Writing Obsessive-Compulsive Disorder

Frequent handwashing can be a sign of a person who is struggling with OCD

Obsessive-Compulsive Disorder (OCD) is characterised by the compulsive and repetitive performing of ritualistic behaviours intended to reduce anxiety. It’s a relatively common condition, and may not be as distressing as some of the others in this book, but a character with it will still be a striking one. This article looks at how to write believable and engaging characters with this condition.

An obsession is a pattern of thoughts that persists despite a conscious effort to get rid of it. These obsessions frequently cause anxiety, especially when they relate to lurid sexual or violent content, as they often do. Some other obsessions can border on the schizophrenic. God and the Devil are frequent subjects for obsessions, especially as pertains to future punishment for some misdeed.

These sort of thoughts can become highly intrusive and maddening in their persistence and the degree they distract from a normal life. If your protagonist has OCD, they might have a distressing interior monologue where anxiety and thoughts of decay and contamination are commonplace. Intrusive thoughts can be just as unpleasant as physical intrusions, especially when they come into the head when you’re trying to sleep or relax.

Compulsions are similar, only they relate to behaviours instead of thoughts. The classic example is compulsive hand washing. Others are compulsively checking that a door is locked, or that a stove is turned off. The person with OCD tends to worry about whether or not something is in correct order and this anxiety increases until that thing can be checked.

A person with OCD will usually be aware that they have a problem. This makes them different to psychotics, narcissists and psychopaths. A character with OCD might not necessarily be an outcast (or at least, not a true outcast), in contrast to the vast majority of characters inspired by this book.

Psychologists talk about a four-factor theory for understanding people with OCD. Essentially this is based on four groups of behaviours. There is a “symmetry” factor, a “forbidden thoughts” factor, a “cleaning” factor and a “hoarding” factor. If the protagonist of your story is or encounters a character with OCD, they will quickly notice one of these groups of behaviours.

The symmetry factor relates to an anxiety-driven compulsion to make everything balance in terms of symmetry. For instance, they might make sure that they take exactly the same number of steps to cross each segment of a repeating pattern of cobblestones. They might also be very fussy about books on a shelf or paintings on the wall lining up perfectly. Every left needs a right and vice-versa.

The forbidden thoughts factor relates to compulsively thinking about things only because one knows one isn’t supposed to. A character with OCD might start having frequently, intrusive, obsessive thoughts about a particular sexual fetish or situation, despite not finding it arousing (more the contrary). Thoughts of incest, pedophilia and homosexuality are all very common here.

Cleaning is probably the best-known of the common symptoms of OCD. The cleaning factor refers to how people with OCD are prone to quickly decide that something is contaminated and needs to be cleaned. For instance, just touching the ground might cause immense anxiety until the OCD sufferer washes their hands. Because there are thousands of potential contamination vectors, people with OCD often end up washing their hands dozens of times a day.

Hoarding is common but not often understood to be a symptom of OCD. Underlying this is often an anxiety about information being lost, and so the hoarder might hoard, for instance, a daily newspaper. The really clinical OCD comes into play when that person doesn’t want to get rid of what they’ve hoarded, even when it becomes a hygiene or fire risk.

It will be easy, if desired, to write sympathetically about a character with OCD. Usually people with the condition are regarded as eccentric rather than malicious. People with OCD don’t tend to take their suffering out on other people, although they can do if those other people prevent them from acting out their compulsions. Hoarding can, of course, lead to malicious behaviour, especially if the space in which the hoarding occurs is contested.

OCD can certainly feel malicious to a person with it, however, especially if the impulsive thoughts don’t give the person any peace. It’s common for impulsive thoughts to come at times that feel especially intrusive, like when trying to sleep or when making love. When this happens for long enough it’s possible to consider that a malevolent demon or entity might be causing them, although this is uncommon.

In contrast to most of the conditions in this book, OCD is not believed to be caused by trauma. The most generally accepted belief is that people with OCD have likely inherited an unusually high genetic propensity towards certain behaviours that were associated with survival in the past, such as checking for dangers and being meticulous about hygiene. A person with OCD is, by this reckoning, usually just hyper-vigilant.

For this reason, a character with OCD is likely to be doing considerably better than the a character with most other conditions described in the book. They might even be in a form of gainful employment where an extremely unusual level of meticulousness and cleanliness were advantages, such as surgeon. Certainly it is more likely that they will have a circle of compassionate friends than people with most other psychiatric conditions.

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This article is an excerpt from Writing With The DSM (Writing With Psychology Book 5), edited by Vince McLeod and due for release by VJM Publishing in the summer of 2018/19.

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