This week we're going to look at Obsessive Compulsive Disorder, or OCD for short. What is it, how does it affect people, and what can you do about it if you're struggling? Read below the line break to find out.
Obsessive Compulsive Disorder is one of the most misunderstood diagnoses, and OCD as a phrase is criminally over-used. Everyone knows somebody who would describe themselves as "a bit OCD," and it's frustrating to have to explain to people that liking your kitchen to be clean or wanting your towels to be put in the cupboard in size order is nowhere near the same as having OCD. In order to hopefully bust this myth for you once and for all, let's break down the different components of the name 'OCD'.
Within the name 'OCD' are two of the things that make up the disorder. Those things are obsessions and compulsions, and they are different:
Within OCD, obsessions are thoughts that are intrusive, and come up again and again no matter how much you try to ignore them. These can be fairly vague (generally "feeling as though things aren't right") or highly specific (intrusive thoughts about someone close to you dying, or thoughts of having done something to offend others). When you're having intrusive thoughts, which are really distressing, you would generally do anything to avoid thinking that way. Which brings us to the second part.
Compulsions are behaviours that someone might do because they are trying to manage their obsessive thoughts. Compulsions can bring some temporary relief from obsessive thoughts, which is why they become so linked to the thoughts. Compulsions are not the same as habits - habits are generally helpful, compulsions disrupt health and well-being.
Hopefully that helps you to see why being a bit anxious about the bathroom being untidy really isn't the same thing. You might be a bit worried or stressed, but it won't consume your every waking thought if you leave it until tomorrow (for some people, excessive cleaning and tidying is a way of coping with the symptoms of stress and trauma, but that's a different story).
Most people know about compulsions like hand washing, or checking lights/door handles, but they may only be a small part of what OCD might entail for a person. Other types of compulsive behaviour include:
As you can see, even though the strategy used to manage the obsession started as a way to try to make the person feel better, over time it becomes much more of a problem than a solution. You might be unable to leave the house until you've spent hours checking and re-checking a certain part of your routine, or you might wash your hands until they're raw. You might not be able to leave the house at all, if fear of contamination has taken over your life.
It's important to say again that generally keeping a clean house, checking an email for mistakes, or making sure that you aren't knowingly going to make yourself sick by touching something that a poorly person has touched are good rules for living. OCD is a problem precisely because those 'general rules' have been hijacked to serve something different - rather than promoting health, they're being used to satisfy an anxiety or fear that just gets worse over time. Spending a significant chunk of time checking light switches is probably a good thing if you're an electrician; otherwise, it's likely to be leading to even more distress. And that's why it annoys me so much when the people I know who like tidy houses refer to themselves as "a bit OCD" - it's not ruining their lives, they don't mind doing it, and therefore it's not a problem.
What can I do?
If you're reading this and thinking that these symptoms sound familiar, then it's important to get some help. A lot of people don't get help for OCD because they're embarrassed - they think that their symptoms sound "crazy," for example. But thinking like that keeps people locked in to being at the mercy of obsessive thoughts and anxiety for longer than they need to be. It's a health condition, and you deserve treatment.
Two things that can be helpful for OCD are medication (usually a type of medication called a selective serotonin re-uptake inhibitor, or SSRI, such as citalopram or fluoxetine) and psychological therapy. Both of these things together are usually more helpful than just one or the other. The type of psychological therapy that is generally regarded as the most effective is cognitive behavioural therapy (or CBT), and a particular type of this called exposure and response prevention (ERP) which aims to expose someone to the things that make them anxious (such as touching a door handle) whilst preventing them from engaging in the compulsive behaviour that manages that anxiety (such as washing their hands). It's designed to make people feel a bit more anxious in the short-term with the understanding that this is the only way to make things easier in the long-term, and it's pretty effective at helping people to control their OCD symptoms or resolve them completely with time. Compulsive behaviour is treated best by stopping them altogether, rather than cutting down on them bit by bit - of course, this isn't possible where the compulsion is something like showering or washing your hands. But the point is to allow people to realise that their worst obsessive thoughts and fears will not happen if they don't engage with the compulsion - and if you can realise that, you're free.
So that's OCD - hopefully shining a spotlight on this condition has been helpful. Let me know how you cope with OCD in the comments.
Dr Sarah Blackshaw: Clinical Psychologist, blogger, tea drinker, interested in dinosaurs and shiny objects