I'm a bit OCD
If only I had a pound for every time I've heard the above sentence recently!
The advent of TV programmes in the past few years that feature anxiety disorders such as Obsessive-Compulsive Disorder (OCD) and Illness AnxietyDisorder (Formerly Hyperchondriasis) together with an increasing propensity for patients to research their health conditions online, has led to therapists often facing clients with an incorrect self-diagnosis.
OCD is a much misunderstood anxiety condition which, treated as humorous material for TV programmes such as Obsessive Compulsive Cleaners, can leave sufferers with feelings of guilt, shame and embarrassment. The basis of the condition is rooted in anxiety, a natural, evolutionary reaction which has the aim of keeping us safe, recognising danger when it occurs and prompting a suitable reaction in response.
At the heart of the condition are an exaggeration of these responses to anxiety provoking situations which result in obsessive thoughts or images. Typically, human beings have in excess of 40,000 thoughts per day, mostly random or generated by physiological stimuli, "I'm hungry", "I need to buy toothpaste", "That's a lovely shade of purple". Some of these thoughts can be thought provoking or upsetting, for example, have you ever stood on a motorway bridge and wondered what it would be like to dive off it? Many of us have. These are just random thoughts and much research has gone into why we have them with mixed results. One suggestion is that the thoughts a regenerated by our brains which test our ability to keep ourselves safe or test our morality and assess how we fit into social norms. They can therefore be seen as a positive influence on our behaviour and our lives generally.
For people with OCD however, such intrusive thoughts can provoke overwhelming anxiety. If the same thought repeats itself and is of a distressing nature, for example a thought or image of killing your children or your partner dying in a road accident, some people (research shows a lifetime prevalence of around 2.3% ) feel the need to develop a coping mechanism to reduce the anxiety - a compulsion.
Case Study
Peter was brought up by his mum and dad in a family in which there were lots of arguments, often as a result of drink. As a child, he never knew what to expect from his parents and described his childhood as "Like walking on eggshells all the time". In a bid to reduce his anxiety, Peter had developed some compulsions as a child which he called "Making things fair". If he touched the right arm of his chair 4 times for example, he felt compelled to touch the left arm the same number of times. His anxiety increased in his late teens when he became involved in a long term, psychologically abusive relationship with a person who was dominant and controlling and Peter developed further compulsions, which he hid from his partner.
In his 20's, Peter met a wonderful person with whom he settled down. He worked hard to create the perfect family environment and the birth of his first child cemented the feeling that he now had it all. However, it also served to increase his anxiety. Peter quickly became terrified that he would lose his partner or child and he began to experience disturbing thoughts about them being involved in a road traffic accident.
Although not a person of faith, he began to say a prayer to himself each time his family was out of his sight. Once did not feel comfortable, but saying it 4 times reduced his anxiety. He often forgot how many times he had said the prayer and had to start over again from the beginning.
At the same time, Peter began to engage in a number of other 'checking' type behaviours. As these related to the safety of his family, he felt that he could justify these to himself. Checking doors and windows were locked, four times each, became a nightly ritual, as did tapping his foot 3 times at the top of the stairs, one for each family member. Over time, Peter developed more and more coping behaviours or rituals, to the extent that they were consuming a huge amount of time in each day. Leaving for work in the morning was taking over 30 minutes, from the decision to leave, to getting in the car. Such was Peter's anxiety about the security o fthe house, that he began to video himself checking the door with his phone, as on several occasions, he had to turn back to check again as he had convinced himself they were unlocked. Whilst Peter realised that this was unhelpful, he felt unable to stop.
Compulsions generally take one of three forms - Countering fears of contamination (involving washing, cleaning etc), checking (Often security measures such as doors, windows) or invoking prayers or blessings in a bid to ensure 'restitution' for some felt misdemeanour. These compulsive behaviours can become quickly repetitive and often, those suffering from OCD will clean, check or bless several times until they feel their anxiety reduce. Often, these repetitions become fixed in nature and number, repeating the same blessing or checking a door handle a fixed number of times (In my experience, 4, 7 and 11 are all common numbers quoted by patients).
Ok, so we all check our doors are locked at bedtime, none of us want to eat with dirty hands and many of us say prayers or blessings according to our faith or belief system. The difference for people with OCD is an underpinning belief that NOT to complete their compulsion will result in a catastrophic event - the death of a loved one, an airplane crashing, being sent to prison for example. The distress that this can cause is only too apparent and patients can often spend hours each day completing their obsessions, being unable to tolerate uncertainty.Treatment can take many months of therapy and will typically focus on identifying the type and nature of the obsessive thoughts and the hierarchy of the associated compulsions. Psycho-education about anxiety and OCD itself is combined with exposure related tasks that attempt to increase the patient's tolerance to uncertainty and the anxiety this provokes. Working through the obsession and compulsion cycle, highlighting the client 's 'Magical thinking',is just the start of a long process of recovery that can involve a significant number of therapy sessions.
OCD is not about ensuring your house is clean, ensuring your labels are the same way round
in your cupboards or using only pink washing line pegs. TV programmes often do OCD patients a disservice by suggesting otherwise. If your anxiety is a condition which is reducing the quality of your life and your relationships with others, help is available in the form of cognitive behavioural therapy (CBT) through the NHS and privately. Sadly, many NHS IAPT services offer just 6 or 8 sessions of therapy, which for many OCD patients will not be enough to tackle what has become a habitual response to their anxiety and whilst services (And their future funding)rely heavily on recovery rates, there is sometimes reluctance to take on patients who may find recovery difficult or protracted. Ingrained habitual behaviours are difficult to shift and many patients find that complete recovery is not possible. However, tackling just a small number of obsessive behaviours and rituals can give patients hours of each day back, enabling them to return to work, care for families and themselves more effectively and become more productive. If you're still feeling you're "A bit OCD", then speak to your doctor or health professional, seeking help could be life changing.'
Keith Swindell is a CBT Therapist and psychotherapist working in the NHS and in private practice, with a special interest in OCD.
