OCD has become a bit of a joke – in that it’s common for people to state flippantly that they’re “a bit OCD” about something – when what they really mean is that they like things to be neat and tidy or they pay particular attention to details. However, the reality of OCD can be extremely debilitating for sufferers. Those who deal with the condition daily can find it exhausting, overwhelming, confusing and increasingly difficult to manage as it literally takes over their life.
The O of OCD stands for Obsessive – and it relates to the obsession behind the condition. Frequently an OCD sufferer comes to believe – often at a subconscious level – that unless they carry out some act or behaviour, there will be a disastrous negative consequence. They become preoccupied by the idea that they must do one thing to prevent something else from occurring. Sometimes sufferers find it difficult to state what the feared negative consequence might actually be – they just have an overwhelming feeling that something bad will happen. Sometimes the fear is very specific, for example that someone will die or that they themselves will harm someone. Many sufferers feel ashamed of their obsession(s), particularly if they are of a sexual nature, or they fear that they themselves might do something violent or harmful. Sufferers are often afraid to talk about their obsession(s), some fearing that they must be going crazy. If not addressed, over time the obsession can become extreme and can make life very difficult for the sufferer.
The C of OCD stands for Compulsive and relates to the compulsion to do something in order to prevent the feared negative consequence from happening. Sometimes the compulsion can seem completely unrelated to the obsession to anyone other than the sufferer. An example is a case I heard about where a woman felt compelled to give away all of her money to charity otherwise something dreadful would happen to her family. The more a sufferer carries out their compulsion, the more it reaffirms their belief in the obsessive idea, and this can set in motion a vicious cycle that can be very difficult to break. The OCD sufferer believes that he/she is controlling their behaviour and their environment by sticking to their rituals, but the opposite is true.
Whilst cleaning, tidying and checking compulsions are the most easily recognised manifestations of OCD, it also presents in various other forms, including:
•Aggressive obsessions – the sufferer believes that they will carry out violent or aggressive acts (this frequently presents in people who may not seem capable of doing any harm)
•Contamination obsessions – fear of germs or dirt or of becoming ill
•Hoarding and Saving – fear of getting rid of or losing things, or an overwhelming need to collect items going far beyond a hobby to the point where it can cause the sufferer financial difficulties
•Religious obsessions – a fear of damnation, blasphemy or the consequences of ‘sinning’ or an obsession with morality
•Sexual obsessions – obsessive sexual thoughts and/or compulsions to carry out acts largely considered to be lewd or obscene, sometimes with aggression
•Symmetry and Order – a preoccupation with order and ritual
•Counting compulsions- the need to count arbitrary or specific items, often over and over again
•Repeating rituals – the overwhelming need to carry out the same rituals over and over, with no flexibility, often ‘safety’ or ‘superstition’ routines – for example the need to always take the same route to get somewhere without any deviation or to always wear the same outfit for ‘luck’
•Checking compulsions – similar to repeating rituals, but involves repeatedly checking things such as door locks or electrical sockets
•Cleaning compulsions – constantly cleaning, often to extremes, and frequently linked to a contamination obsession
All of these subgroups feature irrational or exaggerated fears that the sufferer often realises are irrational but that does not seem to lessen their impact. OCD is classed as an Anxiety Disorder and anxiety is the mechanism that fuels it. Indeed it has been classed as the fourth most common anxiety disorder internationally¹ and is thought to be on the increase. The way to relieve or reduce OCD is therefore to address the underlying anxiety. It is the control of anxiety that is crucial in learning to manage and conquer OCD. OCD patterns follow a typical anxiety curve – the anxiety increases while the sufferer is preoccupied with their obsession or fear, and decreases temporarily when they start to carry out their compulsion. However, the act of performing their compulsion reinforces their belief in the obsession, which causes their anxiety levels to increase again and so the cycle continues. It is also possible to experience obsessive thinking without compulsions and vice versa.
When OCD becomes debilitating, sufferers often seek help to regain control of their lives. I have experience in helping many clients to reduce their OCD symptoms, typically using an educational, CBT-based² approach where they learn to recognise and understand their anxiety cycles and then learn the skills to manage and reduce their effects. I help clients to effectively become their own therapist so that they can cope better and develop the strengths and skills to make the changes necessary to free themselves from the debilitating effects of anxiety.
Call me for a no obligation chat if you or someone you know is suffering from OCD or other anxiety-related problems.
1. Textbook of Anxiety Disorders, second edition; Stein, Hollander et al; American Psychiatric Publishing, inc.; Washington, 2009