I thought I’d write about my other mental health diagnosis; OCD.
What is OCD?
OCD is an anxiety disorder comprised of two main elements: Obsessions and compulsions.
Obsessions are unwanted thoughts, images and urges that cause anxiety for the person experiencing them. These thoughts may include:
- Harm OCD, where people either think they will, or have already hurt someone or something else.
- Thoughts of a sexual nature that may be distressing, particularly if centred around family or children. Some people may worry that they are having thoughts about people of a different gender than they are usually orientated towards.
- Religious or blasphemous thoughts.
- Fears about contamination; that they may contract a certain disease or are spreading one.
- Obsessions with symmetry, a preoccupation with patterns and orders
Whilst obsessions around symmetry and contamination are fairly well known due to their portrayal in the media and the more obvious compulsions related to them, it is obsessions of a violent, religious and sexual nature that are less talked about, more stigmatised and less understood.
Compulsions are actions or behaviours that a person feels compelled to do in response to their obsessive thoughts. They may include:
- Washing hands and cleaning excessively, usually in response to contamination obsessions.
- lining things up, making them symmetrical or putting them in a certain order
- The need to touch things in a certain way
- Seeking reassurance from others in order to combat obsessive thoughts, e.g. “I’ve not hurt anyone have I?”
- Checking behaviours e.g. checking many times that the door is locked or the oven has been turned off.
- Mental compulsions which seek to correct or neutralise intrusive thoughts/images, such as repeating words over and over in your head or outloud.
Intrusive thoughts and Delusions
Sometimes it can be difficult to extrapolate what is an obsessive thought and what is delusion, particularly in those who have both OCD and a psychotic disorder. Take for example someone who has a delusion they have hurt some one and someone who has an obsessive thought about having hurt someone. These thought may be equally vivid but there are differences. For one thing, delusions don’t usually involve repetitive compulsions in order to be neutralised. Secondly, delusions are fixed and rigid beliefs, usually people with OCD know they are being illogical but can’t help the thoughts or associated anxiety. Often you can get them to question their beliefs.
Types of OCD
There are different forms of OCD and OCD related disorders, sometimes known as “cousin” disorders. Some people think they should sit on the OCD spectrum. They include:
- Pure “O” – This is a recognised form of OCD where there are no, or little, signs of external compulsions but there are unwanted and intrusive obsessional thoughts, images and/or urges. Sometimes people with pure O engage in mental compulsions as discussed above.
- CSP (compulsive skin picking) and trichotillomania (pulling out hair)
- Hoarding – where you keep and collect a large number of things to the extent it interferes with your life.
- BDD – Body dysmorphic disorder where someone has repeated obsessive thoughts about the way they look and perceived flaws on their body. Compulsions related to how they look may accompany these.
- OCPD – obsessive compulsive personality disorder – this is similar in some ways to OCD but it is its own condition
Treatments for OCD
There are ways to help people with OCD. These might include:
- CBT (cognitive behavioural therapy)
- A type of exposure therapy designed for OCD called exposure and response prevention (ERP), which helps people confront their fears and avoid submitting to compulsive behaviours.
- Medications, usually antidepressants and primarily a class of antidepressants known as SSRIs. These often have to be at quite a high dosage (higher than those used to treat mood) in order to be effective for OCD.
My experiences with OCD.
I was diagnosed with OCD at a young age. I can remember have obsessions and compulsions at around age 8. At that age, I was sent to a Church of England school, and so they were mainly religious in form and would involved blasphemous thoughts and repeating phrases such as “I’m sorry, God” over and over in my head or aloud. As I got older, and moved away from from religion, they took the form of violent thoughts and harm OCD, which focused on my family and animals. I regularly get thoughts and urges to hurt my cats or to push people in front of trains or stab my own mother. These thoughts might be shocking to hear about, but they’re common, they don’t make me dangerous and they need to be talked about. My compulsions are mainly counting, touching things (usually wood), mental compulsions and seeking reassurance as well as some checking behaviours. I did initially get some, very limited, relief from Sertraline (Zoloft), a type of SSRI, but ending up not being able to take it. I tried CBT in the past for OCD and was unsuccessful but am having some breakthroughs now at the age of 26 with my current therapist. It’s a hard thing to cope with, especially when you have additional diagnoses but it’s a daily battle I’m used to fighting and I don’t plan to stop.
If you need help for your OCD, check out websites such as OCD action and the international OCD foundation!