Oh yeah, I was going to write about OCD/OC spectrum (because I went to the International OCD Foundation's annual conference over the summer and it was really interesting)! So, OCD: persistent, unwanted thoughts plus repeated, undesirable actions in order to reduce the anxiety caused by those thoughts, but the actions have no logical connections to the thoughts or are excessive. OC spectrum: includes everything from eating disorders and Body Dysmorphic Disorder to pathological gambling and trichotillomania (hair pulling) and even autism and Tourette's Syndrome. All characterized by varying degrees of impulsivity and compulsivity. Say what? Basically, an impulsive behavior is one that provides pleasure or gratification, and a compulsive behavior is one performed to reduce anxiety. The two represent opposite ends of a spectrum (impulsivity is associated with decreased frontal lobe and serotonergic activity, while compulsivity is associated with increased frontal lobe and serotonergic activity), but they both refer to an inability to delay or inhibit repetitive (and ultimately unwanted) behaviors.
To illustrate, let's look at the completely random example of skin picking. I have concluded by highly unscientific measures that most people have popped a pimple or picked at a scab at some point in their lives. It's not hard to see why--you have a blemish, you get rid of it, you feel better. And for most people, it stops there. For some, however, there's more work to be done. If you look really closely, you can see tons of little blackheads on your face, and you must get rid of all of them if your face is to be truly clean. If doing so takes an hour and results in severe redness, so be it. At this point, picking is more than a bad habit--it is a compulsion.
The healthy majority who occasionally pick may even admit getting a sense of gratification from the activity--not just the satisfaction of knowing that you eliminated an imperfection from your skin, but the actual sensation of doing so. You may even look forward to the time when a pimple has grown enough so that you may pop it. But do you actively seek these opportunities, searching your skin for any little bump that you may squeeze in order to experience that sensation again? If so, then you may have an impulse control disorder.
Hold up now. Searching for blemishes? That sounds more like compulsivity. Indeed, searching might be a compulsive element that develops from an impulsive activity. And the impulsivity may evolve in the first place from compulsivity--the discovery of a pleasurable activity resulting from an initial desire to reduce anxiety. But now, are we talking about anxiety caused by the imperfection, which may be reduced by eliminating the blemish? Or anxiety from some other source which may be temporarily reduced by engaging in a pleasurable activity such as picking? And which of these corresponds to impulsivity and which to compulsivity? These questions are popping up as I write this, and honestly I'm not sure what the answer is. All I really know is that this stuff is complicated. And really interesting, in my opinion.
If any of this hits close to home for anyone, there's lots of help out there, including these online support groups: http://health.groups.yahoo.com/group/OCDSupportGroups/links
I will also try to answer any questions you may have. You can even comment anonymously!
Also, this is not related to OCD but it's related to mental health: See the movie It's Kind of a Funny Story for an honest, humorous, sensitive look at mental illness. Not that I'm an expert on mental illness, but I hope to be one someday. And I know that a big part of being an expert will be acknowledging that people are individuals, and I can never fully be an "expert" on anyone other than myself. A big part of understanding OCD, OC spectrum, and other mental health problems is putting aside preconceived notions about how people think.
