The following is the transcript for the video by the same name on my channel “What I’ve Learned,” originally posted on February 23rd, 2017.
My first encounter with Obsessive Compulsive Disorder was Nicholas Cage’s character in the movie Matchstick men who apparently has a combination of OCD and tourette’s syndrome. The jerking motions and vocal outbursts were due to the tourettes and the obsessive cleaning and things like locking the door multiple times was due to the OCD. Though we only see these behaviors when he forgets his medication, and otherwise he’s a smooth and successful conman.
Now, I personally don’t have OCD and frankly the term seems to be used lightly too often. Anyone who actually has OCD most likely does not openly admit it. A lot of people don’t realize how serious OCD can be. Lightheartedly saying “I’m so OCD!” because you like to keep your desk really tidy is almost like like saying “I’m so leukemia!” because your nose is runny.
What I’m interested in is how the brain of somebody with OCD works so I can figure out how to deal with a less dire but very annoying behavior of mine.
Some mornings, I’ll already be 5 minutes away from my apartment and will suddenly think “Wait, did I lock the door?” usually followed by “Oh crap I probably left the coffeemaker on too.” I know I just have to rush back and check or it will bother me for at least the next hour or so. This happens maybe three times a week and every single time I go back to check, the coffeemaker was off and the door was indeed locked.
Luckily going back and checking like this is enough and I can get on with my day after that. But I was curious, what happens in my brain that makes me do this, and how is it different from someone who has for example the compulsion to lock and relock their door 50 times just so they can feel comfortable?
Well, there are three parts of the brain that come into play here. A part of the frontal lobe called the orbital cortex is responsible for detecting when you think you’ve done something correctly and when you think you’ve made a mistake. E.T. Rolls, a behavioral physiologist at Oxford University found that the cells in rhesus monkeys’ orbital cortex would fire when the monkey performed a task properly and was expecting some juice as a reward. However, when the monkeys performed the task properly as they were instructed but got salt water instead, the orbital cortex lit up much more intensely and stayed lit up longer. The conclusion was that the orbital cortex is your brain’s error detection system: In general the strong firing of the orbital cortex gives you a feeling of “something is wrong”.
After the orbital cortex fires, it sends a signal to another area called the cingulate gyrus which triggers an anxious feeling that will make you uneasy until you do something to correct the mistake. Then, once the mistake is corrected, a third area called the caudate nucleus activates and acts like an “automatic gear shift,” allowing you to switch gears, forget about it and get on with other activities. In my case, I thought something was wrong and felt anxious until I went back and checked on the door, then my gear shift and I got on with my day.
Brain scans of OCD patients show that all three of these brain areas are hyperactive. This means the “something is wrong” feeling and the anxiety that comes with it are abnormally strong. So even with incredibly trivial imperfections in something like say the fibers on a carpet, the OCD afflicted person feels that a terrible mistake has been made and the consequences will be absolutely horrible unless something is done. This is why OCD can result in such irrational obsessions like “If I don’t vacuum the carpet 5 times, my parents will die.”
As Norman Doidge explains in The Brain that Changes Itself, what happens in people with OCD is that their gear shifter, “the caudate [nucleus] becomes extremely ‘sticky.’ “ He says that “The malfunctioning caudate [nucleus] is probably overactive because it is stuck and is still being inundated with signals from the orbital cortex.” This means that even if the person does something to correct the mistake their brain is detecting, that feeling doesn’t go away – their brain can’t shift to the next gear and they stay very anxious. Most people who have OCD are actually aware of the fact that their worries and behaviors are completely illogical, but since the orbital cortex and cingulate gyrus are stuck in the ON position, they are strongly compelled to repeatedly attempt to correct the imaginary mistake.
UCLA Research Psychiatrist Jeffrey Schwartz calls this situation “brain lock,” and in his book titled Brain Lock he describes a very effective behavioral therapy for OCD.
To understand it, let’s look at hand washing, a common OCD obsession. In someone without OCD the caudate nucleus will register that you have solved the problem of dirty hands by washing them and will then automatically “shift gears” so you can forget about it.
In the behavioral therapy, when an OCD patient has the urge to wash their hands again even though they’re already clean, they are to first mindfully acknowledge that the urge to do this is simply a result of a faulty circuit in their brain, and that nothing bad will actually happen if they don’t wash their hands again . They then have to manually shift their gear by right away doing some other constructive activity for as long as they can. The urge to give into a compulsion is usually overwhelming so Dr. Schwartz recommends to start by waiting at least 15 minutes before giving into it and then expanding that time day by day. With consistent practice, this manual gear shifting becomes an automatic habit to where when the urge to do some compulsive behavior arises, their immediate reaction is to first identify the compulsion as simply the result of brain lock and then move on to another activity.
Brain scans of OCD patients’ who used this behavioral therapy showed that after a while the problem causing hyperactive caudate nucleus in the brain had actually become less active compared to before therapy. As Dr. Schwartz says “We can now say we have scientifically demonstrated that by changing your behavior, you can change your brain.”
I didn’t realize it at first, but this was essentially the strategy I used back when I was quitting sugar. Whenever I got an urge to go buy some sweet garbage from the convenient store, I stood up, set a timer for 20 minutes and started reading something. Sometimes I would give in and buy the snack after the 20 minutes were up, but I just made sure to increase the time on the timer each day. Pretty soon I was setting the timer for an hour; and after a while the immediate message in my head transformed from “I want sugar, time to get some snacks” to “I want sugar, time to stand up and read”.
Alright, so back to my door double checking issue. As someone with a properly functioning caudate nucleus, what’s the solution to keep me from wasting my time? As Norman Doidge explains, “we often check and recheck [things] without really concentrating,” so he suggests to perform the very first check with the utmost care.
If you’re moving so fast during your morning routine without paying attention and being distracted by something like an audiobook as I often am, the “problem solved” circuit doesn’t get processed when locking the door the first time and the gear in the brain doesn’t turn. By simply taking a moment to slow down and be aware of what I’m doing as I check the coffee maker and head out the door, I now no longer get the urge to go back and check again later. Getting my lost 15 or 20 minutes a week back is nice, but more importantly for me it’s nice to no longer be asking “what the hell is wrong with me?”