OCD has a couple of core characteristics that stretch across all dimensions, and also across numerous disorders in the wider spectrum of OCD. A strong desire for perfection is one of these. The patient has a hard time dealing with things and situations that are not 100%, so to speak. A fitting term has been coined for these feelings: not-just-right-experiences (NJRE).
Take Iris, my proverbial patient with a strong contamination/washing obsession. She was awfully afraid of germs. She even took a strong detergent for cleaning windows into the university library, and she did as much as she could to hide this. She sought out the most distant, almost hidden PC to work at, because she did not want anyone to see her little ‘ritual’: she scrupulously cleaned the keyboard of that PC with the liquid, and dried it afterwards with new tissues, many of these. This sole act cost her 15 minutes. It was one of many she had to perform during the day, to ward of those feared microbes. One time, a library worker saw her doing this. She approached Iris and asked what she was doing. Iris suddenly went into panic, mumbled something about the keyboard having been kind of dirty, and fled the library.
This example illustrates in a couple of sentences how the impact of OCD can be. Unbearable fear, unusual remedies, and even then extreme anxiety is always on the horizon.
In brief: Iris placed unreasonable demands on herself, she strived for a degree of perfection that is not attainable in normal life. And this eventually worked against her in a horrendous way. Her studies, her career, her relationships, her hobbies, in short: her quality of life was greatly impaired.
Now consider a couple of disorders that are closely linked to OCD. I give you: body dysmorphic disorder, and anorexia nervosa. These two are related to the perception of one’s own image. In body dysmorphic disorder (BDD), the patient experiences very unsettling feelings about a part of his/her body – it ‘just doesn’t look right’, it’s ‘not up to standard’. Could be a slightly tilted nose, could be freckles, could be the chin that is not absolutely standard… it could be anything.
You may say: but everyone has little complaints about their bodily appearance? That is true. But BDD is the case when a perceived imperfection becomes all-dominating in one’s life. The patient may spend more and more time in front of the mirror, trying to judge what is experience as being wrong; fears about the fault in the body take over all attention for too long a time at a stretch; and the next step may be obsessing over the plastic surgery that may be deemed absolutely necessary. Patients may spend enormous amounts of money on facial reconstruction, for instance. In my opinion, pop star Michael Jackson was a good example of BDD. Everyone who sees pictures of the younger Jackson, pre-surgery, will attest that he was a very handsome fellow. But obviously, Michael did not feel like that himself. And that is sad.
Here are two photos of Michael Jackson. They speak for themselves. I really hesitated some time in putting them up here, because I find his cosmetic decisions tragic. But since these pictures are out in the open worldwide, I thought I’d give it a go. See what fame can do to you… perhaps no one at all dared to speak up to him about it , to make him think.
On a personal note: I find the modern craze about having big, big breasts completely incomprehensible. Why? Because I find small breasts delightful and superbly attractive. Which make it odd for me to see how so many women in Western culture spend so much money on breast enlargement with implants. Apart from the risks involved: why should women aspire to unnaturally large and highly similar breasts anyway? Aesthetics only thrive by interpersonal differences in this area – well, that is my opinion…
Anorexia nervosa (AN) is another disorder close to ‘pure’ OCD. It is a spectrum disorder that predominantly affects girls and women. For one reason or another, the patient thinks she is too fat, she would be better off if she would be able to lose considerable weight. Therefore, she starts fasting. This in itself is a fairly normal form of behaviour. But as in all forms of OCD and OCD-like disorders, the actions get out of hand, slip out of control (think about the term: ‘lack of inhibition’). The patient may become thin, and then emaciated. She will try to hide her habit out of shame. She may pretend to carry a full lunchbox with her to work, only to throw away those sandwiches and that fine salad in the garbage bin as soon as she arrives there. She may get hold of substances that help to lose weight by suppressing hunger, such as amphetamines. Eventually, the damage done will present itself in the form of menstruation having ceased, and an ever-increasing feeling of tiredness and depression. But stopping the AN habit may still be impossible. In the end, a fatal heart attack can occur.
Modern society has certainly some very bad sides to it, in relation to the disorders described here. Hard, uncompromising commercialism hammers the same messages across through almost all media, on a daily basis: you’re only good if you look like a film star; your body must absolutely be perfect; imperfections make you an undesirable person; therefore, you must buy our product. If you don’t, you are a loser.
I myself always have to laugh out loud when I see one of those TV commercials for skin cream, notably when they are of French origin. The French have a peculiar habit of wanting to substantiate their claims with ‘scientific proof’. And thus it can happen that a certain brand of beauty milk states that it will ‘decrease your eye wrinkles by 34% in a mere 3 weeks’. Yes ma’am! (…and in this make-believe world, women are really prepared to shell out their hard-earned money in spades to purchase said lotion; and they even may experience sort of a placebo effect: they believe that their wrinkles became less prominent in 3 weeks, and keep on buying the stuff).
But to be serious again: the negative impact of all that commercial pressure should not be underestimated. OCD, and OCD-like patients tend to harbour intrinsic feelings of guilt, shame, and also experience an excessive feeling of imperfection. Modern mass culture only aggraves those feelings. Perhaps guilt and shame initially are ‘undefined’ in a patient. But if the right buttons are pressed in their minds, so to speak, these feelings may focus on perceived imperfections in the body.
It is intruiging that at present, some researchers think that BDD patients have a visual deficit, in that they have problems with ‘perceiving the whole’ of their face, for instance. For them, their face is not an entirety shapewise; they have to scrutinize parts, even very small parts one at a time, and thus can become really anxious when they see a tiny zit somewhere.
The story of the visual system in OCD, however, will be told at another time.