OCD

OCD is the abbreviation for Obsessive Compulsive Disorder

What is OCD?

I think of OCD as an unhelpful way of managing anxiety. It is almost like OCD pretends to be your friend. A thought makes you anxious, and along comes OCD and says, hey, if you do what I say then your anxiety will go down. And it does, but only temporarily. The behaviour then has to be repeated over and over again. It takes up loads of time and can really get in the way of your life. Not to mention the constant anxiety you feel. Others find it hard to understand sometimes, and so it can also feel really lonely and isolating.

How common is OCD?

OCD is the 4th most common mental health disorder (after depression, alcohol/drug misuse and social anxiety). Around 1-3% of the population experience OCD, that is around 2 million people in the UK using the upper 3% number, roughly, - NICE. And that is only the people that come forward for treatment that we know about.

OCD is the abbreviation for Obsessive Compulsive Disorder. It is a mental health condition that affects people of all ages and backgrounds. It is characterized by two main components: obsessions (the ‘O’ of OCD) and compulsions (the “C” of OCD). Compulsions are often referred to as rituals. Personally, I like to stick to compulsions to separate it from usual day to day to day rituals we all engage in, such as, celebrating birthdays in a particular way or family traditions and so on.

Anxiety comes from thoughts about, for example (not limited to), leaving the gas on, leaving something plugged in, feeling uncomfortable that things have been moved from their usual place, that there is some kind of invisible contamination, is the front door locked properly or have the hair straighteners been left on so the house burns down. Some people with OCD have thoughts about accidently harming others (and sometimes not knowing they have) or what they feel are inappropriate sexual thoughts that are totally out of keeping with who they are as a person. Or having inadvertently run someone over without knowing. Often, people with OCD fear that because they have had a particular thought, it must be true.

Then to get rid of the anxiety, come the compulsions to try to make the thoughts, anxiety or feared outcome safe. This is where checking multiple times that the front door is closed, or the plug is turned off, or the cooker. Or stopping the car and going back to make sure no-one has been runover. Spending ages coming up with 'safe' thoughts to cancel out the 'bad' thought. Reassurance seeking, self-doubt, avoidance and all kinds of other behaviours just to keep others safe from you. Most people with OCD know that all the behaviours they get into make no difference. So many of my clients say they know it is "ridiculous". I think this is such a harsh thing to say to yourself. You are not doing these things because you want to, it is coming from a place of fear.

Have you felt an urge or impulse to do something you don’t really want to. Had a “bad” thought you needed to make ‘safe’ or cancel out somehow? These are, what we call, intrusive thoughts. They intrude into your consciousness and interrupt what you were thinking about. They cause such intense disruption and anxiety that they interfere with your everyday life as you find it impossible to not pay attention to them. They are truly obsessive when they cause no enjoyment and nothing but distress and anxiety.

The O of OCD are the Obsessions

What are OCD obsessions?OCD obsessions are the thoughts that pop into your head that cause anxiety and distress. You don't ask for these thoughts, they are just there. We all experience this as humans but people with OCD respond to them differently. In therapy, we call these intrusive thoughts. They are often in direct conflict with what is important to you as a person. OCD is a bully and like a bully will pick on the things that mean the most to you, making you feel afraid and unsafe. You are probably finding that you are not able to ignore and distract yourself from these thoughts. These lead to feelings of shame, embarrassment and guilt and of course, anxiety and fear. The most well-known obsessions are around the fear of contamination. That could be from germs, illness, asbestos and all sorts of other things. This can lead to behaviours to try to keep yourself and others safe such as excessive handwashing, bleaching everything, changing your clothes often, frequent showers or other forms of cleaning (see compulsions). Whilst the above is the most well known, in reality obsessions can be about so many different things. Other examples are fear of causing harm in some way to others, fears around leaving appliances on, plugs switched on and causing floods or fires often leading to relentless checking (another compulsion). Other obsessions can be around violence, death of others, blasphemy and unwanted sexual thoughts. Children often find it difficult to say what their fears are around them or are too scared to say them out loud in case they come true (we call this ‘magical thinking’ in therapy). If you child start unusual behaviours such as, only being able to settle to sleep if they have said good nite to you in a specific way, check things, touch things or have routines they get really upset about if they are interrupted, do consider OCD (this can be due to other things, of course). Children may hide these behaviours at school for fear of bullying and/or ridicule.

The C of OCD is the Compulsions

What are OCD Compulsions? Compulsions are the behaviours that result from obsessions (thoughts) and the fear and anxiety they provoke. Compulsions, sometimes called rituals, are an attempt to get from that unsafe, anxious place to a feeling of safety. Clients will tell me that they cannot resist, checking, excessive cleaning, excessive handwashing, endlessly seeking reassurance from others that things are ok and safe and that their fears are not going to come true, saying prayers, having special numbers, counting and touching things in certain patterns or number of times or until it feels right and many many others. You may experience having to have things in certain places, doing things in certain orders, doing some things repeatedly or until it feels just right. These are just some examples, there are many more. You may experience one, some or all of these, or something totally different. I didn’t want to put a 12 page list here! All OCD clients know that these behaviours make no sense but feel powerless to resist in an attempt to keep others or themselves safe and reduce that feeling of fear and anxiety. None of us like feeling anxious, and OCD whispers in your ear, hey I am your friend, do this thing and you will feel better. Temporarily it may feel better and so you think, ahhhhh, and repeat. Sometimes compulsions are not physical but can be more in the mind. We call these ruminations or mental obsessions. An example of a mental obsession might be saying a particular word 4 times or until it feels just right, in response to an obsession to make the thought (obsession) safe. Everyone’s OCD is unique to them, so you may experience some of the above or something different, the content may be different, but the result is the same.

What causes OCD?

We don’t really know! I would go so far as to say that if anyone tells you they know, they are lying! There are many theories and ideas, but we don't actually know! It can often start, even on just a small scale, from 9 years up. If you are a parent, you may notice your child start doing odd things that they get upset about if they are interrupted or are stopped. If you are on reflecting on yourself as a child, can you remember those things you did to better about things. A common story I hear is a child having a thought “what if my parents die”. A lot of children have that thought, but children that go on to develop OCD will tell me (as adults or children) that they feared it would happen because they thought it. They then think if they say good nite to their parents in a certain way, it won’t happen, or they may turn light switches on and off or tap things a certain number of times. The permutations of this are infinite. In therapy we call this ‘magical thinking’. Meaning, that if we think a thought, it will come true. Unfortunately, we cannot win the lottery by thinking about winning it, believe me, I have tried! Magical thinking is fear based, not evidence based. In OCD you will be doing compulsions to temporarily reduce your anxiety along with probably avoiding certain things. This has given you an “evidence base” that it appears to help, even though you know it doesn’t. But as it does work on some level, you have bought into it and now find it impossible to stop as the anxiety of not doing what OCD says is too much to cope with. People with OCD often believe that they can influence and prevent bad things happening, we call that an ‘overinflated sense of responsibility’. There is often a sense of having “magical” powers, in that, thoughts can come true and then trying to avoid that happening by doing what OCD may tell you. You will be seeking certainty in an uncertain world, as the anxiety of not knowing what may happen next is too much to cope with. People with OCD often experience being called a “control freak”. But it is not about that, it is just about trying to feel safe and keep others safe. It is a result of fear. There is also the possibility that families may have a genetic predisposition to anxiety or children learn OCD, unintentionally, as the way to manage anxiety from other family members. Stressors in life can also start OCD off. Once OCD has begun, the brain struggles to regulate. The good news is, I have helped many many people with OCD learn to manage it so that it does not interfere with their lives anymore. This is not to say you will never feel anxious again (beware of people telling you they can help you achieve this) as anxiety is needed at times and is a natural human state. But you can learn to manage and regulate your anxiety so you can live your life in the way you want to, not the way OCD tells you too.

Are there any other aspects to OCD?

There can be a lot. From years of helping people with OCD I have noticed that there are often, not always, other things going on alongside OCD. People often have low self-esteem, perfectionism traits and high levels of self-criticism. That is why I have developed a more integrated approach using CFT and ACT alongside CBT to help with these other parts of OCD. You may also become depressed by trying to cope with all this on a daily basis. There is a growing evidence base that mindfulness can also help. Kind of makes sense to me and I have been using elements of mindfulness with my clients for years. Feel free to ask me more about this. I have noticed that my clients often feel ashamed, guilty, not good enough and dangerous. My clients often try to keep their OCD secret in case others think they are mad or might think badly of them because of the content of their thoughts. I have had clients hide some of their thoughts from me for several sessions because they are afraid of being arrested! If you are having thoughts that you fear are perverted, violent or paedophilic in nature and they make you feel disgusted, ashamed and give you no pleasure, then my guess is that this is OCD and not who you are actually are. If such thoughts give you no pleasure and you feel they are ‘wrong’, it is more than likely, OCD at work. I have treated this many times. Don’t forget, a thought is a thought, it does not mean anything. It is the meaning that we attach to our thoughts that is part of what keeps OCD going. It is also about if we have any intention to act on the thought. For people with OCD, they would never act on the thoughts and the thought of acting on such thoughts fills them with horror.

Therapy for OCD

CBT works very well when we are able to accept that unhelpful thoughts and behaviours increase difficult and unwanted feelings and that when we listen to the more helpful thoughts and engage in more helpful behaviours, we feel better.
This is how CBT Works.

I do use ERP in therapy, of course, but not as standalone therapy. If you have tried ERP and it has not worked for you, don’t worry. All this means is that you need to add in CBT around the ERP. If you go to my FAQ’s, I have written more about this. That is what the evidence base actually says, is that it is CBT, WITH ERP that has great results. I also have a huge amount of experience of treating OCD and that is also important.

Many clients say to me that they can see what we are saying is true on an intellectual level but still feel a sense of blame or sometimes guilt and shame around their thoughts and fears. This leads them to not believe what they intellectually know to be true. Clients will say that they still feel to blame and get stuck in a tangle with very harsh self-critical thoughts. It is therefore important to treat these elements of your OCD as well. We can address this by using ideas from Compassion Focussed Therapy (CFT) and Acceptance and Commitment Therapy (ACT) and mindfulness. These therapies are also evidence based and their use in OCD treatment is increasing.

You are here because you are considering getting some help for your OCD. Therapy is very rewarding and is also hard work, for us both. To get the best out of therapy for OCD you need to feel motivated and have time to put in some practice between sessions.

You will see, what I call ‘practice’, referred to as homework elsewhere (this is a repeat from elsewhere in the site, but it is really important). To me, homework can have unhelpful reminders of years gone by from school! The reason I use the word practice is that you have been ‘practising’ the use of OCD to manage your anxiety for, probably, a long time. In order to learn more helpful ways to respond to OCD thoughts, you will need to practice these new ideas, to make them your new default. This is why I think of therapy as a ‘team effort’. I bring a new way of thinking about and managing thoughts and will help you to claim your life back from OCD. You bring your expertise of being you all the helpful coping strategies you already have, even if. you are not aware of them at the current moment. Put these together with some hope, patience and practice, and you can claim your life back from OCD.

What you can expect from me:

I very much enjoy treating OCD, so much so, it is now, a large amount of my practice. All my OCD clients are really lovely people and OCD usually responds very well to therapy, so it is a win-win for me. I think therapy works even better with some humour and I have been known to swear (unless it offends of course)! I am relaxed, down to earth, honest and I don’t use therapy jargon. You will have 100% effort from me in all of our sessions. It is really important to me that you find therapy an enriching and rewarding experience. I want you to feel better just as much as you do and that is what we will both work towards.

Jane Watkins, CBT Therapist

OCD

What is OCD?

Therapy for OCD

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