The seemingly simple act of brushing teeth can become a debilitating ordeal for individuals with obsessive-compulsive disorder (OCD), consuming hours each day and causing significant distress. For 18-year-old Elena, from rural Australia, the compulsion began with a specific way of holding her toothbrush – fingers placed in a precise manner, repeated until it “felt right.” If the motion was deemed incorrect, she would start again, and again, sometimes seven times in a row, delaying her morning routine considerably.
Elena’s experience, shared with the ABC, highlights the often-misunderstood nature of OCD. While commonly associated with excessive cleanliness, the disorder manifests in a wide range of intrusive thoughts and repetitive behaviors, or compulsions, designed to temporarily alleviate anxiety. For Elena, these compulsions are driven by a fear of “spiritual disaster” or a sense of impending doom if not performed correctly. “It does slow you down in the mornings when it doesn’t feel right and you’ve done it seven times,” she explained.
OCD affects approximately 3 percent of Australians annually, yet diagnosis often takes an average of nine years, according to Lara Farrell, a clinical psychologist and director of the Centre for Mental Health at Griffith University. This delay is attributed to several factors, including the ability of individuals with OCD to conceal their symptoms, the frequent co-occurrence of OCD with other conditions like anxiety and depression, and the stigma surrounding mental health issues.
“Often there’s an awful lot of embarrassment or shame around symptoms that are really distressing, obsessions that people feel really uncomfortable telling others that they might be experiencing,” Professor Farrell said. Elena herself initially struggled to articulate the full extent of her symptoms, even to her doctor, and was initially misdiagnosed. She found solace and understanding after watching an episode of “You Can’t Ask That” featuring individuals with lived experience of OCD, realizing there was a name for what she was going through.
The manifestation of OCD can extend far beyond toothbrushing rituals. Individuals may experience excessive brushing duration – spending an hour or more on the task multiple times a day – ritualistic brushing patterns, constant checking for imperfections, obsessive thoughts about oral cleanliness, or even avoidance of certain foods, as detailed by neurolaunch.com. One individual posting on an OCD forum reported spending over an hour brushing their teeth each day, using a very soft-bristled toothbrush to avoid causing damage.
Professor Farrell emphasizes the distinction between clinical OCD and everyday habits. “A common term of phrase is, ‘That’s just my OCD,’ or, ‘I’m so OCD at times.’ Clinical OCD is very different from… healthy rituals that people might engage in out of choice and preference or a drive for having things orderly or clean or tidy.” She added that OCD symptoms “disrupt a person’s day-to-day life and cause an enormous amount of struggle individually and amongst families.”
Elena’s struggles intensified during a period of depression, leading to nightly rituals of repetitive movements, such as tapping her feet on the stairs, often accompanied by tears. Her experience was triggered, in part, by the death of a duckling she was caring for at age 12, a trauma compounded by feelings of grief and embarrassment.
Despite the challenges, Elena credits therapy with helping her manage her OCD symptoms. “It’s so much better now, not thinking a plane is going to crash due to the fact that I didn’t do a little tap dance before bed,” she said. Professor Farrell highlights the effectiveness of exposure and response prevention therapy (ERP), where individuals confront their fears in a safe environment, leading to positive outcomes for the majority of patients. A nationwide trial is set to begin on March 1, offering web-based training for parents treating OCD at home, focusing on ERP techniques.
Elena hopes her story will encourage others struggling with OCD to seek assist and to shed the shame associated with the condition. “You’re not alone,” she says. “And you don’t have to feel embarrassed or ashamed about it.”