Should knowledge be controlled

Obsessive-Compulsive Disorder: When Control Becomes Obsessive

"Even though I hadn't used the stove at all, I touched every plate to check that it was off. After all, I had to keep saying to myself: 'off! Off! Off,' says Michaela (Name changed by the editor).

Two on the right, two on the left

Even as a child there were rituals that she always had to adhere to and from which she could not deviate. There were things that just weren't 'allowed'. She was sure of it. Every evening it was exactly the same procedure: the parents always got four goodnight kisses on each side, no more and no less. That number was fixed, as if it were set in stone. "Two on the right, two on the left and then the other way around: two on the left, two on the right," is how Michaela describes the beginnings of her compulsion to control.

Today she is 48, her control obligation has remained. Everything still has to be exactly the same with her. On her yoga mat she lies exactly in the middle, with exactly the same distance to the right and left. "If I scratch my right, I also have to scratch my left," says Michaela.

To many, this might just sound strange or exaggerated. But it is a serious mental illness that is not easy to diagnose. "There must be an impairment in everyday life, either in professional life or in the social area," says Andreas Wahl-Kordon, Medical Director of the Oberberg Specialist Clinic in the Black Forest.

Symmetry is often very important for people with OCD

"An important criterion in the diagnosis is the length of time, the obsessions or the actual occupation with it. If you check again whether the coffee machine is really switched off, then that's okay. If you do it twenty times or more, however that already compulsively. "

For Michaela, constraints are part of her everyday life. That is exhausting, requires a lot of strength and energy. However, it has gotten a lot better, she says. She owes this above all to her psychiatrist Andreas Wahl-Kordon. He is a confidante and has also treated her as an inpatient several times.

It's not written on anyone's forehead

The obsession to control is a disease that often begins at a young age, but can also develop into adulthood. "It is a common mental illness, but it is usually not immediately obvious because it is often taboo and concealed," explains Wahl-Kordon.

Sometimes the patients and their social environment don't really take the sometimes strange behavior seriously. People with obsessive-compulsive disorder need to first realize that their behavior is abnormal and be ready to start treatment.

One step forward and two back

To find out whether it is an obsessive-compulsive disorder, therapists usually work with various screening questions, such as: Do you ever do a lot of cleaning or washing? Do you often deal with symmetries? Are there thoughts that you do not let go? "This covers the essential areas, says Wahl-Kordon." What is particularly important is the intensity with which such actions are carried out and the time that the patient actually takes, but also in thought spends on it. "

When it comes to therapy, doctors, psychotherapists and psychiatrists then have various methods at their disposal that have proven themselves over the last thirty years or so.

"With many patients, we can achieve very good results through behavioral therapy. The core elements are exposure and confrontation exercises," explains Wahl-Kordon.

Michaela also does such therapies. In doing so, she has to allow situations that she fears or tries to avoid. In this way she should learn to deal with her compulsions and her fears. They are often far back in the past.

People with obsessive-compulsive disorder often feel left alone

"I thought it was my fault"

When Michaela was 16, her sister-in-law died when she was only 28 years old. For Michaela a traumatic experience and one that triggered bad self-reproaches in her. "About a week before my sister-in-law died, I told a friend that there was nothing to look forward to and that I had dreamed that my sister-in-law was in the cemetery behind the cemetery wall and couldn't get out. As mine Then my sister-in-law died, I blamed myself very much. I thought it was my fault because I had moaned around for no reason. "

She makes these accusations to this day, and she fears that she will somehow be punished if she complains about something for no apparent reason. This is just one of the many fears that she has manifested.

"I had bigger and bigger problems leaving my apartment"

Michaela studied law. During her time at university, her compulsive control continued to accompany her and became a never-ending ordeal. "My apartment had a kitchenette within sight of the bed. In the evenings I always had to start checking from left to right whether all devices were switched off: stove, coffee maker and kettle. Did I pull out all the plugs? Then press the refrigerator door again to to see that it is really closed. Then everything all over again. "

Is the coffee machine really switched off?

Sometimes the whole thing took several hours, and sometimes she sat in front of the front door at four in the morning in despair because she couldn't go to bed.

Control the control

Michaela meets her husband during her studies. She immediately involves him and asks him to help her with her checks. "My husband was my salvation at the time. I asked him to do a final check-up after my controls. It felt like he was relieving me of the responsibility if something should start to burn because I had forgotten to check everything carefully. "

For around twenty years Michaela checked every evening whether her husband had checked correctly - the control of the control. Thanks to the therapy, this has now also improved.

"I was always afraid of doing everything wrong"

Michaela was a specialist lawyer for criminal law and social law. She has been on committees and lectured. She had requests from various associations to participate in boards. She was a successful lawyer, at least outwardly.

However, her constant self-doubt and her need to control made her life so difficult that she finally had to give up her job. "I was always just afraid of not doing anything right, of not being able to do anything, of being too stupid for anything and that I was only in the respective office by sheer coincidence. In my work, I was never adequately prepared in my work." she says.

The duration of the respective compulsive behavior is important for the diagnosis

"For example, if I had an appointment at 2 p.m. on one day, I was unable to do anything else that day. I always thought I had to go on and on and on and prepare for this one thing," Michaela describes her situation at the time. At some point, her fears increased so dramatically that she couldn't even go to the law firm.

"At some point, compulsion determines our entire life," explains Wahl-Kordon. "There are those affected who may withdraw completely, no longer eat properly and lose weight. These are then the most serious processes. Everything revolves around compulsions."

Coercion seldom comes alone

In addition to her compulsion to control, Michaela developed further compulsions. Above all, the so-called hoarding is bothering her. People with these symptoms collect all sorts of things for no need or valid reason: small notes, old receipts, papers that are no longer valid. She also finds it difficult to part with daily newspapers.

After a three-week vacation, the daily newspapers piled up in the apartment, but throw them away? Impossible. After all, something important could be hidden somewhere between the countless pages and then she could not find it again.

"I find it incredibly difficult to throw something away. It takes me a long time to organize things. I never get finished. There is just no end. I think that maybe I could use the things again at some point and then they would be gone ", sums up Michaela.

People who are forced to hoard simply cannot throw anything away

That the partner takes over the tidying up and throws things away is not a solution ‘, says Wahl Kordon. "Then a world collapses for those affected. It doesn't work at all. Hoarding is often about objects that I associate with certain events or experiences and that just because of that I just can't separate myself from.

Disposal is then a tough confrontational exercise that the patient must tackle with psychotherapeutic support. Often, the need to have a hoard affects older people in particular. In the worst case, they can downright litter because they just can't throw things away. "

"But first I have to clean up"

Michaela always tries to organize and prepare everything as perfectly as possible, to keep control over everything as possible. This is even the case when her thoughts of suicide come to mind because things are getting too much for her. "It was on a Sunday and I actually managed to organize replacements for my appointments for the entire coming week."

Constant cleaning can become a compulsion

After all, she wouldn't be alive the following week. But then, she says, her husband came home unexpectedly and thwarted her plans. "Later I always thought that I couldn't kill myself because I had to tidy up first. The thought of someone tampering with my things is just unbearable to me!"

New perspectives

Michaela has created a new mainstay. Today she teaches, among other things, social law for special educators. It is easier for her than her work as a lawyer. She can contribute in a completely different way, and is also available as an example.

After all, trainee teachers have to learn to deal with disabled people like you, she says. Everyone around her knew about her obsessive-compulsive disorder - except for her family. That is an exception.

For the past few years she has been doing trauma therapy, depression therapy, and exposure therapy. That helped. "I still control the stove and the fridge. I still have to do everything right. I am still afraid of doing everything wrong. But compared to how it used to be, everything is much, much better now."

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