What exactly is OCD?

I see lots of people with OCD, obsessive compulsive disorder. My client writes in this post about her OCD. On the telly, we get told that OCD is about obsessive cleaners. Or you might have heard it is about being fussy about tidiness. It is worse than that. Obsessive thoughts are repulsive and unrelenting, driving the sufferer to expend almost all their energy on getting rid of the thoughts. Unsuccessfuly. So the sufferer tries even harder. It can be all-consuming.

And it is a subtle bully. Sufferers complain of a lack of confidence, that they are dreadfully anxious and worry all the time. This lack of a diagnosis means it can be years before you can get treatment. But there is good and effective treatment out there.

OCD takes lots of forms. Worrying that you have knocked someone down, so that you constantly go back to look for the body. That just looking at a knife could make you stab someone. Anxious that you are gay, despite an active heterosexual lifestyle. Avoiding using trains or buses because you might need the loo and won't know where they are, and the risk of wetting your pants. If you don't suffer from OCD, these might sound a bit silly. But if you mind tells you constantly that this risk is real, and that you must take all action you can to avoid it, then you might see that this is devastating. So if this sounds like you or a friend, there is help available. A specialised form of CBT has been shown to be very effective. Get in touch with me to find out more.

This is what my client thinks about the OCD, which the client suffered for nearly 15 years. 15 years of unrelenting painful obsessive thoughts. What misery. Here it. is

Along Came A Spider

I’m terrified of spiders. I really am, and I know I am for no explicable reason. I can pick up ladybirds just fine - I can pick up any sort of bee or random bug. I’ve even held cicadas and grasshoppers in my hands, big, big insects. But spiders, no.

That’s why OCD is so like a spider, for me. It’s not something I can explain, and it’s not something that causes me fear for any realistic reason. But it does, and has, for nearly 15 years. And as it stands, it’s been the most terrifying, painful thing I have ever gone through.

It started one lovely May afternoon. I was in the car with my parents and my beautiful boyfriend, in the midst of perfection. Two days earlier his dad had referred to himself and his wife as my “in laws” as they’d met my parents, and I was in pure bliss. Two days later was a different story, as I sat in the backseat of my parents’ car, next to my boyfriend, chewing my lip. What if he proposed soon? That would be amazing, but… what if I wasn’t good enough?

It started that day, as I mulled over the question, and a memory popped into my head. A few months earlier I’d been out with a friend, celebrating the new jobs we’d just gotten. I wasn’t meant to go out and drink that day, but had gone anyway, and in the midst of the excitement and celebration my drunk OCD brain said, “kiss him.” “No, I’d never do that to my boyfriend,” I replied, shocked. And automatically it went, “who cares!” I remember that I stopped drinking then, stopped paying attention to the happy conversations happening around me. Soon after I declined another drink offered by my friend. I went home, distinctly alarmed (even in my drunken haze) that my OCD would make me worry about this. The next day, I was a little concerned, but fine. I remembered the evening well, after all, and I knew I’d never cheat. It wasn’t even something I’d question. (For context, I’ve never once cheated in my life, and tend to get terribly offended at even film characters doing that sort of thing.)

Months later, and back in the car, the thought had suddenly popped into my head again. “What if I forgot something?” I wondered. And instead of dismissing it, like I should have, I spent the next days mulling it over. I spent one afternoon in a yoga-like trance, sitting on my bed cross-legged, trying to recall every single moment of the night – fairly successfully I might add. Yet the satisfaction I gained from every little snippet of well-recalled memory only alleviated the urge to be sure for a few minutes. And each time those few moments of peace grew shorter, and the urge more pressing.

The thought made me sick, physically sick. One night I went home with my parents and boyfriend, only to be violently ill. No one knew why at the time, but it pained me terribly. What if I was a bad person?

The next morning I awoke, and as I stood in the bathroom of my parents’ rental cottage I caught myself remembering a thought from another night. “This is a really empty bathroom, one could have sex in here.” Hah, I thought. Watch my OCD go after that one. It won’t, because I guess that’s far too ridiculous. I laughed it off. How silly could this get, after all?

But it did. And then it spiralled further. While initially, my mind had only focused on that one night, with the one daft thought, because I’d been really drunk then, I now wondered whether I should investigate all the other drunken nights as well. So I did. Then I thought, what about all the nights I drank anything at all, and eventually those became a concern too. No, a concern is putting it too lightly – they became a horrible, deep-seated fear unlike any I’ve ever experienced before.

And then I took it a step further. I made a spreadsheet of all the messages I’d sent on those nights. All the pictures I’d taken. All the messages, pictures, and Facebook posts my friends had made. I asked people, over and over and over again. “Did I act out of line? Was there anything I did or said that was wrong? Did I disappear for any period of time?”

No, was the answer, every time, and the pain would go away briefly until resurfacing. It went from embarrassed, vague questions, to begging people for reassurance.

Yet of course I didn’t remember doing anything wrong, and did remember everything I had done, in detail, much more detail than anyone else in fact. But my OCD had spiralled out of control. I was now wondering whether everyone else was lying to me, whether they’d all forgotten, whether I’d forgotten a specific 15-20 mins where I’d run off with a friend or colleague, seeing as I remembered enough for it to not possibly be longer.

It no longer mattered whether I was able to gain enough reassurance for one night, because inevitably that meant (in my head) that I must have therefore acted out on another night. It didn’t matter whether the other night was one that hadn’t worried me before because I remembered it particularly well. My memory was now labelled as faulty by my OCD, and I couldn’t and wouldn’t trust it. I had to make sure I deserved my boyfriend, after all. I had to be certain I wasn’t a terrible person underneath the calm, gentle exterior. Underneath the moral premise of a girl who’d once felt guilty for speaking to another guy on a bus while in a previous relationship.

I proved it all, with the spreadsheet, all of it. Indeed there wasn’t really a feasible chance I could have run off someplace with one of my friends. But instead of finally finding the peace I so longed for, the thoughts morphed and grew stronger. The OCD was laughing at me. Now it said, “What if you ran off with a stranger?” and worse yet, “What if you wandered off and did something bad at a family event?” What? I don’t really know, just something; something bad, something that would make me not worthy of anything.

That was probably the lowest point, but it was the best too, in a weird way. As I cried, I realised that the thoughts had become ridiculous. I’d gone from a fun, celebratory evening out with my friends, and a silly thought I’d never acted upon, to worrying about every single night out ever. Every time I’d had a sip of alcohol with friends, or even with family. My mind had snapped entirely. At this point I suddenly realised that people who decided to die weren’t selfish at all, they just couldn’t put their loved ones’ horror above their own terrible pain anymore. I never quite reached the point where I would have been suicidal, but I understood it now, and it was a scary place to be.

Caroline's commment. Before you read the next bit, this hunt for certainty is very typical of OCD, as is the need for lots of reassurance. But this reassurance might be someone just trying to be nice. What if they are lying? Around this time, my client came to see me me. And she was at the end of her tether. When my client first booked in it was to help with false memories. The client had tried counselling which had helped a bit, but had not stopped the problem

And then, bit by bit, just as I’d hit my very own rock bottom of hell, I started to heal.

It wasn’t miraculous or over night as I’d so desperately hoped. Caroline had me record my worst fears on a tape and listen to it, sometimes for five hours a day or more.

Caroline's comment. Before this listening to recordings, there were other elements of the treatment programme. Clients need to build up a good working relationship with the therapist and understand how OCD keeps these thoughts going. With trust and a good understanding of what is maintaining the symptoms of OCD, only then can we move into this phase. It is known as Exposure and Response Prevention. Exposure to the thoughts, without taking the action (which can be physical like washing your hands) or further thoughts, for example, trying to figure out what is going on, or repeating magical words, counting numbers. One of the key problems with diagnosis is that OCD presents itself in so many different guises. But now back to my client.

When I felt better, I took the plunge and made the fears worse, writing them out in awful detail before recording them again. I cried a lot. I sat by myself at work a lot while trying my hardest not to cry. I forced myself not to respond to the thoughts, and when my brain became too loud I promised it a few minutes in the evening to think about things. I still do this sometimes, and it helps, because often you forget what you even wanted to worry about. Sometimes I take mini ‘holidays’ from the thoughts too – after all, what difference does it make if you ignore them for a week or two? If they’re important they’ll still be there after (ironically, more often than not they resolve themselves all on their own when you do this.) I made plans to do fun little activities every day, be that trying a new recipe, crafting, or yoga. I exercised a lot, because it relaxes my mind. I started going to church on Sundays because it made me feel peaceful. I spent time with good friends who were willing to listen or distract me. I cut out caffeine and drank copious amounts of camomile tea. And above all else I tried to be kind to myself on my worst days, by buying a book or magazine I liked, or taking a hot bath. I stopped allowing the OCD to punish me all the time, and accepted the thoughts as just that – thoughts.

I still don’t know whether I’m officially on my way into remission now, or whether the OCD will spiral out of control again. What I can say is that the many times I cried to my boyfriend, confessing all the awful thoughts that had been torturing me, he all but laughed them off. “You’re not a bad person,” he’d say, with no doubt at all in his mind. And I’d attend my therapy sessions, knowing I somehow had to push through. There were days I couldn’t eat, days I couldn’t speak, but I can look at it now, with a drink in my hand even, and realise this: They are just thoughts. There’s no need to prove that a thought didn’t happen, even if you were drunk. We’re not different when drunk (I’m just sappier and a little bit more social), and we certainly don’t ditch our most valued morals. And even if that’s not your OCD fear, whatever it is you’re afraid of, it’s a thought. Not you, but rather your worst possible fear, and something you’d never do. OCD is essentially fighting a dragon of your own creation. It takes unbelievable amounts of strength to beat, and the only way you can get there is unfortunately by facing it head on. But then, if I can do that, so can you.

Cheers to that! (And PS: I can actually catch some spiders now too. The little ones. After all, it is best to take things one little step at a time, and celebrate the small successes first.)

Caroline's comment. This client found the treatment plausible, understandable, effective. But it required effort on their part. The client was willing to make this effort, because OCD is already immensely effortful. All that effort to keep going round and round the same things. This different effort flipped the client into a different orbit, able to see what was going on, and what to do to get better. Hard work, and job well done. It took around 3 months. But the client had been suffering for 15 years.

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