Dossier: Strong mind

When being in control gets out of control

Some 150,000 people in Switzerland live with some form of obsessive-compulsive disorder, even though many obsessive thoughts and actions can be treated. The faster those affected get help, the better their chances of recovery.

Text: Nicole Krättli; photo: iStock

“Every time I leave the house, I have to check whether the oven is really off,” writes online forum user Felix. Fellow user Christina89 is familiar with these types of compulsions. On her way to work, she regularly wonders whether she’s turned the coffee machine off. “Sometimes I have to check two or three times,” she writes, and admits that she has even left the office and gone home just to check whether she has really switched it off. Online forums abound with stories like these. Protected by the internet’s cloak of anonymity, people report how they check up to 16 times a day whether the door is shut properly. Forum user Oli explains his behaviour: “I did all these things because my head was telling me that something bad would happen if I didn’t.”

According to estimates by the Swiss Society for Obsessive-Compulsive Disorders, some 150,000 people in Switzerland suffer from an obsessive-compulsive disorder that requires treatment. Many of those affected don’t seek professional help until relatively late. “One reason is that OCD is often associated with feelings of shame,” explains psychologist Sibylle Brunner. Another explanation is that it is difficult for those affected to judge when their behaviour is actually compulsive. “You should consult a professional when it gets to the stage that you’re going through your control mechanisms several times a day, wasting a lot of time on them, and they’re harming your social life,” says Brunner. 

Fine balance between ritual and disorder

Rituals are part and parcel of life. They create order and give you a sense of security. “It’s normal to double-check something so that you can relax in the knowledge that everything is OK,” explains Brunner. However, a person suffering from an obsessive-compulsive disorder will feel insecure again very quickly and feel the need to check again. And again. And again ...

It becomes even more problematic if these checks multiply. At her practice in Bremgarten near Bern, Brunner regularly sees patients who develop very specific rituals that they have to perform before they can do anything else. “Over time, those affected don’t just feel the need to check whether the kettle is off, they eventually have to pull out the plug, too. And at some point, the cable will have to be placed at a specific distance from the socket to make sure it’s safe.” The problem escalates from there. Compulsions of this kind are often extended to other appliances, too. Doors. Light switches. And so on and so forth. In the worst cases, it can take the sufferer hours to check everything. “OCD sufferers get to the point where they plan their whole life around their compulsions until, eventually, they can’t even leave their own house.” 

Cause of OCD still unclear

Obsessive-compulsive disorder takes many different forms. A distinction is drawn between obsessive thoughts and obsessive actions, depending on whether thoughts or actions are involved. These can be associated with violence, dirt and contamination, order, sexuality or religion, for example. Obsessive-compulsive disorder occurs in all cultures and affects both men and women equally. In almost one-fifth of all those affected, the disorder develops before the age of ten. However, it is often diagnosed much later.

Medical science hasn’t yet identified a clear cause for OCD. However, research projects have found that genetic factors may play a role. If one or both parents have OCD, there is a higher risk that the children will also be affected. Nevertheless, neurobiological factors seem to play a more important role than genetics. Researchers at the University of Würzburg in Germany found that the absence of a certain protein in the body can lead, for example, to repetitive ritualised behaviour, such as washing your hands or body time and time again. Normally, the protein inhibits one of the cell’s important signal pathways. When it is missing, this signal pathway is more active than usual, which can result in obsessive-compulsive behaviour in humans.  

A compulsive disorder can be treated through therapy.

The earlier you get help, the better your chances of beating it. “Cognitive behavioural therapy can help replace dysfunctional thoughts with functional ones,” explains psychologist Sibylle Brunner. To do so, those affected are guided and accompanied by a therapist as they expose themselves to situations and stimuli that trigger their compulsive behaviour. This helps them learn how to handle their anxiety and tension in a targeted manner. “It can take time, but the chances of recovery are very good,” confirms Brunner.