand, they will spend hours in a day going over past events, past thoughts, and future events to “figure out” if something is true or not, completely neglecting all responsibilities and tasks to ease their anxiety. An example of this would be a person who fears they may have run over someone with their car unknowingly, causing them to sit in the parking lot at their job for a few hours in order to think back and figure out any hint or suggestion that they may have harmed someone, which in turn may cause that person to lose their job since they come into work late if they even show up at all due to compulsively ruminating. 

 Why can’t sufferers just stop performing compulsions? Unfortunately, it isn’t as simple as just deciding to stop. According to an article from the University of Michigan Medicine (5), after researchers studied hundreds of brain scans of OCD sufferers, it was observed that the brain sets the sufferers on a loop of “wrongness” that prevents them from stopping these behaviors despite knowing they should stop. These loops of “wrongness” occur due to numerous factors. One is an imbalance of serotonin in the brain, serotonin is a chemical that carries messages between brain cells in the brain, it is also known as a “feel-good” chemical. Then, OCD is also known to cause a malfunction between two areas of the brain that are crucial for rational decision-making, the frontal cortex and ventral striatum. The frontal cortex is responsible for decision-making and problem solving while the ventral striatum is responsible for impulse responses. On top of this, OCD causes a reduction in gray matter in the brain, gray matter is packed with neurons and is crucial for processing information in the brain. The less gray matter present means the less impulse control a person will have. According to another scientific study from the University of Michigan, an experiment between a control group and an OCD group revealed that individuals with diagnosed OCD showed excessive electro-psychological responses to errors compared to the control group when asked to respond to a series of the names of colors presented in that color or other colors (“red” presented in green, “green” presented in red, etc) (9). This shows that subconsciously, without the person knowing, OCD sufferers are stuck in an alert state when presented with a problem or intrusive thought. Even though the sufferer may know they are not in danger, the brain does not, so it shoots anxiety through the body. An example of this is a horror movie jump scare, normal people are initially surprised but settle back down quickly, however, with OCD sufferers, that same initial state of shock when the jump scare occurs does not go away, not unless a compulsion is performed. All of these factors combined cause a person who experiences OCD to be unable to identify impulsive behaviors, make them feel overwhelmed by intrusive thoughts and cause them to naturally fall into performing more compulsions. As we said before, OCD sufferers do not enjoy performing compulsions, but because of the malfunctioning in the brain’s decision-making and impulse control operations, the sufferer feels like they absolutely need to in the fear that something “bad” may occur. They may also feel like they’re on a never-ending treadmill of “figuring out” their intrusive thoughts or checking if something “bad” has already occurred without them knowing. This process of obsessive thinking is known as a loop of “wrongness”

The sensation of being on a loop of “wrongness” is often described as being in a moving car on the highway without a brake pedal. Even if the driver wanted to, they would not be able to stop. When the brain is deprived of its decision-making functions, it tries to protect the person by signaling that the intrusive thoughts are a real danger and need to be dealt with immediately, this is manifested as high anxiety caused by the brain and a person performing compulsions for temporary relief. Performing compulsions is the main perpetuating factor of OCD however, since the temporary relief that the compulsions provide signals to the brain that not only is the threat real, but that the compulsion performed is a real solution when it, in fact, is not. The main cycle of an OCD loop is as follows:

1. Obsessive/Intrusive Thought occurs
2. Anxiety induces
3. Perform Compulsive behavior to ease anxiety
4. Temporary relief
5. Step 1 repeats itself.

Obsessive Compulsive Disorder is recursive, meaning it relies on itself to perpetuate. The constant ups and downs of anxiety can lead to depressive symptoms, causing sufferers to feel hopeless, as if they will never break out of these loops. Many sufferers question if they will be able to lead normal lives again or feel as if they’re constantly walking on a tightrope of uncertainty, where they can fall to their mental demise at any moment. One process that fuels a lot of OCD sufferers’ torment is the idea that they can’t stop thinking, making them wish they could shut off their brain. A common thought experiment is used to illustrate why it is so difficult for OCD suffers to stop their loops which goes like this:

Imagine you are in a white room and someone enters the room and tells you, “I have one job for you, if you can do it, you can leave, but if you can’t, you must stay and continue to try and complete the job. Here it is: DO NOT think of a pink elephant. You can think of anything else, but DO NOT think of a pink elephant.”

When presented with this thought experiment, it is quick to see how difficult, practically impossible it is to not think of a pink elephant when asked not to. To not think about something would be to think about it, which transfers over to OCD in the sense that OCD sufferers struggle to stop obsessive thinking when trying to stop it in the first place actually perpetuates it.

The brain is constantly playing these kinds of tricks on a sufferer as a protective protocol, causing people to hole up and put their life on pause despite the consequences. The process of obsessive thinking about unwanted thoughts and having to perform compulsions can be mind-numbing and cause negative effects on other areas of someone’s life such as lack of sleep, lack of eating, and lack of general self-care. With darker OCD subjects like violence and sexual themes, falling into these mind traps can leave an individual questioning their reality and identity. Their obsessive thoughts and fears can take up their whole life and even cause them to fall into excessive guilt and sorrow as if they had committed a horrible mental crime. For example, someone with untreated violence OCD who falls into believing that they might be a closeted serial killer might believe that they are no better than actual serial killers. This can result in the sufferer stopping the pursuit of their hobbies and goals or seeing friends and family since they believe they’ve done something terribly wrong and can’t show themselves to the world. This couldn’t be further from the truth as OCD sufferers suffer from their compulsions to begin with because the subject is usually something they care deeply about. OCD attacks a person’s morals by weaponizing them against the sufferer as a protective measure sent by the brain, almost as if OCD is a hijacker planted in the brain. Another example could be an elementary school teacher that suffers from Pedophile OCD, they fear they might secretly be a pedophile despite genuinely caring for children. This teacher would avoid their job as a compulsion, jeopardizing their career and sending them down a spiral of irrational fears of being around children. Their life turns into a graveyard of the normal life they once lived. This could explain why half of all OCD sufferers experience suicidal ideation with a quarter actually attempting suicide. 

So how can OCD be so deadly and destructive, yet most people don’t know about what it really is? One reason why OCD may not be talked about is the disorder itself. OCD can leave people paranoid, making sufferers question how they would be perceived if they spoke up about what they are going through. OCD itself can cause other mental health disorders like anxiety and depression, suppressing the individual and preventing them from taking action. When sufferers are dealing with OCD for the first time, they can get caught up in the stigma of learning that they have a brain disorder, adding to the fear of being perceived as a person who might need to be wrapped in a straight jacket and locked in a cell. Most people would have a hard time understanding the severity of these intrusive thoughts, so OCD tells an individual that they have to hide their symptoms or else it will make everything even worse (3).

Another reason why OCD may not be talked about is that people are not educated on mental health issues in general. As mentioned before, there is a stigma around conditions such as depression and anxiety. According to the World Health Organization, close to two-thirds of mental health conditions go undiagnosed (6). Many people do not even believe they have severe mental health issues and shrug off common mental health disorder symptoms as either temporary or part of their identity, but anything besides a disorder. If people were able to recognize and get the help they need, many of those two-thirds population would stop their suffering and lead healthier and happier lives. 

The stigma around mental health is also exacerbated through social media, where many acts of violence in the news use mental health conditions as a scapegoat for criminal actions (7). This fact also fans the flame for OCD, making sufferers questions if their intrusive thoughts mean they’ll end up as one of those criminals on TV. People know what the flu looks like, but would they be able to tell what schizophrenia looks like in a person that they know personally without deeming their symptoms as quirks or personality traits?

According to an article written by the National Alliance on Mental Health (NAMI),  it is asserted that mental health services should be more present in schools and suggest the steps necessary should be taken to be able to provide appropriate mental health services and reduce barriers to delivering those services to students. This claim is backed up as it is addressed that one in six youth in the US (ages 6-17) experience mental health disorders each year and that half of all mental health conditions begin by the age of 14 and 75% by the age of 24. Furthermore, it is stated that earlier treatment is more effective and lowers the cost of treatment in the future when symptoms have grown worse over the years. Next, it is brought to the reader’s attention that untreated mental illness can lead to severe effects such as high drop-out rates in schools, substance abuse, unemployment, and early death with suicide being the second leading cause of death for youth ages 10-24. In schools, treatment can be more accessible and cost-efficient, especially for families in lower-income households. The author of this article appears to write in hopes that if the mental health of students is invested in effectively, then mental health sufferers would be able to get the proper care they need at the right time, and that the lives of youth, families, and communities would be significantly improved. (8) NAMI has taken action by writing multiple letters to policymakers in support of mental health services for students.

The key to combating OCD is exposure and acceptance. For patients, this means exposing themselves to their fears or accepting that they have intrusive thoughts and resisting compulsions to break the cycle. But it’s not just patients that need to practice exposure and acceptance, it is society. Mental health, in general, can present these stigmas and fear of being judged or being looked at as crazy, but OCD can happen to anybody. A lot of times when OCD first arises in someone, they can’t identify what it even is, let alone even realize that it is OCD. If OCD and mental health were talked about more in general and taught in schools, it would be very beneficial not only in preventing people from feeling alone and lost when facing these issues, but it would prevent many lives from being ruined by this violent disorder. Imagine if people were never taught what general illnesses were. If they were to occur without our education on them, many people would be left wondering what was wrong with them, not knowing that they had the common flu and that it could be treated with x, y, and z steps. OCD, and many mental health disorders, are just as real as breaking a bone or the common flu. There is no reason to shun or make others feel excluded when they open up about their issues in order to get the help that they need. The key to exposure is to bring all of these problems into the light and to treat them as normal problems with a solution. The key to acceptance is to realize that intrusive thoughts will always occur and to just let them float around in thought without any value or attachment to the individual.

I can say this with credibility as I have dealt with OCD since I was 12 years old. For the past decade, I have dealt with many periods of loops of “wrongness”, starting from fear of unclean surfaces to transitioning to darker subjects within recent years. I did not know what these loops were or what OCD was until February 2021, when I experienced a severe loop that resulted in me neglecting friends, family, and school so that I can perform rumination compulsions, laying in bed for more than 7 hours a day from the time I woke up, for several months. I experienced many other severe effects and symptoms, but thankfully, I broke through my fear of being judged to get the proper psychiatric and therapy care that I needed. My experience with OCD would not have been so severe if I had been educated on mental health in general, in Hispanic culture, mental health is something that is not taken seriously and is seen as something to “just get over.” 

Thankfully, I had support from my friends and family, but being able to talk to a therapist and practice stopping my compulsions while on medication was one of the biggest factors in my recovery. In fact, it was thanks to my university’s mental health support program that I was able to be quickly matched to a clinic that took my insurance and begin treatment. When I first experienced these intrusive thoughts and the heightened anxiety along with them, I genuinely thought I was going insane and that something was seriously wrong with me. I had no idea what was going on with my brain and I was genuinely scared. Like a terrible toothache, no matter how much I wanted to just remove the pain, it was impossible and indescribably painful to constantly want to crawl out of my own head and body just to get away from the anxiety and never-ending mental fatigue. Had I known to recognize what a car without brakes looks like, I wouldn’t have jumped inside in the first place.

Sources:

1. “Morelli, Frank.” International OCD Foundation, https://iocdf.org/providers/morelli-frank/. 
2. “OCD Case Examples.” Change Your Thinking, https://www.changeyourthinking.com/ocd-case-examples/. 
3. “I’m So OCD!”: A Qualitative Study Examining Disclosure of Obsessive … https://www.uwlax.edu/globalassets/offices-services/urc/jur-online/pdf/2021/werner.lily.cst.pdf. 
4. “Obsessive-Compulsive Disorder (OCD).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Mar. 2020, https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432. 
5. “Stuck in a Loop of ‘Wrongness’: Brain Study Shows Roots of OCD: Psychiatry: Michigan Medicine.” Psychiatry, 29 Nov. 2018, https://medicine.umich.edu/dept/psychiatry/news/archive/201811/stuck-loop-%E2%80%98wrongness%E2%80%99-brain-study-shows-roots-ocd. 
6. Casali, Mark. “A Guide to Untreated and Undiagnosed Mental Illness.” Turnbridge, 13 Dec. 2022, https://www.turnbridge.com/news-events/latest-articles/untreated-undiagnosed-mental-illness/#:~:text=It%20is%20easy%20for%20symptoms,of%20mental%20illnesses%20go%20untreated. 
7. Jersey, CarePlus New. “The Biggest Contributor to Stigma Is a Lack of Education about the Nature of Mental Illnesses.” CarePlus New Jersey Mental Health Care, Psychiatrists, Psychologists, Therapy, 12 Dec. 2022, https://careplusnj.org/the-biggest-contributor-to-stigma-is-a-lack-of-education-about-the-nature-of-mental-illnesses/. 
8. “Mental Health in Schools.” NAMI, https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-in-Schools#:~:text=Untreated%20or%20inadequately%20treated%20mental%20illness%20can%20lead%20to%20high,and%20youth%20get%20help%20early. 
9. Gehring, William J., et al. “Action-Monitoring Dysfunction in Obsessive-Compulsive Disorder.” Psychological Science, vol. 11, no. 1, 2000, pp. 1–6. JSTOR, http://www.jstor.org/stable/40063487. Accessed 12 May 2023.