Obsessions, Compulsions, Perseverations, OH MY!

Obsessions.  Compulsions.  Obsessions.  Obsessions.  Obsessions.  Compulsions.

Obsessive Compulsive Disorder (OCD) or characteristics thereof often accompany a diagnosis of Autism.   Obsessions refer to thoughts, and Compulsions refer to actions or behaviors that usually occur because of those thoughts. 

Obsessive thoughts in OCD are not like the typical worries and anxieties one experiences on a regular, healthy level.  Instead, they cause the person excessive anxiety and stress, are illogical or unrealistic, and are unwanted.   The thoughts will not go away and intrude upon the person’s life.   One example of an obsession that people might commonly think of is a fear of germs.     

Some other examples of topics of Obsessions are:

Fear of losing people

Fear of contamination

Fear of losing security

Fear of losing things

Fear of hurting self

Fear of hurting others

Fear of losing control

Perfectionism

Intrusive words or sounds

Religious thoughts

Superstitious ideas (lucky numbers, certain colors)

To compensate for these thoughts, people with OCD or related conditions feel compelled to do certain things.   For example, a person who has a fear of germs may feel compelled to wash their hands over and over again.   This wouldn’t be a person who has just gotten something sticky on their hands or who has just handled raw chicken.   Washing one’s hands under those circumstances would be logical.   But the person with OCD would feel that they HAVE to wash their hands constantly, sometimes hundreds of times a day, to the point that their life is disrupted by the activities they feel they have to perform.   Although not always a healthy practice, the acts of completing the tasks provide security and understanding and help the person experiencing obsessive thoughts cope with their anxiety. 

Some other examples of Compulsions are:

Arranging things

Ordering things

Following routines

Counting (out loud or silently)

Checking (checking locks, checking on people)

Picking skin or pulling hair

Hoarding things

Tapping

Mental tasks, such as praying or repeating words or phrases to oneself

Here is an account from one of my students on what it is like to be compelled to pick at one’s skin:

“In high school I started a new bad habit of picking at pimples. The most common place i would do this was on my arms. My excuse for why there were so many bumps on my arms was they were bug bites. If they were still skeptical i would say have you ever been to my house you have no idea how many mosquitoes there are there. But only I and a few others knew the truth.”- Social Skills Student

Another term used in the world of Autism is “perseveration.”  Perseverations are thoughts and behaviors that are repetitive in nature, and are thought to occur because of the brain’s inability to switch tasks. 

Perseveration, perseveration, perseveration.  Perseverations are related to obsessions, but unlike true obsessions they are somewhat desirable.  This includes topics of restrictive interests.  For example, a person with Autism might appear to be obsessed with trains.  Unlike a true obsession, in which the thought is undesirable, this is a perseveration.  The person enjoys thinking about trains and there is no fear involved associated with about this topic.   Only when the perseveration begins to interfere with the person’s daily activities and functioning does the perseveration become harmful.  The following is an excerpt from one of my students about a perseveration:

“I had a computer game called Darkspore. I had been played it for a long time. It has a ton of heroes, enemies, adventures and bosses. It was the coolest game ever. I was the great game master of Darkspore. Sometimes I became fixated and obsessed with the game.”- Social Skills Student

Part of my Autistic experience includes a lot of compulsions.  My compulsions include skin picking, following routines, ordering and arranging, repeating words in my head, counting in my head, and checking.  The obsessions that cause my compulsions are related to the need for order and stability, and the fear of my world being out of control.   I also experience perseverations.  I perseverate on things until I either obtain the desired item or experience, or until the situation resolves itself.   Some things I might perseverate on include going on an anticipated vacation, getting a new backpack for school, or playing a new video game.   I enjoy the experience of thinking and talking about those things (but I am also aware that when I perseverate on something for too long I can begin to annoy others). 

 Here are some examples of how I seek order in my world at work.  I feel compelled to complete and color code my calendar, and to keep my bookshelf tidy and in order.  

If you know someone who exhibits characteristics of OCD, please recognize the importance of their behaviors.   Show them understanding and patience, and try to help them through their rough times.   While it may be annoying to you in the moment, it can be terrifying and painful for the person who is experiencing obsessions and compulsions.