Understanding Obsessive Compulsive Disorder (OCD)

I work often with people who live with OCD and who struggle to explain what they experience to their friends, family and colleagues.

In response to this I have attempted to capture some of the key features of OCD and also to outline some of the key thinking that may help someone begin the journey to overcoming it. I believe that OCD often thrives on silence and isolation, especially where this enables someone to develop and carry out their compulsions more and more. I hope that this information helps (in a small way) to spread a little more awareness and understanding.

What is OCD?

OCD is the fear network of the brain sending signals that something is wrong and things need to be done IMMEDIATELY.

Obsessions are recurring thoughts and images that cause you distress. You don’t want to have them but you can’t stop them coming and it’s hard to make them go away. For instance, you might obsess over things you think you’ve done wrong.

An obsession is often the flip side of a core value. If you are someone who cares deeply about your family, an obsessive thought might be about murdering them. If you are someone who cares deeply about your job, an obsessive thought might be about leaking company information or saying slanderous things about your boss. You are unlikely to have obsessive thoughts about things you do not care deeply about.

Compulsions are the things you repeatedly do in response to the obsessions. For instance, ruminating on or replaying conversations in your head, trying to make the conversations better.

Doing a compulsion is called neutralizing – it is an attempt to ‘cancel out’ the obsession. Remembering and analysing what you have done wrong may temporarily provide relief or improve your mood, however in the long term going along with your compulsions increases the frequency of the obsessions. It creates a vicious cycle where the more you try to avoid anxiety, the more anxious you become.

What are Intrusive Thoughts?

Intrusive thoughts are very common and are experienced by most people in the population (over 90%). What differentiates intrusive thoughts for people with OCD is the amount of weight and importance they are likely to attribute to the thought.

The reason people with OCD find these thoughts so upsetting is because the thoughts are often so completely at odds with their values. People with OCD do not act on these thoughts, rather they get very upset and distressed about having the thought.

Common Intrusive Thoughts

  • Thought that you might jump off a bridge or into a road
  • Thought that goes against your sexual preference
  • Thought that you might ‘lose control’ and start attacking someone
  • Thought of a sexual nature about someone inappropriate such as a family member or child
  • Thought that you may have committed a crime you have read about
  • Thought that you want someone, particularly a loved one to die
  • Thought that you are going to start swearing or shouting in public
  • Thought of doing something inappropriate in a religious place

How can I lessen intrusive thoughts?

What keeps OCD alive is not the experience of intrusive thoughts itself but rather, your reaction to them. The more you dislike experiencing intrusive thoughts and try to repress or fight with them, the greater the frequency of thoughts you will experience. The very act of trying to ‘not have’ a bothersome thought almost guarantees it will resurface. The only way to know if you are having or not having a thought is to think ‘Have I been thinking about x?’ or ‘I’d better not think about x’ which of course causes you to think about x.

The key to lessening intrusive thoughts is to try not to push the thought away when it comes as this will make it worse. Instead, try to think ‘Oh look. It’s that thought again. It doesn’t mean anything. It’s not me’. Don’t attach significance to it. If it loses its power to be scary it won’t hurt you anymore. Long term freedom from OCD comes from teaching your mind not to take itself so seriously.

How can I work towards freedom from OCD?

There is no way past OCD except through it. The more you try and avoid an intrusive thought, the more you will bring it on. Therefore you need to do the opposite – practice bringing on the thought whilst disengaging from any compulsions that you’ve used to obtain short term anxiety relief.

Common compulsions include:

  • Seeking reassurance
  • Information seeking/ googling
  • Mental reviewing/ making lists
  • Avoidance

The best way to do this is to create an exposure hierarchy that outlines baby steps you can take to slowly but surely prove to OCD who is in charge (i.e. YOU). When you resist a compulsion initially your anxiety will soar higher than if you just did the compulsion, but then over time your anxiety will come back down and it won’t keep going up again and again. The key is to remove the power from the obsessive thought by not paying it attention and by resisting urges to act on the thought.

Voicing your intrusive thoughts out loud to someone you trust who is compassionate and informed around OCD is often helpful. The same intrusive thoughts that feel so real, powerful and self-defining when swirling around your head often disintegrate when said out loud.

If you would like to find out more about how counselling can help you with your OCD, you might want to speak to your GP to see if you can access Cognitive Behavioural Therapy (CBT) or alternatively the BACP ‘Find a Therapist’ site is a good place to look for private therapists in your area. If you are based in Sheffield and would like to see how I can help you please contact me.

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