The following blog was written by Phil, our Physical Health Liaison Worker, for OCD Awareness Week (8-14 October 2023).
“There are many popular conceptions about Obsessive Compulsive Disorder (OCD). Many people who like to be very organised, or are somewhat rigid in their behaviours might say, “I’m a little OCD”. Perhaps you even exhibit some checking rituals, and have wondered if this kind of behaviour is ‘a bit OCD’? But what is clinical OCD? And does it actually bear any relationship to being obsessively organised or tidy?
As an emerging adolescent, I suffered from full blown OCD. In this blog, I will talk a bit about what it was like for me and how OCD manifests more generally, as best I understand it. And lastly, I’ll explore whether it’s possible to see symptoms improve or even to experience recovery from OCD.
What is OCD?
Since the early 1900s, various descriptions of obsessive compulsive disorder have been tendered. The term generally describes individuals who exhibit both obsessions and compulsions. Let’s take a little look at what is meant by these terms.
These are unpleasant thoughts, images or impulses that persistently intrude into one’s consciousness. As a result, an individual typically tries to remove these ideas from their mind.
These are behaviours that someone repeatedly feels the need to engage in. They feel that these actions are capable of either reducing anxiety or reducing the likelihood of some calamity occurring. However, whilst the behaviour may help calm the person a little, they are usually aware that it does not really relate to the supposed calamity all that well.
Whilst many of us may experience these kinds of phenomena, they are not usually considered severe enough to warrant the term ‘obsessive compulsive disorder’. Such a condition will likely only be diagnosed if these symptoms are accompanied by significant distress.
Obsessive ideas (or obsessions) can be linked to many things. However, they can often be linked to some kind of perceived calamity. For example, many obsessive ideas are linked to the fear of becoming ill. And this idea can then fuel compulsions.
For example, I might believe that if I don’t keep things clean, then I will become ill. And if I worry about this enough, I could become obsessed by the possibility that I will become ill (an obsession). But if I then start feeling the need to regularly wash my hands for extended periods of time, then this would be an example of a compulsion. Both the idea and the behaviour can become obsessive and compulsive (respectively) if they start generating extreme anxiety.
Having now outlined the nature of obsessions and compulsions, I will describe a little about how my OCD began to manifest as I grew up.
As a child, I used to engage in number games that I made up. These included having to touch items an odd number of times (never even), and moving saliva around in my mouth in five locations and feeling the need to always complete all five locations. They were quite innocent childish behaviours, but I wonder if this kind of ritual possesses the potential to develop into something more troublesome.
In fact, this is a good example of a compulsion, because:
1. I felt the need to touch items a certain number of times. So this was a compulsive ritual.
2. I felt some anxiety about not completing the touching ritual.
3. Once the ritual was completed, the anxiety was extinguished.
However, the ‘anxiety’ element at this stage was mild. It felt like a little game, and so this innocuous level of adherence would not have been considered as the symptom of a disorder. However, the need to complete rituals became increasingly important as I grew older.
When I was seven, my mother joined a Christian Charismatic Evangelical Church. I was deeply impressed by the teachings of the Church, and by age nine, I had become very religious. One of the beliefs I held inspired by the Church was that every person must commit their lives to serving God, or else they would spend eternity in hell. And this prospect began to become a menacing fear for me to the extent that this idea began to cause me significant distress, so much so that one might classify this thought as an unhealthy obsession.
When I was around nine, I made a formal commitment with my mum to become “born again”. This involved making a formal commitment to be a Christian for the rest of my life and turning my back on my previous life and repenting for my sins.
My mother had told me that ‘repenting of our sins’ meant turning away from the action and not doing it again. And so I began to obsess over whether I had really ‘turned away’ from my sin. If not, then in my mind, I had not really been ‘born again’, and had not become a true Christian. And the result would be that I would go to hell for eternity.
And so I began to constantly obsess over whether I had really ‘repented’ of all my sins.
Hooked on a Feelin’
As the years went by, my obsession with whether or not I had ‘truly repented’ from each of my ‘sins’ continued to increase. By age 17, my level of anxiety had became unbearable.
Each time I committed something which I believed to be a sin, I would try to mentally imagine that I was back in the same situation in which I had ‘sinned’. And then I would try to imagine, as vividly as I could, that I would not commit this sin, if I were able to go through the same scenario again.
I would keep replaying the episode in my mind and try to elicit a deep feeling of remorse about my sin. And eventually, if I felt remorseful enough, I might finally be able to move on. But then another ‘sin’ would occur and I would start replaying this new episode over and over in my mind, trying to (once again) convince myself that I was remorseful enough to be forgiven.
In OCD, this obsessive ‘replaying’ of ideas over and over in one’s head, in the hope that somehow one can have some mastery over the associated feelings, is known as rumination.
One of the factors that is predictive of recovery from OCD, is the extent to which a person realises, deep down, that their obsessions are unreasonable or perhaps irrational. In clinical terms, this understanding is referred to as having ‘insight’.
With regard to my obsessions, I think I knew deep down that if God were a truly loving God, and Christianity were the true religion, then I should surely not be living life in this kind of distress.
And one day I had a kind of epiphany. My best friend was praying with me, and he challenged me:
‘Do you think if God is all loving, that he really wants you to be living like this?’
Perhaps I had just reached the point where I couldn’t go on as I had been, and I was ready to start letting go of my obsessions. In any event, when my friend said this it was like a light switched on, and I started to let go of some of my more obsessive ideas.
Over the next two or three years, I began to feel somewhat better, as I continued to try and become more rational about my obsessions.
The real turning point came when I gave up my religion altogether aged 25. This is not to say that Christianity (or for that matter any religion) is bad. In fact, research tends to show that people who have religious beliefs, on average, have better emotional wellbeing. However my obsessions (and fears of calamity) were completely intertwined with my religion. And it was the decisive break with the latter that really enabled me to drop my obsessive ideations.
Can I recover from OCD?
As with any mental health condition, you cannot expect for it to evaporate for ever and never come back. A more helpful question might be: can we reach a point where we are able to ‘let go’ of our obsessive ideas, and begin to live a life free from them? When I look back now, I can see that a number of things helped me to gradually start to manage my OCD symptoms better.
Cognitive Behavioural Therapy
In terms of therapeutic treatments for OCD, research has shown that Cognitive Behavioural Therapy (CBT) is often quite effective. And I have certainly drawn on ideas associated with CBT when trying to tackle my own symptoms.
Put simply, a core assumption of CBT is that OCD behaviours are driven by underlying irrational beliefs. So, for example, a CBT therapist will first work with you to identify what core beliefs are driving the compulsive behaviours. The next step in the process is to encourage you to test the validity of your belief – sometimes in a very practical way. The therapist will start with less innocuous fears before building to the most difficult ones.
For instance, if you believed that spending less time washing your hands will make you ill, the therapist will invite you to test out this hypothesis and encourage you to try reducing the amount of time you spend washing your hands so it isn’t excessive. If after reducing the duration of time you spend washing your hands you do not get ill, then this will hopefully help you to reassess the validity of your underlying assertion. Which, in turn, will help you to realise that your underlying fear is excessive. Through the therapeutic process, you can learn to cross-examine the validity of beliefs underlying your compulsive behaviours.
I have found these strategies as well as others I have learnt by studying CBT immensely helpful so I would strongly encourage anyone experiencing OCD symptoms to try CBT.
OCD and Anxiety
However, I have found that the extent to which I have been able to employ ‘cognitive’ strategies in the process of combatting my OCD, has been contingent upon my general level of anxiety at any given time. And I’ve noticed that I can sometimes start slipping back into obsessive-compulsive behaviours when I’m suffering from a lot of stress.
So why might my symptoms get worse when I am suffering from anxiety? I often have to do a lot of ‘reasoning’ with myself before I feel able to abandon a particular behaviour. And so when I’m extremely stressed, I just don’t have the headspace to engage in the emotionally strenuous reasoning work that is necessary, in order to convince myself that I don’t need to continue with a compulsive ritual.
It is helpful for me to know this so that, if necessary, I can focus on reducing my stress levels before I look at challenging my thoughts and behaviours.
Sometimes it’s important to be kind to myself, and not try to do everything at once, which might further exacerbate my anxiety and create unnecessary frustration.
I have also found that my general anxiety level is linked to the quality of relationships I am embedded in at any given time. For example, when in my late 20s a long-term romantic relationship began to deteriorate, I started to experience OCD symptoms again. But after I broke up with my (then) fiancée, the symptoms began to rescind.
I have actually become so aware of the link between anxiety and my relationships, that during my thirties I began to be far more choosy about whom I allowed into my friendship circle. During this period, I started to monitor how anxious I became when I was with a person. And if my anxiety markedly increased, I would try to spend less time with this person in the future. Conversely, if I felt emotionally enriched after being with someone, I would then try to meet this person more often. In fact, I would go as far as saying that this process has been central to the improvement of my emotional wellbeing over time.
However, I appreciate that altering our acquaintances is sometimes easier said than done. Sometimes we cannot avoid a person who makes us anxious. In such circumstances, I think it is important that we invest quality time into other relationships that we find more emotionally enriching. I have found that investing quality time into the latter, can help to offset the negative impact of time we are forced to spend with individuals who leave us feeling more anxious.
The Bigger Picture
In summary, I have found it is useful to be aware of this ‘bigger picture’, in which my compulsive behaviours are not simply driven by random ‘cognitive’ impairments, but are perhaps also somewhat tied to my overall state of anxiety and wellbeing. And I have further found it useful to consider the extent to which my general level of anxiety might be linked to the quality of my intimate relationships, and the kinds of people I spend time with. Cognitive strategies are fantastic; however we may also need to consider the nature and stability of our wider environment (in both social and practical terms), if we are to fully understand the context in which compulsive behaviours are likely to flourish and, conversely, the scenarios in which they are likely to diminish.
For a comprehensive treatment of the Cognitive model for understanding Obsessive Compulsive Disorder, and its various manifestations, I thoroughly recommend reading: “Obsessive Compulsive Disorder: Theory, Research and Treatment”, edited by Ross G. Menzies and Padmal de Silva.”
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