Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder characterised by:

• Intense or intrusive worries/ruminations/thoughts/images about potential harm or negative consequences befalling you or others (obsessions)

and

• Repetitive actions (compulsions) done in an attempt to reduce the anxiety generated by the obsession.

As with other anxiety disorders, people with OCD often overestimate the threat of harm to themselves or others and/or underestimate their ability to cope with things should something bad happen. For example, a common fear for people is that of being contaminated by germs. Some people with OCD worry persistently and disproportionately about the likelihood that they will catch something and then worry further that if they catch something that it will be life threatening. In an attempt to reduce the almost constant fear of this, the person may spend many hours of their day cleaning, disinfecting and sterilising things.

However, OCD is far more complex than being a “clean freak” or simply liking things in a certain order. People with OCD:

• Spend huge proportions of their day consumed with their worries: they can often become trapped in thought, with associated loss of productivity and disconnection from life.
• Feel compelled to engage in the compulsive behaviour
• Feel very unsettled or anxious if unable to do the compulsion
• Feel trapped by their thoughts or behaviours

The fear of contamination/cleaning image of OCD is the most well-known however there are many ways that OCD can present.

• Fear of not having done something (e.g. locked door, turned gas off) and associated repeated checking.
• Fear that you have said or done something bad with extensive rumination after the event and checking with yourself or others whether this occurred. Persistently seeking reassurance that you didn’t shame yourself.
• Persistent thinking about thinking- the need to analyse every thought you have and think up the perfect answer or solution to the situation. Being unable to let your mind move on until you have “finished” the thought.
• Trying to control your thoughts based on the mistaken belief that any thought that enters your mind is indicative that you are a bad person (e.g. the sudden thought that you want to hit someone means you are a violent person, even though the though popped into your head randomly and you have no intention of acting on it).
• Fear that you have a serious health problem or you are dying and persistently seeking reassurance from others that you are ok.
• Hoarding behaviours- from fear that if you throw something out you may later need it and therefore you made the “wrong” decision.

Like many things, OCD is on a spectrum: some people with the disorder manage well and their issues are not evident to others. Some people are completely debilitated by their symptoms and have a lot of associated depression. Complicating OCD is the fact that many sufferers know that their behaviour is irrational but they feel unable to stop.

How does OCD develop?

Human feelings are complex and sometimes, in an attempt to deal with this complexity and discomfort, our mind unconsciously comes up with creative ways to cope. OCD often represents a fear about uncertainty or vulnerability and an attempt to control the uncontrollable. For some people anxiety is an inherited or learnt thing from their family. For some people OCD emerges in childhood or adolescence. For some people there may have been long-term anxiety but the specific obsessions and compulsions do not emerge until adulthood. For some people the disorder starts after a single, perception-changing event, such as starting university, or an incidence of bullying etc where they felt suddenly frightened or unsafe. In an attempt to stop this happening again they developed some control-focussed behaviours. Perhaps initially the behaviour (such as hand washing) helped them to feel safe and reduce the fear of uncertainty. But over time the behaviour provided less and less relief until in the long run people often feel trapped by the disorder.

Part of the recovery process is learning to make space for uncomfortable thoughts and feelings and make peace with some of the inherent risks in life, rather than live in fear of them. It also requires learning to be more realistic about the likelihood of harm befalling you. Therapy can assist people with this process. Things that can help with OCD include learning mindfulness skills, understanding what it is you’re afraid of and using exposure therapy to help people manage their response to feared situations. Other things that can help include medication, support groups and hearing about how others have overcome these issues.

For all sufferers there is hope and there is help available.

For more information about therapy and counselling please contact Virginia on virginia.pulker@gmail.com or 0476 674 094.