Obsessive-compulsive disorder: How much control is too much control?

Turning off the iron must be checked several times! And, when shopping, never take the first item off the shelf!” Almost all of us have a quirk that accompanies us in our daily lives, but very few of us really suffer from them. It is quite different with an obsessive-compulsive disorder: This differs from the above-mentioned habits in the extent of the resulting impairment – and it is not rare! About two to three percent of people are affected, not their entire lives, but for many years. The transition between everyday behavior and obsessive-compulsive disorder is fluid. But at what point does one speak of obsessive-compulsive disorder?

Trapped in compulsions

It is an obsessive-compulsive disorder (also known as obsessive-compulsive neurosis) when certain thoughts or actions are no longer just a habit that has become dear or that provides security, but continuously impair the life of the person affected and those around them. Obsessive-compulsive disorder can consist of obsessive thoughts, obsessive actions, or a mixture of both.

Obsessive thoughts are images or impulses that recur incessantly. “I could have germs on my hands and infect myself with them!”. These thoughts have an unpleasant effect, can cause fear, tension or even disgust. Probably the most significant characteristic of obsessive thoughts, however, is that they take on irrational dimensions.

Obsessive-compulsive behaviors are behaviors or rituals that sufferers “must” do over and over again. Corresponding to the above example, a compulsively ill person might, for fear of becoming infected, clean his or her entire body and clothes after coming home according to a set ritual.

Although the mind knows that the obsessive thoughts and fears are nonsensical or exaggerated, the sense of threat that arises cannot be calmed. Only by ritualized counteracting with compulsive actions or mental rituals can it be reduced by those affected. This can sometimes last for hours and affect the entire daily routine.

Important: Obsessive-compulsive disorder is the fourth most common mental disorder. The first symptoms often appear in childhood or adolescence. There is evidence of a clustering of onset of the disorder between the ages of 12-14 years, as well as between the ages of 20-22 years. In 50-70% of all affected persons, critical life events or stressors are already present before the disease. (Dgppn Guideline, 2013)

What are typical symptoms of obsessive-compulsive disorder?

There are countless compulsions in a wide variety of forms. The following forms of obsessive-compulsive disorder are among the most common:

  • Washing and cleaning compulsions: The washing processes (e.g. of the hands) are usually excessive. Behind this is often the fear of certain bacteria or diseases that must be avoided.
  • Control compulsions: These often involve situations that could endanger the safety of oneself or others. These include locking the front door or checking electronic devices in the home.
  • Order compulsions: any kind of disorder makes people with order compulsions extremely nervous. They often develop elaborate and rigid ordering systems, e.g., laundry in the closet must be sorted by color and folded “on the bump.”
  • Repetition and counting compulsions: Everyday actions, such as combing the hair, must be repeated until a certain number is reached. If sufferers are interrupted while counting or their attention wanders, they start again from the beginning.
  • Collecting and storage compulsions: Objects are acquired that would seem worthless or meaningless to other people (e.g., advertising brochures, deposit bottles) and then hoarded. Reasonable” reasons are usually cited as the motive, such as: “I could use this brochure again” or: “You should keep your money together”, but in reality those affected have built up a personal attachment to the objects and experience throwing them away as if a piece of themselves were being lost.

Symptoms of obsessive-compulsive disorder can change over the course of a lifetime, they can decrease as well as increase in phases, and they can occur in various combinations.

Suffering of the patients

Obsessive-compulsive behavior is almost always associated with feelings of shame. Precisely because those affected are aware of the senselessness of their actions and the deviation of their behavioral standards from those of other people, they often do everything they can to hide their disorder from the outside world. People with obsessive-compulsive disorders are therefore often inventive when it comes to justifying their unusual rituals and concealing the compulsion. The level of suffering is almost always related to the extent of the disorder and the amount of time and energy it requires: Patients whose compulsive rituals take up at most an hour a day are often capable of acting to a large extent and manage to meet their private and also professional demands. However: Even for them, everyday life is often very exhausting, because it requires continuous preventive measures, hidden acts of control and the invention of ever new excuses in order to be considered “normal” by others.

How do obsessive-compulsive disorders develop and what keeps them alive?

There is no single cause for such a disease. However, various risk factors can be identified for its development:

  • Heredity
  • Education
  • Stressful life events
  • Personality
  • Unfavorable life circumstances before the onset of the disorder
  • Biological factors

Today’s models for the development and maintenance of obsessive-compulsive disorder are so-called multifactorial models. Psychologists assume that a large number of different factors and their interaction contribute to the development of obsessive-compulsive disorder and then often persist for years.

There are a wide variety of reasons why an obsession can become a persistent companion despite the high level of suffering it causes every day: One possible reason is that the factors that led to the development of the compulsion continue to exist. Quite crucial to maintaining an obsessive-compulsive disorder is a self-reinforcing vicious cycle of obsessive-compulsive disorder. Also, a mental disorder can have “positive side effects” for the sufferer. For example, a compulsion might distract them from difficult situations or unpleasant feelings.

Obsessive-compulsive disorder as a vicious circle – a case study

It is assumed that intrusive thoughts – “Is the door really locked?” are initially completely normal and occur in many people. What makes this thought problematic is that it is ascribed an abnormal meaning associated with danger. Through the sensation of fear and anxiety, the affected person experiences a strong urge to act – “I have to control this, otherwise something terrible will happen and I will be to blame!”

If the impulse to act is then acted upon, this leads to a brief calming. At the same time, however, performing the controlling action is also a sign that the relevance of the thought was appropriate-“It’s lucky that I checked everything again, who knows what would have happened otherwise!”. In this way, a vicious circle has developed that perpetuates the compulsion and must be broken in the course of treatment.

Treatment of obsessive-compulsive disorder

The most effective form of therapy as a way out for obsessive-compulsive disorders, according to the latest research, is behavioral therapy. A basic assumption of behavioral therapy is that a variety of behaviors and ways of thinking do not arise by chance, but have been “learned” in the context of specific conditions of development. In this regard, behavior therapy focuses on the following starting points: Working on the obsessive-compulsive symptoms and on one’s own person or life situation. The aim is to develop effective coping strategies for the patient’s problems and symptoms through new experiences.

Methods are learned to combat the obsessive-compulsive symptoms directly and to change the conditions under which the obsessive-compulsive disorder could first take root and spread. If one speaks in the scientific context of the treatment of obsessive-compulsive patients of behavioral therapy, then this also includes the implementation of a stimulus confrontation training.

This involves patients deliberately exposing themselves to an otherwise avoided stimulus (e.g., touching a supposedly soiled object) and then refraining from a calming compulsive ritual (e.g., washing their hands). Such psychotherapy can also be combined with medication in some cases. The aim is for those affected to be able to shape their lives again in a self-determined and self-responsible manner in the future.

A large number of studies have shown that treatment of patients with obsessive-compulsive disorders in specialized clinics and hospitals is particularly effective. Thanks to the high level of expertise and the possibility of intensive on-site care, patients can be helped on a very individual basis.

  • Althaus, David ; Niedermeier, Nico ; Niescken, Svenja: Obsessive-Compulsive Disorder: When the addiction to security becomes an illness. Munich, 2018.
  • Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V.: https://www.dgppn.de/leitlinien-publikationen/leitlinien.html, accessed 28.11.2021.
  • Förstner, Ulrich; Voderholzer, Ulrich; Külz, Anne-Katrin: Disorder-specific treatment of obsessive-compulsive disorders: A therapy manual. Stuttgart, 2018.
  • Fricke, Susanne: Understanding and managing obsessive-compulsive disorders. Cologne, 2018.
  • ICD -10- GM. Systematic index, International statistical classification of diseases and related health problems (10th revision). Cologne, Germany: 2020.
Verena Klein
Author Verena Klein
"LIMES Schlosskliniken specializes in the treatment of mental and psychosomatic illnesses. With the help of the blog, we as a clinic group would like to examine the various mental illnesses in more detail and present different therapies as well as current topics."

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