DO HORRIBLE THOUGHTS MAKE ME BAD?

Dear Dr. K.,
I have these horrible thoughts over and over even though it seems nothing will ever happen. I worry that I have germs on my hands that might infect someone. While driving, if I pass a hitchhiker, I worry that I might have hit him and have to turn around and check. In church, I worry that I might yell out something obscene. What does this say about me?
T.J., Osprey

Dear T.,
What it sounds like you have is Obsessive-Compulsive Disorder or OCD.
This is an emotional problem in which you are driven to do things over and over by thoughts that go over and over. All of us worry about things. If they are truly big worries, we obsess over them because of their seriousness. We all, also, have doubts and superstitions of one sort or another. That is part of being human. There are those of us who are fastidious, very organized and detail-oriented. In fact, those people may make a good income because they are this way. This is not OCD. When you cannot stop the thoughts and actions, like washing your hands repeatedly or checking a door 20 times to be sure it is locked or going around the block over and over to check that you did not run someone over, then OCD becomes the issue.

In psychiatry, OCD is in the category of anxiety disorders. It can be a potentially disabling condition that persists throughout someone's life. It is called the 'secret' illness because people who suffer from it are plagued by strange and repetitive thoughts and actions that they feel very pressured to do. They keep 'silent' about it because they are aware of how bizarre the symptoms are and, because of this embarrassment, say nothing and rarely get treatment. They wonder if they are crazy and, fearing this, avoid talking about it. The irony is that those that are aware of the inappropriate quality of their thoughts are never crazy, they only suffer (people who are psychotic do not recognize how bizarre their symptoms are).

I have had patients who, like a mother of a newborn infant, had very distressing thoughts of stabbing her infant with a safety pin. She did not, but felt very guilty about the thoughts. Another patient had to wash her hair seven times each morning in the exact same way. If she diverged from the pattern, she had to start all over again. Another patient was so obsessed with germs that, should the clothes she had just washed touch anything as she transferred them to the dryer; she HAD to wash them again.

The thoughts (which are the obsessions) are senseless or frightening but so repetitive that they are hard to resist ("Did I really lock the door?"). The action (the compulsion) is the checking or action ("I'll go and check it one more time to be sure it's locked"). Sometime the thoughts can be fears of doing something bad like the mother with her infant or they can take the form where someone fears he may yell out obscenities in church as you describe. The compulsions are ways of relieving the worry, like washing your hands when you worry about germs, but the relief is only temporary.

The most common obsessions are checking (for example, worry that the door is locked, the alarm clock set or the range is turned off) and anxiety over germs or contamination. . . The corresponding most common compulsions are checking and rechecking and washing or cleaning. Some people can spend 1-2 hours checking and rechecking the door to be sure it is locked. This is the curse of OCD, the perpetual doubt.

Often OCD is accompanies panic attacks. It can and often does run in families with it occurring as often in males as females. We do not know what causes the problem but we do know that it is related to areas of the brain that have the brain chemical serotonin. OCD can start at any time from preschool age to adulthood. It usually occurs by age 40. On the average, people spend many years keeping the illness a secret and then many more years in getting treatment since they still hide parts of the symptoms so it becomes difficult for the doctor to diagnose. Some types of OCD take the forms of trichotillomania (trick-oh-till-oh-mania) which is pulling hair out and body dysmorphic disorder where a person obsesses about body parts being 'not right'.

Treatment of OCD involves medications which boost the amount of serotonin in the brain and thus help the problem. Many times, behavioral therapy can also help. However, a combination of the two is frequently the best way to eradicate the symptoms and allow the person to have a normal life free of unrelenting obsessive thoughts and spending enormous amounts of time performing senseless compulsions.
An excellent website for more information is www.ocfoundation.org. An excellent book on the subject is The Boy Who Couldn't Stop Washing by Judith Rapoport.

As I have stressed with other emotional problems, this malady is treatable. If you have symptoms which you might consider to be obsessive compulsive disorder, seek out a psychiatrist and discuss your concerns…without embarrassment. This is nothing new to a psychiatrist and he or she can help you. But get treatment.

Dr. K is Stan Kapuchinski, M.D., a board-certified psychiatrist practicing with Psychiatric Associates of Charlotte County located at 3390 Tamiami Trail, Suite 104, Port Charlotte, FL. 33952. Phone 941-764-0444 for an appointment. Please write him there with questions or email him at DrK@Sun-Herald.com.