The Nature of Obsessive Compulsive Disorder: The Basic Phenomena

This is the first part of a series of blog posts that I will be writing regarding the nature of OCD. This first blog post aims to introduce the basics for those who are interested in learning some of the theory behind the phenomena. Please stay tuned for further updates regarding cognitive theories,  prevalence, what keeps OCD cycling, cognitive distortions and thinking errors, treatment options and relapse prevention.

A good understanding of the basic phenomena, to what obsessions are and the nature of how compulsions relate to obsessions is crucial for working effectively with service users with OCD. In my experience of offering training courses on OCD and working with this client group, there seems to be confusion over the basics, which is not exclusive to the general population, but also health care professionals. The following blog post aims to introduce the basics of OCD, the theories and provide examples of how it all fits together.

Obsessions

Obsessions are involuntary and often described as unwanted, intrusive thoughts, images, impulses or urges that are regarded as repugnant, senseless, unacceptable and very difficult to dismiss. Obsessions are accompanied by intense feelings of anxiety and discomfort, and an urge to ‘neutralise’ the thoughts (Salkovskis, 1999).

Intrusive thoughts have been researched extensively and regarded as universal, are experienced by those without a diagnosis of OCD or complaint of anxiety and are not thought to be problematic (Freeston et al., 1991; Rachman & de Silva, 1978; Salkovskis & Harrison, 1984). However, for those with OCD marked distress is common.

Rachman (2003) outlines the core, classical obsessions as aggressive/harm, sexual or blasphemous in nature and is common to experience more than one theme and explains how obsessions are regarded as ‘ego-dystonic’. This means that the obsessions are contrary to the person’s beliefs about themselves, their morals and what they find socially acceptable. It is understandable, knowing that obsessions are as far removed from the person’s own sense of being, that one might experience intense anxiety, and attempt to neutralise the intrusive thought or attempt to prevent the thought from entering one’s mind again.

Compulsions

Compulsions are voluntary, and often regarded as ‘neutralising’ behaviours that are carried out to offer temporary relief from the discomfort and anxiety caused by the obsession (Rachman, 2003). Although compulsions are seen as entirely voluntary behaviours, to the person experiencing obsessions the need to ‘neutralise’ is not seen as voluntary but vital to avoid catastrophic events or harm coming to self or others, or to minimise the impact of any obsessions they fear they might have carried out.

Compulsions can take the form of both overt (visible) and covert (unseen) behaviours, such as hand washing (overt) or mentally praying repetitively (covert) (Rachman, 2003). As overt rituals are easily seen, it is easier to recognise the possible symptoms, but for those who experience purely covert rituals it can be a little more difficult to detect.

There are two further forms of neutralising behaviours that are theorized. The concepts of Verification and Restitution has been widely discussed and researched. For people seeking verification, they may neutralise in order to prevent anything “bad” from happening, e.g. cleaning rituals to prevent cross contamination or spread of germs, or checking doors to ensure they are secure. Secondly, Restitution neutralising may be performed when one becomes convinced that something “bad” has already occurred or they fear they might have caused harm, and the neutralising behaviours take form to minimise its impact and put things right (Cougle et al, 2007).

Examples:

Obsession: “I might not have turned the gas off properly, the house might blow up and I will lose all of my belongings, because of my carelessness”.

“If I don’t check the gas, it might be left on and I will be responsible for the house blowing up, and if people are in next door, they could be killed by my careless behaviour and I will go to prison”.

Compulsion: Repeatedly checking the gas hob or switch is off and checking the oven for the smell of gas (overt compulsions/rituals and verification).

Obsession: “What if I am potentially a psychopath and I might want to harm my own children”

Repetitive intrusive images of harming one’s own children.

Compulsion: Avoiding spending time with children or avoiding motherly/fatherly roles or hiding or eliminating objects that are potentially weapons from ones home e.g. sharp knives (this is a non exhaustive list of examples).

Obsession: “How do I know I haven’t put poison into my mum’s cup of tea?”

Compulsion: Pour the cup of tea down the sink and make a new cup (overt, restitution), or avoid making drinks altogether (covert).

The case of ‘false memories’

It is not uncommon for those who live with OCD to experience ‘false memories’. A false memory is an event that one might believe has took place, but is nothing but imaginational. False memories can seem very real and understandably can heighten anxiety. Needless to say, false memories cause anxiety because intrusive thoughts, images, impulse or urges are never pleasant in nature, and when one becomes frightened that they may have played out something heinous and terrible, it starts the process of restitution and reassurance seeking behaviours.

 

*Note to healthcare professionals – obsessions are ego-dystonic and not a true reflection of the person who experiences them and there has never been a single case of anyone undertaking any single obsession or intrusive thought. Obsessions are as far removed from the person’s morals and values that the mere thought of these creates intense anxiety and fear. People who experience intrusive thoughts/obsessions are not at any risk to harming themselves or others.

References

Cougle, J., R., Lee, H. and Salkovskis, P., M. (2007) “Are responsibility beliefs inflated in non-checking OCD patients?” Journal of Anxiety Disorders. 21 (1) pp. 153-159.

Freeston, M. H., Ladouceur, R., Thibodeau, N., & Gagnon, F. (1991). “Cognitive intrusions in a non-clinical population: I. Associations with depressive, anxious, and compulsive symptoms”. Behaviour Research and Therapy, 29, 585–597.

Rachman, S., & de Silva, P. (1978). “Abnormal and normal obsessions”. Behaviour Research and Therapy, 16, 233–248.

Rachman. S. (2003) The Treatment of Obsessions. Oxford: Oxford University Press

Salkovskis, P. M., & Harrison, J. (1984). “Abnormal and normal obsessions: A replication”. Behaviour Research and Therapy, 22, 549–552.

Salkovskis, P. m. (1999). “Understanding and Treating Obsessive Compulsive Disorder”. Behaviour and Research Therapy. 37, Supp. 1 S29-52

Creative Writing as a Therapeutic Intervention: A Reflection on a Training Course

I attended a training course at the University of Huddersfield yesterday, actually called “Yoga for Creativity”. As much as the course was demonstrating how yoga techniques can enhance well-being, the facilitator asked us to explore how to use creative and meditative writing as a means of therapeutic intervention. The basis of this reflection is how creative and meditative writing can be applied in  mental health settings as a therapeutic intervention, and a further reflection will be written exploring Yoga as a therapeutic intervention.

The first exercise which the facilitator asked the group to engage in really excited me as I started to think that this is an intervention that could be utilised within my practice. The activity was taken from Goldberg (1986) where writing is used as a ‘timed exercise’. The facilitator asked us to:

  1. Write continuously for 10 minutes 
  2. To keep our hands moving with no pauses in writing
  3. No crossing out
  4. Forget the rules of spelling, punctuation and grammar
  5. Lose control, don’t think and forget logic
  6. Go for the jugular (don’t be afraid to dive right into writing that exposes our feelings or makes us feel naked)

After the allocated 10 minutes we could read what we had written and discuss with our neighbours the content (if we so wished). Surprisingly, the activity didn’t end there and the facilitator asked us to highlight up to 8 sentences in our creative writings. These sentences had to ‘jump out’ at us or offer meaning. After choosing our 8 sentences, we were asked to then make a poem out of the sentences in any order. This was brilliant. I began to think about how I could potentially use this as a therapeutic intervention related to mental health, and namely within my OCD Support and Recovery group.

As I was carrying out the exercise, I felt a sense of exposure, but this wasn’t anxiety provoking. It led to more of a curiosity as to what would come out from my 10 minutes writing without pausing. I guess it’s a lot like Freud’s  ‘free association’ but with a little bit of a twist. I like that idea a lot!

I think that if this intervention was used within my group, it has the potential to get a lot of ‘thoughts’ out on paper. For some this could be more anxiety provoking than others, dependent on the nature of OCD and the content of intrusive thoughts and obsessions. This is something that will have to be further explored through talking this activity through with members of the group to hear their perspectives and possible anxieties.

Possible Intervention

Follow the guidelines for intervention above but:

  1. Ask group members to write for 10 minutes continuously on the theme of OCD
  2. Highlight up to 15 positive words or sentences
  3. Adapt those 15 words into a creative poem related to their OCD.

Action Plan

  • I intend to research the evidence base for creative writing as a therapeutic intervention further. I have bought a book titled “Writing Well: Creative Writing and Mental Health” by Deborah Philips, Liz Linington and Debra Penman and also have a couple of chapters photocopied from “Ordinary Magic: Everyday Life as Spiritual Path” by John Wellwood from the training course attended. This will be read and studied further.
  • Speak to group members about their perspectives on using creative writing as a therapeutic activity to inform part  of their Recovery Action Plan.
  • Conduct the adapted activity on myself and see if it works.
  • Reflect further once I have used this activity on myself, and within a therapeutic environment.

References

Goldberg, N. (1986) Writing Down the Bones. Boston: Shambhala

Philips, D. Linington, L. and Penman, D. (1999) Writing Well: Creative Writing and Mental Health. London: Jessica Kingsley Publishers

Wellwood, J. (1992) Ordinary Magic: Everyday Life as Spiritual Path. London: Shambhala

Reflection on Discussion: Child and Adolescent OCD

Reflection

Today I had an interesting conversation with a fellow OT on twitter, I was asked for advice on what best practice would be on working with children and young teens with OCD, this has got me thinking of how occupational therapists can assist in the assessment, treatment and management of OCD in children and young people.

I think this is an area of practice that needs to be explored, and with OCD being cited as the 10th most disabling condition outlined by the World Health Organisation, this is a huge area of practice that has been very unexplored, especially within child and adolescent mental health.

Where to go from here? 

I think it is my duty now to research how occupational therapists can offer assessment, treatment and offer support to children and young people who experience OCD. I will look for articles to inform my practice and pass these on to relevant occupational therapists who would benefit from this information.

Action Plan

  • Research the evidence base
  • Liaise with other mental health professionals
  • Document my findings in another blog post and make this accessible to other occupational therapists

Part 1 of Occupational Therapy and OCD: Positive and Negative Occupations

Introduction

Law et al (1998) assert that occupational therapists believe that a direct link between occupation, health and well-being exists. However, little if anything is proposed to the role of occupation as a root cause for ill-health, distress or be the harbinger of occupational disruption and occupational dysfunction to the lives of  those who live and suffer from obsessive compulsive disorder (OCD). The current view seems to be  that any occupation that deviates from the ‘occupational norm’ is dysfunctional and hold no worth to occupational beings. This piece aims to challenge this notion.

I wish to pursue a discussion for the possibility of what may be perceived as ‘meaningful and purposeful activity’ leading to harm, injury or distress. For the purpose of this discussion I am going to analyse the common compulsion of hand washing related to ‘contamination OCD’ and discuss the potential for endangerment to health, well-being and occupational lives.

As this piece is directed mainly at occupational therapists, said ‘sufferers’ will be termed as ‘occupational beings’. That said, I welcome all to read my work related to OCD in order to raise awareness, understanding and the promotion of occupational therapy as a possible therapy often left unexplored and very misunderstood.

What is OCD?

We may in our own personal lives ignorantly use such phrases such as “I don’t like mess…yes ‘I’m a little bit OCD’ about things like that…”! This is easily done as the true nature of what is OCD is, and the wider symptomatology and behaviours are widely misunderstood. OCD is poorly portrayed by the media, with particular attention placed on cleaning, creating an image of the ‘clean freaks’ disorder or one of those eccentricities often aspired to be had by those who simply fancy a title for a fashion statement or fleeting accessory.

For the purpose of this discussion I will outline a broad description of OCD, but progress only onto the description of contamination OCD as the compulsions for this specific form of OCD will be outlined and analysed in an occupational context.

Smith et al (2012) outline that “Obsessive-compulsive disorder (OCD )is a debilitating disorder characterized by recurring distressing thoughts or images (obsessions), and behaviors intended to reduce distress,including repetitive overt or mental rituals (compulsions; American Psychiatric Association (APA), 2000) and avoidance. The relationship between obsessions and compulsions is such that obsessions evoke anxiety (or another state  of negative affect), and compulsions are enacted to ameliorate the aversive feeling.” (p. 54).

Now for contamination OCD, there are generally two elemental parts commonly referred to as ‘contamination obsessions’ and ‘decontamination compulsions’. There is a popular view that contamination OCD is isolated to fears of germs, dirt and viruses but this is quite a narrow view, for a far broader list of ‘contaminants’ are commonly associated.

Bodily excretions (urine, faeces, mucus, sweat, saliva etc…), blood, semen, rubbish, household chemicals, radioactivity, broken glass, sticky substances, people who appear unwell, dirty, or unclean looking, spoiled food, soap , lead, asbestos, pets, birds, dead animals, newspaper print. 

It is common for those who live with contamination OCD to hold irrational beliefs related their obsessions, such as how small amounts of a contaminant, for example a drop of blood, can ‘contaminate’ a large area, such as the entire person, a house, a car or even everything owned and come into contact with by the individual.  There are other forms of ‘contamination obsessions’, known to be ‘magical’ or those that one fears of contaminating others through a variety of methods or mediums. These can include:

Intrusive thoughts, intrusive mental images, colours, words, notions of bad luck, names of illness/disabilities/deceased, or of those who are ill or are disabled, overweight or unattractive.

An example of potentially contaminating others and fearing of causing harm to another is if one intrusively imagines poisonous substances on their hands and fears everything they touch will cause harm to others or believes that harm would come to those in close proximity to them if certain words, such as ‘death’ or ‘die’ are intrusively thought.

Common decontamination compulsions:

Excessive hand washing, disinfecting and sterilisation, changing of clothes, throwing things away, avoidance of touching certain objects, people or going to particular places and creating ‘clean areas’ where no-one is permitted to go.

(Adapted from the International OCD Foundation). 

Positive Vs Negative

As occupational therapists, we are committed to promoting the independence of others and where dysfunction occurs we problem solve how to enable occupational participation. We are taught that occupations are activities that have meaning and purpose to us as ‘occupational beings’ who engage in a range of dynamic environments, and as explained in the opening paragraph, we believe that these occupations shape our health and well-being (Law et al, 1998).

The following paragraphs will analyse whether what we are taught as occupational therapists offer the fullest perspective of what occupation truly is or if there is a spectrum to consider in the complexity of occupation.

Occupation is commonly researched as something that we engage in that is positive, productive and enabling (Townsend, 1997) however, Twinley and Addidle (2012) argue that not all occupations promote health nor well-being, using violence and anti-social behaviour as their examples. This leads me to question the nature of occupation and what can be classed as a positive or negative occupations? Are occupations simply socially acceptable activities or is there a darker dimension unexplored? In this blog I use OCD to propose how meaningful and purposeful activities can both be positive and negative occupations, related to compulsions.

Hand Washing as an Occupation

Hand washing is what occupational therapists refer to as a self-care occupation and is an essential activity of daily living to avoid the spreading of pathogens to ourselves and others. We learn the importance of having clean hands as children and it inevitably integrates in our daily habituations for the rest of our lives. For some though, hand washing can become a much more important and ritualised occupation than to most and is often the most commonly looked for behaviour to identify signs of OCD.

The ritualistic ‘hand washer’ may spend hours washing their hands. This becomes a dysfunctional method of controlling anxieties, through washing away intrusive thoughts or images, but offers a sense of relief until the next time one may feel contaminated. To the person living with the torture of OCD, hand washing may be perceived as a behaviour with meaning and purpose, as it reducing anxiety and aids in their ability to function temporarily in their occupational lives. But for healthcare professionals, and wider society, this is viewed as dysfunctional behaviour perpetuating the pattern and cyclical continuation of OCD. My analysis of this compulsion leads me to argue that for the person living with OCD, this can be classed as a ‘negative occupation’, that has meaning and purpose.

Excessive Hand Washing and its Effects to Health

Excessive hand washing in OCD can lead to numerous health complaints, some more obvious than others. The most commonly understood effect of over washing is a loss of essential oils in the skin leading to damage to the dermis and dermatitis. Blistering, redness, bumps and peeling skin are common when excessively scrubbing in attempt to rid the hands of perceived contaminants. In more severe cases of OCD, chemicals may be used as a radical means of decontamination, such as the use of bleach. As a result, chemical burns, soreness and ultimately limited range of movement in the hands may be experienced.

Less thought of is the mental effects that hand washing as a compulsion can have on the individual. The compulsion can take over the individuals life to such an extent that participation in any other activities of daily living can be almost impossible due to fears of contamination and a preoccupation of finding sinks to wash in, or avoiding anywhere where washing may be impossible.

Heyman et al (2006) suggest that a greater awareness of the symptoms, presentation and various manifestations of OCD is crucial amongst healthcare and non-healthcare settings and that clinicians need to more confident in recognising the spectrum of signs and symptoms. Therefore, occupational therapists should be more aware of this disorder and consider it an area in which occupational therapy skills can be utilised.

In part 2 of this blog I will propose the potential role of occupational therapy for mild to severe OCD and discuss the possible therapeutic interventions to utilise in the treatment of this disorder.

References

Heyman, I., Mataix-Cols, D. and Fineberg, N. A. (2006) “Obsessive Compulsive Disorder”. British Medical Journal. 333, pp. 424-429.

Law, M., Steinwender, S. and Leclair, L. (1998) “Occupation, Health and Wellbeing”. Canadian Journal of Occupational Therapy. 65 (2), pp. 81-91

Smith, A. H., Wetterneck, C. T., Hart, J. M., Short, M. B., and Bjorgvinsson, T. (2012) “Differences in Obsessional Beliefs and Emotion Appraisal in Obsessive Compulsive Symptom Presentation”. Journal of Obsessive Compulsive and Related Disorders. 1, pp. 54-61

Townsend, E. (1997) “Occupation: Potential for Personal and Social Transformation”. Journal of Occupational Science. 4 (1), pp. 18-26

Twinley, R. and Addidle, G. (2012) “Considering Violence: the Dark Side of Occupation”. British Journal of Occupational Therapy. 75 (4), pp. 202-204

Obsessive Compulsive Disorder: My Personal Story

Before you read this story, please bare in mind that this is a true story, it is my personal experience of OCD and I believe that as a “therapist” I have a duty to be honest about this and to work towards tackling the social stigma that mental health problems make you weak, weird, inadequate and less of a human being than most. I am of the opinion that EVERYBODY at some point in their lives will experience some degree of mental distress, and it is our duty as a population of caring individuals to be honest, supportive and compassionate towards each other and do all we can to assist in the recovery of others. Let’s break that barrier, that stigma, stand tall and be proud of who we are, and work towards a shift in attitude towards mental health.

Some may laugh at some of the things I am going to write, and that’s ok, I laugh at them too sometimes, but although I am tolerant of others laughing at my OCD, I ask you to be compassionate to my experience, and importantly to others who you may or may not know who may be experiencing something similar. OCD is truly awful, it isn’t a secondary illness or disorder in any way, shape or form….it is torturous and frightening and it needs exposing for what it really is, not what people ignorantly consider it to be. Thank you.

 

What is OCD?

Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterised by persistent reoccurring distressing intrusive thoughts or images (obsessions) and repetitive behaviours, impulses, urges or rituals often used to reduce anxiety, counteract or cancel such obsessive thoughts or images (compulsions) (Smith et al, 2012).

There are numerous obsessions and compulsions that people with OCD experience, and here they are defined:

 

Obsessions

  1. Contamination (fear of dirt, germs, viruses, chemicals etc…)
  2. Fear of harm (doors not being locked, cooker left on)
  3. Extreme concern for symmetry and order
  4. Obsessions with the physical body and symptoms
  5. Religious, sacrilegious or blasphemous thoughts
  6. Sexual obsessions (e.g. homosexuality or paedophilia)
  7. Thoughts of violence and aggression (e.g. stabbing you own child)

Compulsions

  1. Checking (taps, gas, cooker etc…)
  2. Cleaning, washing, showering
  3. Repetitive acts
  4. Mental compulsions (saying special words to cancel out thoughts, saying prayers, repeated in set manners)
  5. Ordering, symmetry, exactness
  6. Hoarding/Collecting

OCD has no socio-cultural boundaries. It can affect anyone, no matter what age, gender, religious belief or economic status. The World Health Organisation (WHO) has ranked OCD as in the top ten most debilitating conditions, in relation to quality of life and loss of earnings over an individuals’ lifespan. To me, this marks OCD as a much bigger problem than what I believe most people, professionals and the media give it credit for. I also wonder what impact OCD has had on the economy as a whole, I wonder how many others, like me, have had to stop working due to their illness, and I wonder how much ignorance truly costs the government. I also fear for those unfortunate enough to depend on their Disability Living Allowance, and who are now worried about the prospective Personal Independence Payments, as I fear the lack of clarity on how disabling, destructive and limiting OCD can be is very misunderstood by parliament and policy makers.

Luckily though, OCD is being exposed more these days, it is a little more understood, and with the help of such charities as OCD-UK, more and more people who have suffered years of torment are now learning and gaining more insight into their condition and receiving support both from professionals and the wider OCD community (me included). I still believe though that more needs to be done to make the public aware of just how serious OCD can be, and this is partly why I am writing this piece. Another reason is purely and simply as a therapeutic intervention.

There is a common misconception that those who live with OCD are “clean freaks” and enjoy undertaking their compulsions, such as cleaning or tidying, which is often heralded as the epitome of OCD. However the truth couldn’t be more different, as for the individual presenting with obsessive compulsive symptomatology, their personal experience is one of torture, torment, doubt and terror. I for one can confirm this.

 

Can OCD affect Health Care Professionals too? YES! Here’s My Story…

One of my best friends is a manager of a Community Mental Health Team, and I am so lucky to have him in my life. I love him dearly for the support he has given me. He describes me as having “an inflated sense of responsibility”…I believe that this is very common in those suffering from OCD…

I graduated with a first class honours degree in occupational therapy in June 2009 after being given the opportunity to study on the occupational therapy programme at the University of Salford. I had no qualifications as such, but my experience as a support worker with adults with learning disabilities and commitment to the programme secured me a place. I was so grateful and so happy. I made “OT” my life! Ask any of my friends or any student in my cohort…it really became what I refer to as a “positive obsession”. Whether any obsession is healthy I am unsure about…the jury is out on that one, but I can positively say that my time at University was possibly the happiest moments of my life, and I personally put that down to said “positive obsession”.

My graduation day was probably the happiest moment in my life. I never imagined I would have achieved what I had, coming from a relatively poor background with a long string of failed academic experiences from school to college. I had hopes to find a job in inpatient mental health (my dream job; and there were also OCD reasons for this to which I will explain later), complete a Masters in Advanced Occupational Therapy and yearned for the opportunity to study for a PhD. My dream was to one day be an inspirational lecturer in occupational therapy, as I had been inspired by so many passionate lecturers/therapists at my University. I even managed to worm my way into presenting at a student conference at Sheffield Hallam…to me this was such a fabulous experience to hopefully make my name known in wider occupational therapy circles.

I had always suspected that I was “a bit OCD” (the ignorant person’s frequently used term) but I had no diagnosis, nor had I really sought professional help for my often distressing attacks of anxiety and, now what I know for sure is OCD.

In November 2010, I started to experience severe anxiety attacks and my doctor signed me off work due to what he referred to as “intrusive thoughts and depression”. I refused all medication, as I couldn’t accept that as a therapist I needed help. I threatened suicide and my doctor advised that I be better hospitalised, but I managed to convince my doctor that these thoughts were passive suicidal ideations. I was just dumbfounded by the whole thing, and medication would have just been the confirmation that I feared most: That I wouldn’t ever be able to practice in the profession I treasured and spent years of my time and heart in. Unfortunately I became very bitter, as I was in a very different frame of mind than I had experienced before! My love, excitement, and passion for the one thing I wanted the most (to be an occupational therapist) turned into a downward spiralling hatred and frequently the bile I carried inside would come gushing out in frustration of my experience. I guess this was some kind of warped coping mechanism looking back, as I felt cheated out of what I had invested so much in.

After a few weeks of seeing my GP, he suggested I seek “professional help” (oh those words pained me) for my “intrusive thoughts” and in the spring of 2011, I was awarded the very unsatisfying title of “Obsessive Compulsive”, after an assessment prior to commencing a failed series of Cognitive Behavioural Therapy (CBT). I say unsatisfying because I had always believed that I was meant to be the therapist, not the client, and my dream was to work as an occupational therapist with people with severe and enduring mental health problems. The mere thought of having some other therapist tell me how I should manage my mental health angered me and made me feel inadequate as a therapist. Still refusing to take any advice on medication from my GP, I began questioning myself on what am I going to do now? Who would want to employ a therapist who clearly is as “mad” as me? How could I possibly help others if I can’t help myself? I was utterly lost and did not know what to do or who to turn to.

After years of delaying learning to drive, I passed my test. I say delay because driving had also been an obsession of mine, and I avoided driving for as long as humanly possible. Alas, without a licence I would never find a “proper job” as a therapist as 99% of jobs demanded a license to even apply for the job. Maybe it won’t surprise you, but since I passed my test I have never sat behind the wheel of a car again…and do you know why? Because of OCD! I have intrusive thoughts that I could accidentally run somebody over and not know, and being OCD, I would have to return to the same route over and over and over again or check the car for signs of damage time and time again to convince myself that I had not harmed anyone! I’m quite sure you all think that that is ridiculous. It is, but this is OCD we are talking about. The realms of ridiculousness have no boundaries.

I still won’t drive, but unlike before I now want to build up the confidence again to drive independently (when I can afford to run a car that is)!

In September 2011 I began teaching health and social care at a local college. I had decided to try to take hold of my life again and so enrolled on a Postgraduate Certificate in Education. The stress of this ultimately made me even more ill than I had ever been, and I had to exit the programme in February 2012.

How did it affect me?

ALL areas of functionality to put it bluntly! I couldn’t go out alone as I believed that I would forget what I had done or convince myself of doing something truly awful or saying something equally appalling to another person.

I couldn’t pick up items in supermarkets as I held the belief that if I did, then the food would become “contaminated” and turn poisonous and I would cause harm to another person. If I touched anything, it had to be bought, I couldn’t risk somebody else touching the item of food, a book, you name it, as in my warped mind, I had to protect others from my “dirtiness”. Yes, I thought that I was “dirty”, “contaminated” some how and even had my own cutlery at home and yes I would taken these out on meals out too (had I been well enough to go out for a meal)! I couldn’t visit friends’ houses either, because I was frightened that I would accidentally contaminate them and ultimately make them ill. So because I cared so much about my friends, I refused to visit their homes, occasionally friends came to see me, but I struggled being near them, touching them, I couldn’t make them a drink even or touch anything that they could or would touch. Imagine what kind of operation that would be!

Communication with both friends and family had completely broken down, I couldn’t communicate over the phone or even online, I had to constantly be reassured of everything I said, did, thought and imagined. When the phone rang, it would be ignored, unless of course somebody was around to verify what I had said, or written in a text message. The obsessions just were relentless and I’d reached a point where I couldn’t do anything alone, even the basic things such as talking to others.

This is slightly embarrassing, even now, but still, I feel compelled to be honest, but for 3 months, I couldn’t even sleep in my own bed as I could not be alone, (and yes I was 29 man at the time, now 30) so I slept on the floor beside my dad where he frequently comforted me in the dead of night when I’d wake up almost screaming, or crying or tearing my hair out! Sometimes I would jump out of bed, at 2am or 3am, 6am, it made no difference, to check and check and check that my worst nightmares were not going to unfold. Check things I had written in the past…you name it, I checked it…even bits of rubbish! Cereal packets or empty boxes, I had to check them all because I had intrusive thoughts that I had written awful things without my knowledge. This became such a time consuming activity that completing this compulsion left me worn out physically and mentally. Everything had to be shredded…and then even the shredded paper was difficult to let go of and I had to go back again and check the shreds. I even remember one time, I was out with my parents (as I couldn’t be left in at home alone) and unfortunately I needed the loo whilst out….could I go alone? No! My dad had to come with me, luckily not into the cubicle, but after I had come out, my dad to had go inside of the cubicle and inspect it for anything I could have touched or written disgusting words on. Even the toilet paper! Yes! Mad! I know! Nevertheless, if he hadn’t have done this, I’d have been frantic and probably wouldn’t have left the public toilet for love, nor money!

MAD I know and I hear you say it…but OCD has a very clever way of convincing you of the unbelievable, the worst possible outcomes coming true and your worst fears and nightmares become reality. I had many other obsessional thoughts, most of which I cannot discuss because they’re truly and deeply distressing and I do wish to maintain some element of privacy, but also because I have experienced so many different kinds of intrusive thoughts, I fear I could be writing this blog for a long, long time!

But for the record, all obsessions are equally evil and to reassure you, they prey on your inner most fears, your disgusts and make you believe that you’re something or someone you are not. So don’t fear, you’re not the homosexual that your thoughts tell you that you are, you’re not a paedophile, you’re not a murderer, and you’re not going to lose control, harm anyone or blaspheme and be condemned to Hell. I PROMISE YOU! What you ARE however, is unfortunate enough to be affected by OCD, and not just any OCD, but a tpye referred to as ‘PURE O’! One thing I feel important to add to reassure those who have OCD and obsessional disturbing thoughts, there have been no cases of anyone with OCD carrying out any obsession…mental health professionals KNOW this…and they have heard YOUR story a hundred times before! Believe it or not, you’re not a freak!

Coping Strategies

So how do I cope now? Well…I finally gave in to taking medication and I now take 40mg of fluoxitine daily (that is Prozac)! Yes it is an antidepressant, but it is also well known for reducing OCD symptoms…and thankfully it has with me! My advice to anyone would be, take the medication, and don’t resist. You wouldn’t want to go through what I did! What I experienced, I wouldn’t put my arch nemesis through…not that I have one, but you get the gist of how distressing it all was…

I am working towards going back to CBT. This is a highly frightening prospect, but I know that it is necessary for my own health and wellbeing.

I now use art as a therapeutic activity to channel my thoughts, to take my mind off the OCD and to feel a sense of achievement again. I love art, and only through my experience have I truly understood what a positive tool it can be for recovery.

Where next?

My goal is work on my recovery and work towards reclaiming the career that I wanted and worked for. My dream was to be an occupational therapist, but I believe that my experiences will make me an even better, more empathic therapist than I could have ever imagined. I have now started to immerse myself back in the world of occupational therapy and am ready to get back in the saddle.

Recovery is a slow and long process, this is know, but I feel that writing this exposé has triggered a strong sense of determination for recovery.

Watch this space because this occupational therapist is well and truly back in town 😉

One final note, I came across this quote when trying to cheer a friend up, but it is so apt for this blog for anyone experiencing OCD…

“Don’t confuse your path with your destination, Just because it’s stormy now doesn’t mean you aren’t headed for sunshine”

 

References

Smith, A. H., Wetterneck, C.T., Hart, J. M., Short, M.B., Björgvinsson, T. (2012) “Differences in Obsessional Beliefs and Emotion Appraisal in Obsessive Compulsive Symptom Presentation” Journal of Obsessive-Compulsive and Related Disorders.(1) pp. 54-61.

By otpod Posted in OCD Tagged