Anyone can have obsessive moments. Plenty of people have walked back up a flight of stairs to double check the locks, and roused themselves from a comfortable bed to make sure all the knobs of the stove are turned off. But when obsessive behavior starts to have a bigger impact on someone’s life, that’s when it requires further examination. However, obsessive-compulsive disorder (OCD) has a long and complicated history, which can make it challenging to properly identify and treat.
A Brief History of OCD
Descriptions of OCD-like symptoms have been identified in writing throughout history, as far back as the sixth century. Throughout the sixteenth and seventeenth centuries, most descriptions of what is likely OCD occurred in religious texts—rather than in scientific or medical journals. OCD and OCD-like symptoms were generally described as symptoms of “religious melancholy.”
Historically, clergy members were the ones who observed or were confided in about symptoms of OCD by their students and parishioners. Without today’s medical understanding of mental health, the clergymen relied on religious and philosophical teachings.
They largely considered individuals who came to them with obsessive thoughts or compulsions to be possessed by outside forces. One of the early descriptions of OCD comes from an instruction manual about witch hunting, and another attributes obsessive behaviors to being possessed by evil spirits.
The most common treatment for obsessive behavior or thoughts during this time was exorcism. Saint John Climacus also writes about a monk who suggests his pupil simply “pay no attention to [obsessive thoughts] whatever.”
In the early nineteenth century, science began to replace religion as a basis for medical care, but leaders in the field were still divided as to what caused OCD, and how to classify it. Across Europe, scholars and doctors in different regions disagreed about the source of the disorder.
The French focused on anxiety and a person’s loss of will, while English psychiatrists stayed focused on the religious perspective. Germany considered OCD to be an intellectual disorder and believed irrational thoughts were neurological events.
The current terminology comes from German psychologist Karl Freidrich Otto Westphal, who used the German word zwangsvorstellung to describe his patients. In England, it was translated as “obsession,” while the US translated it as “compulsion. “Obsessive-compulsive disorder” emerged as a compromise.
Modern Misconceptions of OCD
Unlike the language of a lot of other mental health conditions, the term “OCD” is casually used in our societal vernacular quite often. You’ve probably heard someone say “I’m so OCD about organizing my notes,” or “I love cleaning my apartment, I’m practically OCD about it.” In reality, these people just prefer that their things be organized or clean.
To throw around language like this without considering its impact is insensitive to people who actually do have OCD, and, more importantly, it actually can be damaging to people who should seek treatment.
It dismisses the severity of OCD to confuse obsessive moments or tendencies—which many people have—with actual obsessions and compulsions. Especially for children, it can be difficult for themselves or their family members to differentiate between a symptom that needs to be addressed or just a personality trait.
All of this is not to say that practitioners don’t take OCD seriously, or that the field is ignoring people who have OCD. But in society at large, there are stereotypes of the disorder that are inaccurate, and that makes it difficult for people to recognize if their behavior is something they should seek help for. The stigma surrounding OCD might also make it harder for people to buy into their diagnosis, especially for less common manifestations.
The Challenges of Treating OCD
Some practitioners may not recognize all the symptoms of OCD, especially for particular subtypes. Most can identify common external compulsions like hand washing or repeating an action a certain number of times. However, there are other ways obsessions and compulsions can reveal themselves that are internal and harder to identify.
In a lot of cases, practitioners don’t go through much or any training on the “Pure O” subtype of OCD, and aren’t told how to look for more subtle obsessions that people can have. This means a lot of those symptoms go undiagnosed, and the correct treatment plans aren’t put in place.
The compilation with the “Pure O” subtype is that it’s often mistaken for—and treated as—a more general anxiety disorder. A lot of clients will come in saying “I’m anxious,” or “I worry a lot about X.” This makes it easy to try treatment for general anxiety first, but it’s critical to find ways to differentiate what’s just a worry, and what’s actually an obsession.
OCD is not the only disorder that has been overlooked and misunderstood for years, but well-informed and compassionate care is the first step to easing the way for future generations.
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