Obsessive-compulsive disorder - When brushing becomes an addiction
She leads a long fight against disgust and fear. And she wins him
Knock off shoes, take off their clothes, brush their soles, wipe them, put them on a rag. Sabine Köhler * was under stress when she closed her apartment door after work. The whole day in the office she had made lists, which was in addition to the usual evening cleaning routine at home. Twice a week were the kitchen windows and the stairwell. Sofa pillows, shelves, windowsills and TV were dusted daily, the bed borders were wiped and wiped wet, the bath was scrubbed, rinsed, scrubbed and rinsed again. Everything in the right order and finally again, it could be that she had forgotten a corner. Always the same procedure, every operation was ticked off the list. Before her partner came home, Sabine had sucked the whole apartment, many square meters even two or three times.
Sure, that was nonsense, some laughed and said: "You with your cleaning!" Sabine laughs a little defiantly: "I hate cleaning!" and raises her hands over her head defensively. If only she could have done otherwise! But she suffers from an obsessive-compulsive disorder. For 30 years. The 45-year-old woman with the pretty blond pageboy, discreetly made-up, has completed a behavioral treatment in the Münster-based Christoph Dornier Clinic and hopes that she has her constraints under control, does not do what she does not want to do.
OCD - The dark figure is high
More than one million women and men in Germany obsessively do things and suffer from it. This can be cleaning, hand washing or showering out of panic fear of germs, mold or dirt. Others control the lights in endless loops, whether the stove is switched off, others feel forced to count, stairs or windows, to collect and repeat things. In women, the compulsory cleaning predominates, in men the control compulsion. Dr. Schide Nedjat, the medical director of the Dornier Clinic, reports on patients who drive a car but constantly think they are driving at someone. For every reason they turn around and search the route again and again after the supposedly injured. The unreported number of those affected is high, most are ashamed of their constraints, but can not resist. In contrast to anxiety patients, obsessive-compulsive patients do not avoid unpleasant feelings - they actively displace them by nonsensical or exaggerated rituals, orders and rules, substitute actions. "Crazy in your right mind," they describe their illness, in which perception, thoughts and actions no longer fit together.
* Names have been changed by the editor
Sabine is excited as she tells. During the day in her job as an administrative assistant, she managed well, apart from her cleaning lists. But as soon as she entered her own four walls in the evening, hell began. For decades, she could think of nothing but dirt that needed to be wiped clean. Every evening the same rituals. Sabine's obsessive-compulsive disorder started in puberty. "Creeping," she says, she can not remember a trigger. The pressure in school maybe, she was not a good math student, but blindingly in German. "I always wanted to please everyone", she was not blessed with a "healthy" self-esteem. She also did not trust her own opinion, for that she was neat, correct, punctual, inconspicuous - too much, eventually exaggerated. Already at the age of fifteen, she recalls, dusting her daily, cleaning the bathroom and loo and forbidding her parents to use it afterwards. She sensed that something was wrong with her behavior. Instead of being praised for her eagerness to expose, she was reprimanded. And while other mothers scolded about the messiness of their children, her complained about the daughter's cleaning.
The border between "normal" cleaning and compulsive is a tightrope walk
"Cleaning" sounds harmless. But the border between "normal" cleaning and obsessive is a tightrope walk. "When the environment begins to annoy you, even though you just want to do everything right", Sabine defines the alarm signs of an obsessive-compulsive disorder. Often such a disorder begins in adolescence. Unnoticed, some constraints disappear again; others may be accompanied by depression or anorexia. "If young people are emotionally and psychologically overwhelmed during difficult life stages, obsessive-compulsive disorder may develop," says Schide Nedjat. The young people are under pressure but do not talk about their feelings. They hold on, unspoken fears are restrained by obsessive thoughts and ritual acts. If this behavior manifests itself, the affected person quickly integrates his immediate surroundings, often with relentless severity.Parents and siblings are induced to go on laundry worries; Friends should check to see if doors are locked properly, or wait until steps have been counted and certain patterns on a sidewalk gone. At the latest then, the compulsion can no longer be overlooked, professional help would be necessary says Schide Nedjat. Others should by no means go into it, but counter it, even if it leads to violent conflicts. At the beginning of her illness, sufferers are still aware that their behavior is "abnormal". But while not compulsive people would reconsider their "cleaning", people with obsessive-compulsive disorder persist stiffly and firmly.
When her friends went to the movies, she scrubbed the hallway.
"Either you or us," it was said when Sabine was 21. Her family could not keep up with her and sought her a flat. This would have been the right time to visit a psychologist. But Sabine felt rejected, "involuntarily," she says, when she moved out. She did not want to give up her cleaning, "and at some point I thought that brushing just belonged to me". Although Sabine always lived in relationships, she has withdrawn anyway, settled down at home in her cleanliness delusion. When her friends went to the movies, she scrubbed the hall, and when her partner played football, she polished the bathroom fixtures. If he stayed at home and wanted to watch TV with her, at most she was leaning against the door with the cleaning rag. Sweatbathing for fear of not being able to run their program.
Cooking did not work, because "cooking makes a mess". Eaten was incidentally. If her friend wanted to prepare a warm meal in the evening, there was a fight. "As soon as he got a plate out of the closet, I became aggressive." Likewise, when he showered, shaved, brushed his teeth. "Sex only in places that could be thoroughly cleaned afterwards." Preferably in the bathroom, where she wiped the tiles several times a day anyway. Once you slept in bed with one another, then like on hot coals, until it could be changed. "At first we thought we could do it together if we just love each other enough." But soon her friend went to the ceiling, if he only heard the "Pffft" the detergent bottle.
People who live long in constraints, lonely. No disco after closing time, Sabine could never spontaneously leave for the weekend, that would have messed up their cleaning program. Invite friends or family was out of the question. Once Sabine has overcome and organized a Sunday brunch. But any bread crumb that she could not immediately move away gave her panic and a bad mood. The next day was of course reserved for cleaning. "The longer you have the constraints, the more they expand," says Schide Nedjat. In many of their patients, 80 to 90 percent of the time of day is occupied by obsessional thoughts. This results in neurobiological changes in the brain. For the first therapy therefore also medicines, so-called serotonin reuptake inhibitors, are used meanwhile. But it usually takes a long time to start treatment. On average, seven to 14 years pass. Too great is the shame to face your own nonsensical behavior patterns.
Sabine was 30 when she first consulted a naturopath. In the following group and individual therapies she learned to talk about her compulsions, so they did not disappear. But become more aware: "At some point I had the feeling that the blow job keeps me from life." Their partnership threatened to fail. "We live together, but I'm still alone," complained her partner. This got under the skin, Sabine did not want to burden her partner any longer and sought a clinic for inpatient therapy. It took a couple of months and a lot of overcoming power before she could trust her employer and take the paperwork hurdles for health insurance. "But worst of all," she says, "is to endure the idea that there would be a lot of filth left in my absence at home." But she did it for four weeks.
Almost a little proudly she tells how she has learned in more than 80 individual behavioral therapy exercises to put her handbag on wet streets and to hang them again, despite disgust, uncleaned over his shoulder. And how she had waded through the mud with the therapist on the Münster promenade. A walker was happy and called "like the children". Sabine herself was not pleased, but tense to the tips of her hair. His pulse pounded, his hands tingling, sweat on his forehead. She also practiced with the therapist at home: opening the windows, rummaging the bed, cooking in pots and pans, bathing in the bathroom. The confrontation exercises, as psychotherapy says, were tough, but Sabine overcame fear and disgust, over and over and over.
After being released from the clinic, Sabine received telephone support from her therapist for another six weeks. In the meantime things are going well, except for minor relapses. It still has a "cleaning plan", but it has shrunk considerably.In addition, there is now a "leisure plan" on which is also a delicious self-cooked dinner.
More information about obsessive-compulsive disorder
German Society for Obsessive-Compulsive Diseases e. V., PO Box 70 23 34, 22023 Hamburg, www.zwaenge.de
Christoph Dornier Foundation for Clinical Psychology, Salzstr. 52, 48143 Münster, www.christoph-dornier-stiftung.de
Christoph-Dornier-Klinik GmbH, Tibusstraße 7-11, 48143 Münster, www.c-d-k.de
