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August 16th, 2011
12:35 PM ET

Why are my OCD feelings so intense?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Susan from Oklahoma

I have OCD. When I hear the sink faucet turn off, it makes a squeaking noise, and I feel tense and need to use antibacterial wipes on my hands. I also feel tense and need to use antibacterial wipes when I hear someone say the word "gas," when I see a red gas tank anywhere, when I see a gas nozzle at a gas station (or on TV), and the red color of a gas tank on anything plastic similar to a red gas tank. I also hate looking at sinks in the bathroom and kitchen because I feel tense and literally walk around the apartment covering my eyes so I do not see those objects when I am passing them. Why do I feel so intensely about these things? What can I do?

Expert answer:

Dear Susan,

I am sorry to hear about your very intense and disabling struggles with sinks and red tank-like objects.

Your issues might sound odd to folks who don't know much about OCD (obsessive-compulsive disorder), but for anyone who suffers with the condition, or has treated it, your problems are very typical.

This is good news indeed, because it means that your problems can very likely be improved significantly.

Although OCD is one of the most disabling of psychiatric conditions, it is also one of the most treatable. And although many patients are not able to rid themselves of symptoms entirely, almost always, the symptoms can be brought down to a manageable level, allowing people to resume their normal lives.

Given the intensity of your symptoms, I would recommend you see a mental health clinician, who will recommend a specific type of behavioral therapy, a serotonin antidepressant, or both.

I wish I had space in this blog to tell you any of the myriad cases I've seen of people whose lives have been turned around by these interventions.

But in the meantime, because you've asked me what you can do, let me make a few simple suggestions

All effective psychotherapies are based on the discovery that the intense discomfort caused by obsessions (in your case the fear of germs) fades if a person can resist doing the compulsion that the obsession sparks (in your case, using hand wipes or avoiding looking at sinks).

On the other hand, compulsions - while giving immediate relief - actually make the obsessions worse over time.

Here's an analogy: We've all had the experience of having a place that itches. When you itch, you scratch, but we all know that the scratching, while relieving the itch briefly, only makes it worse over time.

On the other hand, if you ignore the itch, it fades over time. Obsessions are like the itches, and compulsions are like the scratching.

So the way forward is not easy, but it is doable if you take it a step at a time. What you need to do is purposely expose yourself to the things that cause the mental torture and then tolerate them for as long as you can without doing any compulsions.

You could start with any of the obsessive triggers. I might start by saying the word "gas" over and over again for as long as you can stand without wiping your hands. Another simple - but far from easy! - approach might be to sit in front of a sink in your apartment, staring at it without looking away.

The longer you can do this, the more you'll notice that the anxiety is fading.

If you are saying to yourself that these activities are too difficult to even contemplate trying, then I doubly recommend that you seek professional help.

Believe me, I know from experiences with patients and family members how terrible this disease is. But remember: I also know well the sweet relief in people's eyes when they take action and begin to heal.

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soundoff (23 Responses)
  1. Howie

    Why do they always recommend an anti-depressant. I have a similar thing going on that causes granulomas. The worse the granuloma the worse the compulsion to mess with it. Causing it to get worse. I've tried several things and at times I do well if I am able to maintain the effort.

    But the underlying anxiety is the problem. Yet they docs always prescribe an anit-depressant which does nothing at all for it yet has weird side effects...

    My requests for the occasional generic anti-anxiety med say once or twice a week, yes they work great and in one half an hour, are always met with take "X" brand name anti depressant for a year. The....

    I'm not depressed..... What gives with that?

    August 16, 2011 at 13:39 | Report abuse | Reply
    • SANJOSEMIKE

      OCD people often get depressed when they feel they are "giving in" to their objects of their compulsion. It's like an extraordinary, magnified desire to see the results of a terrible accident, and later on the guilt after you partake in it. You want to say "no" but something in your brain does not permit it.

      That something is usually dopamine. You have a dysfunction in neurotransmitters. It's often surprising that you do as well as you do with that defect. I'm not sure I could.

      This is basically a brain chemistry problem. I don't have compulsions or OCD. The reason I don't is because I don't have an inborn error in serotonin and dopamine metabolism on the brain level. Depression is specifically a side affect of this disease, not a primary cause of it.

      sanjosemike

      August 16, 2011 at 15:17 | Report abuse |
    • JLS639

      Antidepressants have many effects (e.g., those weird side effects you cited). They are used to treat conditions other than depression. For example, selective serotonin reuptake inhibitors can reduce bed-wetting. Serotonin does all sorts of things in the body. Using antidepressants this way may or may not be wise, of course.

      August 16, 2011 at 22:12 | Report abuse |
    • Scott

      Doctors are extremely reluctant to prescribe anti-anxiety medication to their patients because they like to keep the pharmacies stocked for themselves.

      August 16, 2011 at 22:50 | Report abuse |
    • whonos

      SSRIs are effective with some patients suffering from OCD symptoms. I've worked with some patients that are really grateful for the Prozac. Doesn't work for everyone, much like most psychiatric meds.

      August 16, 2011 at 23:08 | Report abuse |
  2. travis in Yukon Canada

    Great article Dr Raison – a lot of what you speak of is captured in more detail in the Shwartz (sic) book "Brain Lock", and I did what you and the book recommends. I went from super-debilitating to more or less conquered in just over 1 year. The intense relief of not being tortured anymore is very sweet. And you are right, the initial feeling of seeing the trigger doesnt ever really go away, but you learn to handle it and minimize it. So, I wish I would have seen this article/book years ago when the OCD was a super-monster, but at least now I have peace. And so will the readers of this column – trust me, it WORKS. Cheers, Travis

    August 16, 2011 at 14:13 | Report abuse | Reply
  3. travis in Yukon Canada

    oh, and yes, I think it's not necessarily anti-depressant meds, but it's OCD meds. Look at it that way, and the stigma wont be so bad. Regardless, doing the cognitive therapy AND taking the meds is a very wise course – both go hand in hand, that's my experience.

    August 16, 2011 at 14:15 | Report abuse | Reply
  4. Anonymous

    Anti-depressents and Anti-anxiety meds are the same thing. The SSRI's and other types of anti-depressent meds work on anxiety just as well as they work on depression, and are commonly prescribed for both.

    August 16, 2011 at 14:21 | Report abuse | Reply
    • Beth

      Anti-depressents and Anti-anxiety meds are not the same at all.You use med's like Ativan and Klonpin for Anxiety and panic attacks.Lexapro and many other Anti-depressents (I have been on quite alot)do not help anxiety at all...I know this from my own experiences.

      August 16, 2011 at 15:50 | Report abuse |
    • schuyler

      Anon is right, the benzos you speak of are more for acute anxiety because a tolerance is gained pretty fast, and withdraw symptoms make anxiety worse. Generalized anxiety is better taken care of by things like paxil and therapy.

      August 16, 2011 at 17:12 | Report abuse |
  5. Annonomyous

    A very good and useful response from the doctor, and very well said. Take it from me I have OCD.
    LP

    August 16, 2011 at 15:39 | Report abuse | Reply
  6. Jill

    I suspect Dr. Raison's use of the phrase "serotonin antidepressant" was a reference to a selective serotonin reuptake inhibitor, or SSRI. These meds can be used for depression, but it is also believed that a lack of serotonin may create or enable the obsessions of OCD. The lack of feelings of completion or satiation that prompt a checker to return 20+ times to see if the door is locked, or that make a washer use soap & water on his/her hands 100 times a day can be ameliorated by the use of an SSRI. As the med keeps the serotonin longer/greater/more, the serotonin may be able to deliver more messages of completion, of being OK, of "enough." The fact that many SSRIs are also used (often in different dosages) for depression, for eating disorders, and other problems doesn't make them any less useful for OCD.

    August 16, 2011 at 16:04 | Report abuse | Reply
  7. OCD-Awareness

    I have ocd, and so do others in my family. First,There are different types and intensity of ocd, and varying levels of desire to check/perform compulsions. My father is a hoarder and compulsive spender. My sister worries about plugs being plugged in and will unplug them to prevent fire. My thoughts are mostly negative thoughts that pop into my mind (I am more of a pure o"), but I can control my checking behavior, mostly. The issue is that checking behavior rarely comforts you and in the long run undermines your ability to function. The best thing one can do with the compulsion to check or perform the compulsion, is to DELAY. Say you are worried a window is open and a burglar may enter. Tell yourself, yes, its important, you can check in an hour. Next time you get the compulsion, delay a bit longer. The issue with OCD is that OCD people like to be 100% sure, and cannot cope with any level of uncertainty. Allowing for uncertainty in ones life, and accepting one's ocd thoughts helps a lot. Many OCD people fight the idea that they have this thought or compulsion, and this anxiety over it merely strengthens the thought. Accepting the ocd thought and that you have these negative thoughts, feelings or obsessions will put you on the road to recovery. Another thing that helps is habituation. IF you write out your ocd thought and force yourself to read it for at least 10 minutes and more you will slowly become bored with what the thought contains. I did try Paxil, and it helped with OCD thoughts, however I gained 30 lbs on it and it slowed down my metabolism. If you must do meds, then you should do what you have to to feel better, however, sometimes the side effects are worse than the condition. In the end, cognitive behavior therapy and habituation is the best for helping you cope with this illness.

    August 16, 2011 at 16:21 | Report abuse | Reply
  8. Fuyuko

    Oh, the reason the feelings are so 'intense' is because you fight them and they bother you. This only strengthens the ocd thought. Once you recognize that your thoughts are ocd related and accept the thought/compulsion, the feelings will have less power over you.

    August 16, 2011 at 16:44 | Report abuse | Reply
  9. Larry

    There is alot of talk on this thread regarding the lack of or over stimulation of neurotransmitters and the medicine used to regulate them. My question is how come there is not a way to measure the amount of sertonin/dopanine in the first place? If there is no way possible to measure the amount of seratonin or dopamine how does one know if they are off to begin with?

    August 16, 2011 at 21:19 | Report abuse | Reply
  10. JeffinIL

    For Susan in the article: Try getting your faucet fixed/replaced so it doesn't squeak since that seems to be a trigger. I have nothing to add for the red/tank issue. Sorry. I hope the first suggestion is worthwhile.

    August 16, 2011 at 22:49 | Report abuse | Reply
  11. Larry

    I was thrilled to see that you gave real advise rather than just listing drugs. SSRIs are the new favorite drug of doctors.
    "When all you have is a hammer everything looks like a nail", sadly a prescription and no practical advice is what people
    usually get these days. Yes there is likely a physical issue behind the condition (more complex than a chemical imbalance)
    but that doesn't mean patients are powerless victims who can only (must) be helped by drugs.

    SSRIs work great for some people, but for many they just add insult to injury. Another layer of misery, unacknowledged
    withdrawal symptoms which may lead them deeper into trouble when they do try to get off them.

    August 17, 2011 at 03:09 | Report abuse | Reply
  12. ocdtalk

    My son suffered from OCD so severe he couldn't even eat. That was a few years ago. He is now a senior in college with a great future ahead of him. Exposure Response Prevention Therapy saved his life. He was on some meds for a while but they caused more harm than good. Everyone is different but it is possible to conquer OCD without meds if you have the right therapist and therapy.

    August 17, 2011 at 09:33 | Report abuse | Reply
  13. Pankaj Manocha

    Dear Susan ,
    I undersatnd your everyday struggle in life with red tank and sinks. I agree with Dr Raison's suggestions of resisting the compulsion of using hand wipes or avoiding looking at sinks will help fade your obsession. Taking help from Mental Health clinician in terms of psychotherapy classes and using selective serotonin reuptake inhibitors like Fluxetine along with Tricyclic antidepressants like clomipramine will be very helpful in your case. I hope using multiple therapies will help you control your symptoms.

    August 17, 2011 at 15:09 | Report abuse | Reply
  14. ilona

    I have ocd/bdd , I am very obsessed with my face its so bad that its hard to work or have conversations with the people.
    Its always on mine mind my looks. I had an Effexor for 2 years but dosn't help much. My feelings are very intense to the point that get panick attacks.

    September 12, 2011 at 18:20 | Report abuse | Reply
  15. Maggie

    Hello I have ocd/post traumatic stress disorder. I was very against taking any anti- depressants. Until a friend told me that I should at least consider it. Well, I did a few months ago and nothing happened but really bad side affects that made my anxiety worse. I took wellbrutrin for about 7months combined with other meds like Prozac, Paxil, Zoloft, Anafranil, elavil, celexa, klonopin, and none worked! I only took wellbrutrin which just made my ocd worse. I have bad violent intrusive thoughts about love ones only when I'm close. I live with my boyfriend and I have bad thoughts about him and it drives me crazy. I don't like having these thoughts towards him and I don't understand why. I get very angry towards him due to his forgetfulness. I feel responsible feeling like a mother and he is my child sort of way. He forget everything and it's frustrating for me. He has ADD. I feel horrible for this and makes me afraid! My mind tells me I don't love him and it frightens me. And it gets stronger. I love and care about him so much but I get really upset angry even feel rage. And all I want is to feel happy and balanced. Klonopin makes me tired it's horrible. I need advice help!!!!

    September 6, 2012 at 17:21 | Report abuse | Reply
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