“I’m so OCD about that.”
If you’ve ever said these words then you probably don’t have OCD. You’re not 10% OCD, or 75% OCD or whatever that godforsaken Buzzfeed quiz told you.
Want to know how I know?
Diagnostically speaking, one of the biggest reported struggles for an OCD patient is actually believing they have OCD.
Contrary to media portrayal and popular belief, OCD is not characterised by a desire for order, colour co-ordination, or neatness. It is not the quirky ‘ha ha I colour code my socks against the spectrum of the rainbow, lol I’m so off da wall,’ – syndrome it is often portrayed as in the mainstream media.
FACT: The World Health Organisation classifies Obsessive Compulsive Disorder as one of the ten most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life.
Instead, it is a disease of the thoughts characterised by a cycle of intrusive mental images, guilt and doubt. Doubting your sexuality, doubting whether you want to harm your pets, doubting whether you want to harm your children, doubting whether you love your partner, and of course doubting whether or not you even have OCD. To give you a sense of the severity of the disorder, below I have included some quotes from anonymous sufferers:
Sufferer A: “Three years ago I had it first pop into my head and it paralyzed me. I have a 4 year old daughter and for a month after this came into my head I didn’t take care of her, I didn’t want to look at her or hold her. I got rid of all the photos of her on my phone, I was scared… I was so scared I would act on it and hurt my baby.”
Sufferer B: Over 42 years OCD thoughts have stolen so much happiness from me that can never be replaced, the worst for me was how I missed doing so many things with my daughter. I avoided places and people, lost friendships, childhood memories, job opportunities, favourite hobbies, relationships… the list of what this has cost me is endless.
Sufferer C: I just want all this to stop. It’s like my mind hangs onto my every thought and makes it some kind of sick weird thought. How will I get myself back? I’m afraid that the old me is lost forever.
Thanks to the obscene levels of misinformation in both mainstream and social media, OCD is viewed by most of the public – not as a life-ruining illness -but as a character quirk (after all, Sheldon just wouldn’t be the same if he wasn’t so OCD about his Star-Trek DVDs– right?) This article is a straightforward description of what the disorder actually is, what it does, and to a lesser extent, a plea for the public to become better educated.
FACT: 27% of OCD patients have attempted suicide.
Because misinformation costs lives.
To my knowledge there are three stages to OCD:
Stage One: Intrusive Thoughts
Intrusive thoughts are horrible thoughts that enter the mind unbidden, for instance a sudden flashing image/urge to hurt your pet dog.
Stage Two: Compulsions
This can either be a physical compulsion (turning a light switch on and off a certain number of times to ‘prevent’ this from happening) or a mental compulsion (replacing the mental image of you hurting your dog with one of you stroking your dog). Up to 50% of sufferers have only mental compulsions – known as ‘Pure OCD.’ Compulsions are performed to try and either correct or neutralise the thought – in other words to balance out the ‘badness’ of the thought.
Stage Three: It Becomes a Cycle
As with the classic thought experiment: ‘don’t think about a pink elephant’, the more you fear and resist the thoughts, the harder it is to not think about them. But instead of a pink elephant, in OCD the thing you don’t want to think about is nothing less than your greatest fears. The more compulsions an OCD sufferer performs to try and neutralist the thought, the harder it is for them to rid themselves of the thoughts. Severe patients can spend up to eighteen hours per day performing compulsions.
FACT: Up to 50% of all OCD diagnoses are labelled as severe.
Imagine your obsession is harming your mother and the only thing your mind produces all day is unrelenting and graphic scenes of you hurting her. In severe cases, not a single thought will deviate from this pattern, and all that runs through a sufferer’s head are increasingly distressing mental pictures.
In OCD the anxiety is so severe that the brief relief provided by performing a compulsion becomes addictive. Let me repeat that, the anxiety from OCD is so severe that sufferers become psychologically addicted to performing compulsions. Compulsions provide, on average, less than two seconds of relief.
So in the case of a patient with the impulse to hurt their mother, they performed compulsions for hours, arguing with themselves, telling themselves that they’d never harm anyone and making long lists in their head about all the reasons they loved their mother. All it did was make the OCD worse; the images became more violent and harder to remove from their mind.
At this point the anxiety became so severe that she started to avoid physical contact with her mother, and eventually stopped face to face contact with people all together.
“I was afraid to touch her because I was worried I wouldn’t be able to control myself and that I’d do something to harm her. Then I began to worry I was not just a danger to my mother, but everyone. I slowly started to retreat until eventually I was afraid to leave the house.’
Avoidance is incredibly common in OCD, and functions as a form of compulsion, only serving to make the disorder worse.
THE GOOD NEWS
The sufferers of OCD are the most harmless demographic in the entire population. The truth is that EVERYONE suffers from intrusive thoughts and the difference between the OCD sufferer and the average person is simply that the OCD sufferer finds their thoughts more upsetting. Instead of dismissing strange or upsetting thoughts, the OCD sufferer agonises over them. They feel guilt over even being able to picture such horrible things! It is precisely because they couldn’t even stand to do these things, even within their head, that they monitor their thoughts so carefully.
Thankfully, OCD is incredibly treatable, with a strain of cognitive behaviour therapy known as exposure/re-exposure therapy averaging a 70% improvement in symptoms over the course of three years. The problem is of course, that so few OCD sufferers realise they have the disorder because it is so often mislabelled and therefore do not access the treatment.
Treatment
Whilst it is always preferable to go to a doctor and seek professional help, many people with OCD are too afraid to tell anyone of their thoughts and fears. Therefore, I have outlined the basic steps of exposure/re-exposure therapy below. They are as follows:
Exposing yourself to anything that ‘triggers’ you
To demonstrate the treatment I will (with permission) use the example of the patient who is scared that they wish to harm their mother. The first step for the patient is to expose themselves to their fear. This can be done in several ways depending on the severity of the case and many treatment plans use a pyramid scheme wherein the difficulty of the tasks start smaller and get more difficult as the patient adjusts to the different levels of anxiety. As the patient is extremely severe and afraid to even touch her mother lest she hurt her, she might begin by just holding her hand for ten seconds. As she moved further up the pyramid scheme she would take on more triggering tasks. Depending on the type of OCD, the types of exposure will vary – but as a general rule of thumb you need to do what frightens you.
Resisting compulsions
Once the anxiety has been triggered the OCD patients’ natural response is to perform a compulsion. The compulsion provides a momentary relief from the doubt, fear and worry bought on by the trigger. To recover from OCD you must do two things. The first is to learn to live with the doubt that whatever it is you fear might come true, and the second is to sit with and adjust to the anxiety. The brain literally cannot sustain such high levels of anxiety for an extended period of time and so eventually adjusts to the trigger. The relief the compulsion provides therefore unintentionally perpetuates the anxiety, which is why you must STOP performing compulsions in order to recover. You have to force yourself to adjust to the anxiety.
To my mind, there are five primary types of compulsion:
- Body checking (checking you have the correct amount of revulsion to a specific mental image or bodily reaction).
- Memory checking – looking back into the past for ‘proof’ that the thought isn’t true
- Arguing with, or analysing the thought
- Attempting to replace the thought with a nice/better one
- Trying to prevent and neutralise the thought through an action
Final Word
Exposure/re-exposure therapy can be extremely difficult, but it can have life-changing results for the sufferer. If you suffer from OCD I want you to know that this doesn’t have to be forever and that you can get help. Go to your GP and ask for someone who specialities in mental health to speak to you. I know it is terrifying, but they will understand – I promise you. If you are not a sufferer then I would ask you to simply cease using OCD as a slang term for being a bit anal about tidiness. This isn’t political correctness, so many sufferers have no idea what is wrong with them and it makes people afraid to get help. As I said earlier, misinformation costs lives.
If you’d like to donate and help the cause:
Mind: http://www.mind.org.uk/
OCDUK: http://www.ocduk.org/