Most people have heard of obsessive compulsive disorder (OCD), but misconceptions about the condition are common. The one we probably hear most frequently is that it’s mostly about being really neat and clean! If we delve into OCD, however, we find that there’s much more going on.
Someone who has OCD will tend to have very strong beliefs about responsibility: specifically, how much responsibility they personally have for making sure that something bad doesn’t happen. This quite often forms in childhood. Other factors that can contribute to someone developing OCD are generalised anxiety, the need for certainty, and perfectionism. Stressful events can also sometimes be the trigger.
How do people experience OCD? The condition typically has three ‘layers’: intrusive thoughts, which lead to obsessions, and then compulsive behaviours.
Intrusive thoughts are spontaneous thoughts, images, urges or doubts that pop into our minds seemingly out of nowhere. We all experience intrusive thoughts, and normally these aren’t problematic. Someone with OCD, however, is more likely to be bothered by these thoughts and to wonder what they mean. As a result, they can become more frequent and distressing.
For example, a parent might have intrusive thoughts about injuring their child, and feel this is alerting them to a ‘danger’ they are responsible for preventing.
Obsessions or obsessional thinking happens when these intrusive thoughts return again and again. This can be very upsetting. The parent mentioned above might worry that their child might get injured because they keep thinking about it, or even that they want to injure their child.
Compulsions are behaviours the person with OCD carries out because they believe they will reduce or prevent the danger they perceive is there. These might include physical actions such as repeated hand-washing or checking something, seeking reassurance or avoiding a situation, or they could be something that happens in the mind, such as trying to suppress or ‘argue’ with the thoughts.
The compulsions are the way in which people with OCD try to cope with their intrusive thoughts – but they only serve to amplify them, or become problematic in themselves.
For instance, imagine that someone who considers herself to be conscientious and responsible made a potentially serious mistake at work, which was quickly spotted and put right. She now experiences doubt about whether everything is correct whenever she carries out her tasks, which drives her to check details multiple times. This slows her down, and makes her distressed and anxious – leading to an increased sense of doubt and threat. She tries to deal with this by extending her compulsive behaviours into other areas and tasks. This keeps the cycle going.
How is it treated? As well as misconceptions around OCD itself, people sometimes have the wrong idea about what the treatment will involve – expecting it to be focused on trying to convince them that their beliefs aren’t true. Instead, CBT treatment will involve you and your therapist working collaboratively to understand and change the beliefs and behaviours that are causing you problems.
An important part of this is helping you to get a different perspective on your difficulties. For instance, the therapist could help a parent who thinks they’re careless and might injure their child to consider another view – for instance that they’re an extremely caring parent who’s worried about being careless and injuring their child.
Behavioural experiments can also be helpful. The employee who’s worried about making a mistake might believe that checking every email several times is necessary, because it makes her feel less doubtful that there are errors. She can test this by checking the email once and asking herself how sure she is there are no mistakes, then checking it several times and asking the same question. People tend to realise they actually feel more doubt when they check multiple times, so doing this serves no purpose, and in fact creates more worry.
The therapist might also set up some enlightening conversations with the patient to potentially change her view of responsibility, by getting her to consider:
- Is there someone you know who you’d say is responsible?
- What makes you think they are responsible?
- Have they ever made a mistake?
- Did you think they were no longer responsible when you heard about their mistake?
These exercises would help to change her thinking from: “I’m an irresponsible person who makes mistakes, so I need to follow any doubts I feel, and check everything to prevent mistakes” to “I’m a responsible person who occasionally makes mistakes. I worry about this because I care about being organised. But following my doubts just makes me worry more”.
If you’re experiencing OCD symptoms and would like to try a self-help resource, there’s a book called Overcoming OCD that will give you lots of techniques to try. If the symptoms are significantly affecting your life, you can read more about how CBT can help, and find out whether you can sign up for online treatment with Ieso.