For most of my life, I knew I had Tourette’s Syndrome. At some point, in my Tourette’s journey, I learned that people with Tourette’s often have comorbidities of Attention-Deficit/Hyper-Activity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD). But I never in a million years thought those comorbidities applied to me. I was well into my 40’s before I learned that they very much apply to me, and that those comorbidities had profoundly affected my life.

Comorbidities, despite the dreary sounding name, is simply a term used in the medical field to identify medical conditions that exist simultaneously with other medical conditions. Sometimes science is able to clearly understand why the connections exist, and other times science can only identify correlation, but no causation. In the case of Tourette’s and ADHD/OCD, science’s best theory is that it has something to do with brain chemistry and neural networks. Despite the relatively small size of the brain, understanding it is an enormous task, and one that humans are just starting to scratch the surface of.

It was primarily the stereotypes, and stigmas, of ADHD and OCD that prevented me from considering them as components of my own mental health. I didn’t know much about ADHD, but I wasn’t bouncing off walls (in retrospect I can see it though), and I wasn’t on Ritalin (probably should’ve been), so I figured I didn’t have ADHD. Stigma. Turns out there is SO much more to ADHD and we’ll talk about that in another post, for now we will keep our focus on the OCD. In my limited knowledge of OCD, I thought it meant that a person washed their hands until they were raw or stood at a light switch flipping it on and off a certain number of times. OCD can be this, but I have learned that OCD is like a giant tree with many branches. Like that picture of the iceberg where we see just what’s above the water, but so much more is going on that isn’t as visible.

OCD, in simple terms, is characterized by excessive thoughts and fears (obsessions), that lead to repetitive behaviors (compulsions). This basic definition is what I refer to as the trunk of the OCD tree. The branches are all the different thoughts and fears that the OCD brain grabs onto, and those branches are as vast as the human imagination. People with OCD can experience one or more of the branches at a time and they can even jump to different branches throughout their lives. 

One of the more common branches (obsessions) that you might recognize is contamination, or germ, OCD. This is a common obsession because it an easy one for the OCD brain to grasp. Germs are everywhere, and it doesn’t take much effort for the brain to identify germs as a threat over which it can obsess. The obsession becomes so intense for the person with OCD, and the fear becomes so debilitating, that compulsions are formed in an attempt to “neutralize” the threat. For a person with contamination OCD, the compulsions might present as excessive hand washing, or sanitizing. The compulsions can also present in more subtle ways, such as avoidance. Examples of avoidance can be: not going to public places, not touching handrails, not wearing shoes in the house, throwing out food that is at or near “use by dates”. You might be thinking, “I do that- does that mean I have OCD?” Probably not. It is when the obsession and compulsions become “excessive”, and debilitating to our daily lives, that we are entering the realm of OCD. This determination should be made with the guidance of a mental health professional. 

A personal example that comes to mind is not allowing meats to touch produce when I am grocery shopping. Because of my OCD tendencies, I can be obsessively careful when placing items in my cart to make sure that meat products are well spaced from produce items. Sometimes, when my cart gets full and chaotic, like during those Costco trips, I start to worry that the contamination barrier between meats and produce might be threatened. I recognize at that point that I have a strong “compulsion” to stop my shopping, even if I’m running late or plugging up traffic in an aisle, to completely empty and reorganize my cart in a way that will ensure the meat and produce are “properly” separated. I even consider putting the meats down below the cart- but then I obsess about floor germs contaminating the meat- and round and round I go. Obsessive-Compulsive Disorder. 

What do I do when these obsessive thoughts and fears get wrapped up in the OCD cycle? I practice mindfulness and ERP (Exposure Response Prevention). ERP is a “gold-standard” OCD management technique that I will explore in greater depth in another post. In my shopping example, the mindfulness step would look like taking a breath, or a few, and getting present with myself and my surroundings. Once grounded, I would move onto the ERP. In this example, I would keep shopping. I would leave the cart as is, knowing the possibility of contamination exists. This is the “Exposure”. The “Response” is my anxiety level rising because of the fear of contamination. The “Prevention” is me preventing myself from doing the compulsion of stopping my shopping to reorganize the cart. It is me embracing the uncertainty of possible contamination and all that might mean. Again, more on this later, but essentially, I am reprograming the neural pathways of my mind to teach my brain that this “threat” is not as big of a deal as my brain has made it out to be.

Why does the OCD brain do this? Why does the OCD brain obsess on these threats so much that is drives a person to compulsions? To keep us safe. The why’s and how’s of how it gets to that point are vast and varied, and scantily understood by modern science. Ultimately the OCD brain wants to keep us safe, and it gets hypervigilant about doing so. 

Some other common themes of OCD that I will dig into in future posts are Harm OCD, “Just Right” OCD, Hoarding OCD, Sexual Orientation OCD, Pedophilia OCD, “Hit and Run” OCD, “Real Events” OCD. Some OCD themes that have been particularly present in my own life, that I look forward to exploring with you are: Relationship OCD, Religious OCD (also known as Scrupulosity), and Pure OCD.

So many different branches, right? But remember, all the branches stem from the same trunk: excessive thoughts and fears (obsessions), that lead to repetitive behaviors (compulsions).

Learning about OCD in my own journey has been life changing. It has helped me to recognize and manage a variety of anger, addiction, and avoidance issues that plagued my life for far too many years.

Disclaimer: I am not a licensed or trained mental health professional. I am writing from my own research and experience. If you are concerned about the health of yourself, or a loved one, please seek the advice of a mental health professional.