Obsessive compulsive disorder - what is is and how to cope
It is said that the true definition of an obsession is an unwanted thought, doubt or image that repeatedly enters the mind. This is the reality for the estimated 750,000 people in the UK who suffer from the condition obsessive compulsive disorder (OCD). In this article I will look at how OCD potentially develops, the causes of it, different forms of it and what can be done to combat it. I hope that it serves as useful for those suffering from obsessive compulsive disorder and also for those who may suspect that something is not quite right.
It's important to emphasise that every individual will experience it differently but there are some common themes within individuals that can lead to OCD traits manifesting themselves: overinflated responsibility and overestimation of threat.
The over-inflated sense of responsibility could present itself as feeling that you are unduly bound to be responsible for others. This could be that if you are a nurse you may feel that if you do not wash your hands correctly then you will take germs back to your family and everyone will become ill, so you vigorously clean your hands to the point that it affects your daily life.
The other aspect is overestimation of threat, in that you attach danger to situations where none exists. This could be worrying about a small cut in your arm turning septic and dying of blood poisoning if you do not clean it right away. The repetitive nature and recurring theme of your thoughts may then lead you to attach meaning to them that is not warranted.
This is what differentiates people with OCD to those without, everyone experiencing negative intrusive thoughts from time to time but those with OCD attach special significance to them. The other thing that clients with OCD often seem to display is the absolute intolerance of uncertainty. They often feel that they must have a guarantee of absolute safety and certainty, again this is where the over-inflated sense of responsibility comes in.
So how does OCD develop? Well, like a lot of conditions, there is evidence that it can be both biological and behavioural in nature. There is research that suggests that people with OCD are four times more likely to have another family member with the condition than someone without the disorder. It is also believed to sometimes develop from learned behaviour as over time someone may develop negative thoughts about what they perceive as a threatening situation and to mitigate it certain behaviours arise. The onset of OCD has also been linked in some cases to Streptococcal infections due to chemicals the brain produces in the immune response.
Obsessive compulsive disorder is not a condition that only affects people in one particular way, there are many common themes but it does differ from person to person. The common "types" of OCD are contamination, whereby a person will worry about potentially spreading infection and this leads to either compulsions or avoidant behaviour. The need to have symmetry or order is another form of it, whereby a person will feel the urge to have everything in perfect symmetry be it clothes, books or cans of food to prevent something bad from happening.
The compulsion that a person carries out will initially reduce the initial threat and momentarily make them feel better which leads them to carry it again until they find they just cannot fight the urge to resist their compulsions and it becomes their main and very time and thought consuming coping strategy.
There is another type of OCD known as "pure o", pure obsession. This is where the individual may experience disturbing and repetitive thoughts often they are in stark contrast to the person's values and seem to highlight their fears such as thoughts of a distressing sexual or violent nature.
The thoughts themselves can be distressing to someone as they are terrified that they are even capable of having such thoughts, however people experiencing this are the least likely to actually act on their thoughts because they find them so repugnant. But as OCD clients are often so fused with their thoughts, they may think that simply having a distressing thought is the equivalent to carrying it out and that they must be a terrible person for simply having them.
Individuals with pure o may still have compulsions and although they can sometimes be physical they can also often sometimes just be mental compulsions that they carry out. In light of this it is not unusual that clients with OCD often also display symptoms typical of depression also.
So what can be done to help? Well there are many approaches that can help this condition due to the amount of research that has been carried out. The most important of these is to try and distance yourself from your thoughts, earlier in the article I mentioned how clients with OCD can be fused with their thoughts - well to solve this you need to try and defuse from them. This is called cognitive defusion and is the process of becoming untangled from your thoughts not reacting or becoming caught up with them and seeing them simply as thoughts. It in essence requires you to try and distance yourself the distressing thought and to look at it with detachment.
This could be done by simply acknowledging the thought when it occurs, thank it and leave it - do not suppress it or try and resist it as this will strengthen it. This can also be achieved by becoming an observer of your thoughts, recognise that same thought has occurred again, notice the familiar theme but do not label it, do not think of it anything other than just a thought.
In the context of hypnotherapy there is the possibility through the subconscious mind of actually getting a client to visualise the thought, what it looks like and creating distance between them and the thought. This can be accompanied by ego strengthening of how well they are doing, how calm they feel and how they can return to this feeling of calm any time they wish.
Indeed the Hypnotic process may in itself help clients to identify certain OCD thoughts or train thoughts that they are not actually consciously aware of.
There is also some people who argue that through hypnosis you could regress someone to the point of the earliest memory of when their obsessive behaviour began and nullifying the negative emotion from it, however regressing anyone to a point in their life that is potentially distressing runs the risk or re-traumatising them and is not an approach I favour.
The other known approaches that may be helpful are mindfulness and exposure response and prevention therapy. I always encourage clients to practice mindful breathing with anything that is anxiety provoking. In people with OCD, with your eyes closed it can be helpful to breathe deeply in and out and as you breathe out imagine the area where you feel uncertainty expanding, store and make room for the doubt. In doing this you are not trying to get rid of the sensation but are calmly learning to tolerate it.
Exposure and response prevention helps disrupt the cycle of compulsions and obsessions by gradually exposing you to what you fear and have been avoiding in a slow and graded way. In doing this you are reducing the power of the obsession and the accompanying anxiety. It is generally helpful to start with more manageable one's first and build up to more challenging ones.
In summary, although obsessive compulsive disorder is a distressing condition that blights people's lives and comes in many forms there are things out there that can help. I hope any people that are suffering right now can take some comfort from the information in this article and know that distressing thoughts are natural but allowing them to affect your life is not.
I find that the more you understand a problem the more manageable it is, so I hope this article has alleviated some anxiety. Finally please when seeking out any therapist in the treatment of OCD ensure that they are fully trained and have experience of working with the condition and that they always carry out a thorough initial assessment first.
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