OCD - Escape from those compulsive chains -

There is a constant flux of intrusive thoughts telling you that some terrible thing can happen and you need to do something to prevent it.

These thoughts are intensely negative and repetitive and you have a continuing feeling of doubt or danger. You generally feel an overwhelming obsession with several things that other people seem to be OK with.

You feel worried and distressed about it. You naturally attempt to alleviate these feelings by checking, hoarding, avoiding certain places, certain people, certain activities, cleaning and washing or opening and closing a door a certain number of times. You feel the compulsion to complete these actions so you can feel better and go on with your life. You attempt to reduce the fear through these protective behaviours. It feels like you are in a perpetual search for reassurance.

You feel isolated and sometimes trapped and cut off from the rest of the world. Most of the time you just want to keep your symptoms hidden. You know you are acting differently from other people and you want to prevent embarrassment and misunderstandings.

To be able to hide it you stick to imperceptible compulsions when around other people as much as possible, or have an easier time holding back while you’re out, and then you get overwhelmed by fear and the need for compulsions when you get home.

You may feel ashamed and alone or like you are losing touch with reality.

There is help out there

Maybe, like most people who live with OCD, you think there is no help for you. You think you need to resolve it by yourself. In fact, people who struggle with OCD (1-2% of the population), in general wait 12 years before seeking support. This means several years, sometimes decades dealing with a condition that can be treated. Many people with milder forms of OCD do not realise that they can be helped, and do not seek help until their condition becomes much more severe. But there are reliable and proven treatments available.

So much unnecessary suffering!

OCD is not only difficult for you, but also for your family members and friends too. You are experiencing a high level of anxiety – and this can damage your health, relationships and work life. OCD rituals can take a huge toll on your family life and drive a wedge between you and your loved ones who often feel unable to comprehend the pain you are experiencing, let alone how best to support you.

Are you going crazy?

Absolutely not. You are not mad – you are just anxious.

Yes, the malevolent tyrant OCD is driven by anxiety.

Stress makes us want to do something and if there is nothing obvious to be done then we will find stuff to do. And this might include repetitive actions. When we feel anxious and there is no obvious cause for anxiety, our minds will find stuff to be anxious about – even if we have to ‘shape’ the anxiety through our imagination.

OCD’s underlying principles are similar to the old joke.

‘Why did the Frenchman sprinkle salt on the road? To keep the elephants away, of course. But there aren’t any elephants in France! See, it works!’

You imagine that by not thinking certain repetitive thoughts and worries or not taking certain repetitive actions, bad things can happen. And then, because a bad thing did not happen, you have your “theory” confirmed.

You are not a fool. You know that this is not “good science” to say the least, but this is the way you fulfil your innate need of feeling safe and secure. At the same time, you feel that you have at least some control or influence over your life and environment – and that is an innate need too.

Repetitive behaviours and thoughts are basically your attempt to make you feel safe through routine and the familiar – even if the ‘familiar’ is washing your hands a hundred times a day. The attempt to feel safe then becomes a habit in itself and, paradoxically, can make you feel even less in control.

To complete the scenery, there is an addictive aspect of OCD. In fact, just like any addiction, OCD is making you constantly think about the next thing you need to do to keep yourself safe, you may feel a build-up of stress if you are not able to do it, you can become agitated if other people try to stop you, and you might be using these compulsive behaviours to escape from the problems of everyday life. As with any repetitive behaviour, habituation gradually kicks in – and that means the more you do, the more you have to do. Fifty hand washes turn into seventy, turns into a hundred… and so on.

Why is this happening?

No clear cause has been established for OCD, although theories have been put forward that it may be genetic, and/or due to a faulty serotonergic system in the brain.

Research shows that OCD does run in families and that genes likely play a role in the development of the disorder. It is also known that very stressful events (like the death of a loved one) and experiencing trauma or abuse during childhood can precipitate the onset of OCD.

Some innate personality traits can predispose to OCD, such as easily feeling negative emotions and tendency to excessive perfectionism.

As with many anxiety conditions the usual drugs are often prescribed. These include Betablockers, Antidepressants and Benzodiazepines. But medication will not teach you how to deal with the problem when the probable relapse happens in the future. And, obviously, you need to be aware of the secondary effects.

First aid for when you are feeling the compulsion

Spot the underlying need the OCD was promising to meet and generate alternative ways to meet that need.

Stop and focus on what is happening.
Ask the OCD what it is trying to do for you right now.
Listen to what it’s trying to do for you (such as trying to make you feel safe or in control).
Think of three ways you could feel safer or more in control outside of the OCD, and write them down. (for example breathing slowly and deeply, talk to your partner, thinking about your baby, imagining a beautiful garden, etc)

2. Focus on and trust the observable reality around you. Move from imagination to observation

Focus on three things you can actually see – say, a door, a window, and another person. Then run through in your mind three things about the door (it’s blue, it’s locked, it’s about 7 feet high), three things about the window, and so on.

This is a distraction technique, that is going to move you from imagination to observation. The more calmly you can rehearse doing this in your mind, the easier it will be when the OCD tries it on with you.

3. Detach from the OCD

You know the OCD is not you. Even if the label served you for a while, you know it is just something that happens to you. You can see it now for what it really is: A charming and convincing conniver, a parasite living off your real self.

Each time you felt tempted to jump at the OCD’s command, you should question:

What arguments is it using to try to convince you to exhaust yourself and waste your time?

What are all the persuasion techniques it uses?

What does it seem to promise you?

What lies does it tell you?

The OCD is trying it on, isn’t it? But it is losing its power because you are now totally detached from it.

What will we do for you?

The emotional brain, an older part of the brain in evolutionary terms, cannot distinguish between an
imaginary threat and a real external danger. Such misuse of the imagination is one of the main reasons people have problems. Worrying switches on the ‘fight or fight’ response just as if you were facing a predator. Rational thinking is switched off.

Imagination is a major player in the formation and maintenance of OCD, above and beyond beliefs and mood states. The obsessive doesn’t think their hands are contaminated, but they feel as if they are. This is an important distinction and shows us why just trying to deal with the thinking part of emotional responses can be slow, laborious, and ineffective.

It is remarkable that OCD sufferers typically report feeling dissociated or in a mesmerizing state when they are engaging in their obsessive thoughts or compulsive acts. They focus only on their behaviour and everything else disappears, time vanishes and nothing else matters. They might report that an hour of handwashing seems like five minutes, or that their usual life just fades away during these times.

Obsessive thoughts and compulsive actions narrow the focus of attention and are, therefore ‘hypnotic’. Recent research found that not only there is a disassociated from reality during the trance (and therefore not necessarily thinking at all), but they also rely heavily on their imagination as a guide to reality. So they may see that their hands are clean, but imagine they are contaminated.

Catching thoughts and challenging them, and of course, deliberately changing behaviour, can help to disrupt the pattern of OCD and make it easier to learn how not to succumb to it – this is the aim of Cognitive Behavioural Therapy. It is a good method to help you understand your thought process, but the problem here is that OCD isn’t a thinking disorder – it’s a feeling disorder. The feelings produce the thoughts, not the other way around. Thus, the therapy should include CBT and also a way of dealing with the emotions behind it.

We will use Guided Imagery to help you relax and calm down your emotional arousal. We are going to help you understand what is the need behind the behaviour. We will also rehearse and guide you to imagine yourself being relaxed and confident when you are not performing those behaviours. We will also discuss how you can engage in other activities and pursue your true goals.

You are going to learn how to manage this part of you, accept it as something that was useful in a certain stage of your life but it went out of control and is not needed anymore. You are going successfully meet your emotional needs in ways that are satisfying to you.