Obsessive-Compulsive Disorder (OCD)
Posted on Feb 21, 2012 by Joyce Dallimore
OCD is a highly upsetting condition in which a sufferer experiences powerful, intrusive and distressing thoughts or images, usually connected with an imagined disastrous event (perhaps that one's son will die in a car crash) and devises some or many rituals designed to reduce or ward off that event or make reparation for having the 'bad' thought. Usually, the more the rituals are carried out, the more the thoughts recur, requiring yet more rituals.
The condition first occurs because of raised stress levels, often as a result of physical illness, worry, fear, lack of sleep, some personal setback or crisis, or even a fright. people who develop the compulsion to wash their hands, and who often end up spending many hours a day in this activity, may first have experienced a generalised anxiety about their health or safety and then focused on a fear of germs. The bottom line is that some important emotional need is not being met. That's why the approach that I use, which focuses on helping people in distress find healthy ways to meet their emotional needs, is so successful.
Rituals can be extremely varied and numerous, may involve walking across a room a certain way, picking up cutlery a certain way, counting or clapping a set number of times etc, and have to be carried out iin exactly the right way, otherwise the whole sequence must be begun again. Yet many sufferers are amazingly resourceful in hiding their condition.
What happens in OCD is that a primitive part of the brain, called the amygdala, which is our emotional alarm system, starts to associate the thinking of the OCD thought with danger, setting a stress reaction in train which leads the sufferer to carry out the ritual to avert the danger and reduce the stress. Sufferers are convinced that something dreadful will happen if they don't complete their rituals, however many times they are required to do them. When they are caught up in this thinking and carrying out the rituals, they are in a trance state, just like a dream. And, just as our dreams seem totally real and believable to us when we are in them to the trance state of OCD is equally compelling and believable to sufferers. They are, therefore, absolutely terrified about stopping their rituals.
It is essential to help a sufferer see that they are separate from the OCD - a lot of people choose to call it 'the bully', as a means of starting to se it as something outside of themselves. This helps them take a step back and begin to identify OCD thoughts ("if I don't make and re-make the bed 10 times immediately, my daughter will be abducted on her way home from school") as very different from normal thoughts. To help them to resist performing the rituals associated with the intrusive thoughts, they need to have distracting activities prepared, which they can launch into instantly - for instance, calling a friend, taking a walk; activities need to be varied, so that a new ritual isn't established.
The more that the OCD sufferer does not carry out the ritual after experiencing the thought, and realises that nothing terrible does happen, the more the rational part of the brain can override the nervy messages from the amygdala. As time goes on, and the messages continue not to be acted on, the thoughts start to fade and stop altogether.
This is not easy for sufferers to put into practice, of course, because they believe strongly in the power of ritual. I can use effective techniques to help you, which involves encouraging you, while deeply relaxed, to visualise yourself, as if on a TV screen, experiencing the frightening thought but not carrying out the appeasement ritual and calmly doing something else instead, such as making a cup of tea or doing the washing up. Going through this, in a calm state, in the imagination helps instruct the brain to respond this way in reality.
Just as important, I will help you to identify what is lacking in your life (it is quite common for instance, for sufferers to have ceased to have a social or work life, because the rituals are so demanding) and help them to get their needs met in fulfilling ways.