Obsessive Compulsive Disorder: What is it? What can we do about it?

When I think of OCD, I think of constant hand washing and flicking a light switch a million times. Whilst this is a component, there is a lot more to understand about OCD.

Obsessive Compulsive disorder can be broken down into ‘obsessions’ and ‘compulsions’.

Obsessions

Obsessions refer to intrusive, automatic and irrational thoughts. They can be horrific, frightening and upsetting. It is not actually the thought itself; it is how we process this thought. Everyone has intrusive thoughts, whether you have a mental health condition or not. The difference is how we think about these thoughts.

For example, imagine driving along and seeing a pedestrian crossing the street. The thought pops into your head ‘I could easily run that person over’. Someone without obsessions would maybe approach this as ‘Oh, well that’s weird I hope that doesn’t happen’. Someone with obsessions may think ‘That is awful! I must be a horrible person, am I a psychopath?’.

People diagnosed with OCD will spend at least 1 hour each day ‘obsessing’. However, this is usually more. The thoughts usually lead to irrational beliefs. We each have things that we have been through in life, but it is how we think about these events, not the events themselves.

For instance, a client may have experienced a parent leaving them. The obsession does not come from simply the parent leaving, it is how the client thinks about the event.

‘They don’t care about me’, ‘I am unloved’, ‘I don’t deserve to be loved’, ‘I am worthless’. The rumination leads to negative beliefs. These beliefs are whole-heartedly believed. We can see how this would lead to depression, anxiety, even suicide.

Common Obsessions include:

· Fear of contamination

· Fear of harming oneself

· Forgetting or losing information

· Inappropriate sexual thoughts

· Worry about offending a religion

· Cancelling out bad thoughts with good thoughts

The important thing to remember about intrusive thoughts is:

Everyone has them

The thoughts do not equal reality

Our way of thinking affects our behaviour, the ‘compulsions’ experienced by people with OCD.

Compulsions:

Compulsions are the behaviours that stem from the thought processes experienced with OCD. For example, if someone has a fear of contamination, they may over clean. Repeatedly washing their hands, or surfaces. Perhaps in a ritualistic manner.

They may worry about hurting themselves or others. They may remove sharp objects from their space and avoid people.

OCD is within the top 10 of debilitating diseases. It can be exhausting and stir up anxiousness and low mood. In the UK alone, 741, 504 people live with OCD. 50% of the cases being severe. There is relation to eating disorders; irrational thoughts about food, changing eating behaviour (i.e. eat certain things, certain colored food). Similarly, self-harm can be accompanied with OCD, self-harming in a ritualistic way (i.e. the number of cuts being odd or even).

Despite the struggles faced by people with OCD, people often feel ashamed and lonely.

Individuals with this disorder may be too embarrassed to ask for help. However, there are proven beneficial treatments for OCD, mainly cognitive behavioral therapy.

What can be done?

Cognitive Behavioral Therapy (CBT) is a very useful form of treatment for sufferers of OCD.

CBT involves bringing awareness to intrusive thoughts and challenging them. Stopping the obsessions will in turn break the link to the behaviour. There are several ways CBT can manage the intrusive thoughts.

Thought tracking refers to noticing thoughts and being aware. Our thoughts can be overwhelming, writing them down or saying them out loud can help us to notice them. Go through one thought at a time. Think about how long it has been on your mind.

Then investigate the underlying assumption. This can be done though downward questioning. ‘The person I like has not messaged me back’, ‘They do not want to talk about me’, ‘I must not be likable’, ‘No one likes me’. The underlying assumption here is that they are unlikable. The belief from the intrusive thought. This can stir us up and make us upset, angry, anxious etc.

Intrusive thoughts will come, but we can stop escalation. We must stop rumination. You can say out loud ‘STOP’. You can visualize the word ‘STOP’. Catch those thoughts. It may be more effective to physically out loud say stop because it will be harder to visualize things in our mind, when our mind is so noisy.

Also, talking back to the negative voice or writing down alternative ways of viewing things. This is known as cognitive restructuring. For example, imagine not passing an exam. Automatic thoughts could be ‘I am a failure’. Restructuring this could look like ‘I failed one exam, but I am not a failure. I have succeeded at other things in my life’. Putting the reality back into the thoughts is important, therapists are very skilled at doing this. It is something that can be taught and self-managed.

There are many techniques that CBT can implement to manage OCD. This is a very effective and powerful method. It should be investigated if you feel that you may struggle with this condition. Feeling embarrassed or ashamed will only lengthen the time spent suffering. It is easier said than done to get help, but I would strongly encourage it.