Obsessive Compulsive Disorder (OCD) is classified by the World Health Organisation as amongst the top ten disabling illnesses in the world. OCD is a presentation we see quite often at Evolve. Over the number of years I have been a therapist, from outset throughout, during my time - what I have commonly seen is clients presenting with high levels of anxiety and labelling certain thoughts & behaviours they have as “OCD tendencies” or they may often use phrases like “oh that is just my OCD acting up”. These phrases and terms are so commonly used without reserve often from places of complete misunderstanding and misinterpretation of what OCD actually entails.
With many mental health issues these days, terms can get loosely used with growing information on social media being so readily accessible but often not fully understood we find ourselves saying “I feel depressed” , “I have OCD” and much more without fully experiencing these mental health experiences as what they truly are. It is important for ourselves and others that we have the correct information to what these issues actually look like as a true lived experience.
Throughout this blog I am going to attempt to equip you not only with evidence based information which supports what OCD is, but I am also going to aim to squash and eradicate the narrative which is used far too often without realistic context in terms of OCD.
Obsessions - the obsession aspect of OCD like all aspects of this illness can vary from person to person, however - what is commonly experienced by all suffering with OCD would be thoughts which are intrusive, distressing and often coupled with an urge or desire to do something repeatedly coming in the form of thought to a distressing severity. As the obsession continues to progress and the thoughts build, the more the person ruminates the more they feel out of control which further builds upon and provokes intense feelings of anxiety and distress.
Compulsions - Usually driven by the obsession and closely liked to the patterns of thought, compulsions usually manifest as behaviours which are repetitive in nature but often have no rational stance or logic in terms of alleviating the mental distress. However - what we do find is that the compulsions often bring short lived relief but when engaged with over long periods of time the person suffering with OCD will become a slave to these behaviours in order to get any form of psychological and often physical relief.
Temporary relief - The compulsion which follows the obsession will quite often alleviate the symptoms of distress but what we find is that the compulsion is essentially feeding the obsession and reinforcing the need to complete the compulsion in order to alleviate distress. This further keeps the cycle in motion, leaving the individual reliant/dependent on the compulsion with a person thinking they have to do “x” to not feel “y”. Or they have to do “x” so “y” doesn’t happen.
During my time working with clients I have discovered that is it in fact possible that clients may experience the obsession without the compulsion and for many clients they may in fact experience both. Obsessive thoughts usually are coupled with imagery which in many cases can be violent, intense and often thrive upon fears and worst case scenarios.
Something I feel a pressing urgency to make clear as I write this is that if you are having any sort of thought and it is intrusive or distressing by nature, whether you suffer with OCD or you’re somebody reading this without OCD - please rest assured that having intrusive thoughts does not suggest or mean that a person is definitely going to act upon these thoughts. Why I want to eradicate that ideology and narrative is for the simple reason that I have met many clients who have intrusive thoughts, be it of a sexual nature, thoughts of suicide without intent or thoughts of a “dark” nature and these clients present full of anxiety in fear that thinking this way will result in them committing an offence etc. Let me just say this, although distressing…. thoughts are very often just thoughts. If you would like to further delve into this concept feel free to get in touch with me.
Veering back towards OCD specifically as I try to conclude this blog, I will just speak briefly on compulsions. The common example we often hear of is hand washing. The fear driven obsession may be about getting germs on your hands followed by an irrational belief that there is need to repeatedly wash your hands or you may for example get extremely sick and in some cases the belief may even be that you may die. The compulsion here brings temporary relief in belief that this action reduces the germs on one’s hands which in reality yes is true, however - what we find happens is this behaviour is fused with the belief that this prevents (i.e death) and becomes more and more severe with clients becoming avoidant of all potential germs and needing to wash hands at any hint of exposure.
Naturally OCD is not just based on germs and obsessions and compulsions can be attached to a wide variety of areas. In my experience of working with clients with OCD, it is quite common for clients to acknowledge and be consciously aware of the irrational nature of their compulsions, however - they also can admit that feeling so stuck when obsessing leaves them in a place where they engage with the irrational compulsion for that temporary relief regardless of knowing it holds no logical basis.
However - while many may be able to acknowledge their compulsive behaviours, these behaviours are not always obvious and these behaviours would be what we term “covert” behaviours. Within therapy we want to identify these covert behaviours and intervene therapeutically for symptom reduction and alleviation of distress.
In summary below I will give a few concluding points on what OCD is, followed by what OCD isn’t.
What OCD is (3 examples):
Intense worry about disease or infections followed by excessive irrational and avoidant behaviour.
Counting and repeating the same thing many times in order to reduce anxiety or create a sense of safety
Intense fear of acting inappropriately or causing harm to yourself or others alongside asking for reassurance or repeating “safe” words in your head.
What OCD is not (3 examples):
A thought such as being unsure if you have turned off the oven and needing to go back and check if the oven is off.
Cleaning your home and feeling like it needs to be in order or tidy due to feeling anxious when it’s not.
Having negative/irrational/intrusive thoughts.
In part two of this blog series on OCD I will be looking at treatment for OCD through the lens of a Cognitive Behavioural model, providing information on both prevention and intervention.
I do hope that this blog shed some light on OCD and the true presentation of what we see in sessions with clients.
If you or someone you know is suffering with what you believe to be OCD and you would like support in overcoming this area in your life - please get in touch with us on firstname.lastname@example.org and our team will be more than happy to help you get started on your journey towards feeling well.