"I couldn't do anything without rituals. They transcended every aspect of my life. Counting was big for me. When I set my alarm at night, I had to set it to a number that wouldn't add up to a "bad" number. If my sister was 33 and I was 24, I couldn't leave the TV on Channel 33 or 24. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. If I was writing a term paper, I couldn't have a certain number of words on a line if it added up to a bad number. I was always worried that if I didn't do something, my parents were going to die. Or I would worry about harming my parents, which was completely irrational. I couldn't wear anything that said Boston because my parents were from Boston. I couldn't write the word death" because I was worried that something bad would happen."
The disturbing thoughts or images are called obsessions, and the rituals performed to try to prevent or dispel them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the discomfort caused by the obsession. Obsessive-compulsive disorder is characterized by anxious thoughts or rituals you feel you can't control. If you have OCD, as it's called, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You might be preoccupied by thoughts of violence and fear that you will harm people close to you. You may spend long periods of time touching things or counting; you may be preoccupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs. A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life. Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary. OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the disease is variable—symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families. Depression or other anxiety disorders may accompany OCD. And some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes. This diagnosis is usually restricted to people who spend at least one hour per day involved in their obsessions and rituals.
Treatment for OCD depends on the severity of the symptoms. Medication, such as Anafranil, Paxil, or Prozac is usually necessary for treating this disorder. Behavior therapy can also be very useful in helping control the symptoms.
Post Traumatic Stress Disorder
"I was raped when I was 18 years old. For the first few days afterward I was a mess. I was crying a lot and couldn't sleep. Then I went through a period of about a month when I felt kind of numb. I thought I was doing okay but I guess I wasn't. It wasn't until I went to a frat party that I realized something was wrong. Seeing those guys trying to pick up women gave me the creeps. When some guy came onto me I suddenly felt terrified. That night I had horrible nightmares. I started having flashbacks. I would be terrified. Every instant was startling. Yet at the same time everything felt unreal. After a flashback I'd be finished for the rest of the day. I started having nightmares. I didn't feel safe anywhere, not in my bed, not at home, not even with close friends."
Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that follows a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. PTSD, once referred to as shell shock or battle fatigue, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. The event that triggers it may be something that threatened the person's life or the life of someone close to him or her. Whatever the source of the problem, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult. PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. In severe cases they may have trouble working or socializing. PTSD is more common in people with previous history of anxiety or depression. People who tend to feel less secure in life to begin with are more likely to get PTSD after exposure to a traumatic event. In those who do have PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn't show up until years after the traumatic event. Antidepressants and anxiety-reducing medications can ease the symptoms of depression and anxiety. Sleep problems and nightmares can also be controlled with medication. Focused therapy, helping the person deal with the trauma itself, may be helpful. When the individual has had a previous history of problems adjusting to life, psychodynamic therapy will provide the greatest benefit.
