Written by Samantha Wall, LCSW
Edited by Joe DeNoon
Most people experience unwanted and intrusive thoughts, images, or urges from time to time. Obsessive Compulsive Disorder (OCD) is a disorder related to anxiety where these unwanted, intrusive thoughts, as well as images and urges, occur so frequently that they are categorized as an obsession that leads to a compulsion. This is a disorder some are more at risk to develop, based on genetics or environments they have been exposed to throughout their lives. When I think of being a nurse, this is already a high-stress environment where there are specific steps that you need to follow to make sure the lives of your patients are safe. This, along with the fear of making mistakes, can increase anxiety to the point where it can lead to a diagnosis of OCD or you display OCD tendencies. In this first part, I will discuss what OCD looks like and the cycle of OCD. In the next blog, I will discuss ways to combat these intrusive thoughts.
The cycle of OCD starts with a trigger, leads to the obsessive thoughts, and you put meaning to the obsession. This leads to anxiety, and then due to the anxiety you are experiencing, you find safety strategies to cope with the anxiety. The safety strategy is also known as the compulsion or unhelpful behavior. For an example of this process, imagine you are worried those around you will die. From there, you start to have obsessive thoughts about ways people can die, and these obsessive thoughts then increase your overall anxiety about death. This all can lead to you feeling responsible for keeping others alive. Due to your feelings of responsibility for other people’s lives, your compulsion is to have a strict routine daily because that is the only thing that is keeping those around you alive. If you mess up or something feels wrong in the routine, you have to re-do the task until it feels good because this is what the intrusive thoughts are telling you to do. Although to an outsider, these strict routines seem unnecessary, to you, that is the only thing that has decreased your anxiety about others dying over the years. The tough part about compulsions is the compulsion actually reinforces and worsens the anxiety long term.
There are also many different ways OCD can look in each person’s lives. Common obsessions are contamination, losing control, harm, perfection, unwanted sexual thoughts, and diseases. These cover a variety of fears and anxieties, such as anxieties about germs, household chemicals, fear of harming others or self, fear of being responsible if something terrible happened, fear of not being careful enough, or fear of not remembering something important or not knowing important information. All of the anxieties I listed above could affect the everyday life of a nurse. These anxieties can also affect how you are able to do your job! However, obsessions are only half of the diagnosis! Compulsions are the other half. Common compulsions include washing hands excessively, cleaning excessively, checking and double checking that you are not causing harm, that nothing terrible happened, that you didn’t make a mistake, re-reading, re-writing, repeating routine activities until you ‘do it right’, mentally reviewing events to prevent harm, and counting while performing a task until it is ‘right’ or ‘good’ or ‘safe’.
As a nurse, a lot of responsibility is put on you to make sure things are safe, clean, and processes are followed to keep a patient healthy. With all the different steps and tasks involved to make sure a patient has the best care, there are so many lists for you all to follow each day. The life of a nurse in general can increase overall stress and anxiety, which can lead to OCD tendencies or a diagnosis of OCD due to the severity of the worries, anxieties, and compulsions. Nurses are told they are the last line of support, and the pressure to make sure everything is in place can be draining on our brain and start the cycle of intrusive thoughts. It is important to assess and think about how these processes are affecting your life at work and at home.
Questions to ask yourself as you look at the different symptoms of OCD:
- Do I struggle with this cycle?
- Is it affecting my daily life functioning at work and at home?
- Is this me doing my job or am I experiencing intrusive thoughts about my job?
In the next blog, I will go in depth about how to start challenging these thoughts and tendencies. If you are experiencing a severe level of OCD that does affect more than one part of your life, please reach out to a doctor or therapist for further resources.
Sources used:
https://www.anxietycanada.com/articles/vicious-cycle-of-ocd-how-ocd-takes-over/
https://iocdf.org/about-ocd/
This is excellent and my personal experience. How can I find Part 2?
Hi Dawn! Here is part 2: https://www.operationhappynurse.org/ocd-tendencies-part-2-how-to-address-and-combat-the-cycle/
Hi there,
I have OCD and just graduated as a nurse. I work 12 hour shifts in the ICU and love my job but have started getting anxiety about rotating shifts and the negative effects these have. I’ve tried researching but there is little guidance on how to deal with rotating shifts as a nurse with OCD. There is lots of guidance for nurses without OCD however I feel that doesn’t address my concerns. For example, I know my OCD is worse when I’m more tired and don’t have good structure but finding this can be hard when you work rotating shifts. I don’t want to give up something that I’m so passionate about as it will just be another thing my OCD has taken from me but I’m also struggling to find a work schedule that fits for me and just really need some advice
Siobhan,
Thank you for sharing this and know that you are not alone in feeling the heightened response to OCD and anxiety with the presence of rotating shifts – the nature of 12 hour cycles without a constant pattern interfere with our physiology resulting in lack of sleep and proper nutrition- both of which combine to disrupt our ability to emotionally regulate. One suggestion I may have is look to put as much consistency in other areas as possible – this will help to offset some of the anxiety around unpredictability – look for ways to incorporate meditative reflection, seek out places of calm during break, activate other senses to break the cycle – ie mint gum or hand cream to shift focus to another sense. Important to remember where you do have advocacy in your life and allow that to bring you confidence in that stability can be present.