OCD stands for Obsessive Compulsive Disorder and is characterised by obsessions (troubling, unwanted thoughts) and compulsions (the things you do to help you to cope.) It is not the thoughts that makes you suffer with OCD, rather it is the meaning you attach to the thought and how you respond to the thought that makes you suffer.
I shall pick up on this point as I explain OCD to you
This page will cover
- Types of OCD
- Signs and symptoms of OCD
- Obsessions and Compulsions
- What causes OCD?
If you want to read about the recommended models of treatment for OCD, including self help, you can read about them here.
Types of OCD
I find it easier to break this down into
- People who check
- People who hoard
- People who are worried about contamination and germs
- People who ruminate and have Intrusive Thoughts or Pure O
OCD and Checking
This can be checking
- Door, windows, locks
- Emails – that they were sent properly, or checking that they are perfect before you send them
- Turning off cookers, curling tongs, electrical appliance
- Sending loads of texts to make sure someone is okay, that they got home okay, that they are alright with you
- The route (thoroughly) before you travel
- That you have everything you need with you – even though you have just checked
OCD and Hoarding
This is what it sounds like – you can’t get rid of anything. You keep everything just in case you need it, and it is extremely anxiety provoking to consider getting rid of anything. The anxiety spike is so intense that it is just easier to keep everything even though it is making your life difficult.
OCD and Contamination – OCD and Cleaning
In all the years that I have worked with people like you, if you have contamination OCD, somewhere in the back of your head (and it could be there and you don’t know it yet) is a fear of harming yourself or other people.
I think because OCD and cleaning has been the subject of many television programs, it looks like the cleaning became the focal point as opposed to the real fear and anxiety that is behind it.
I always think, if I had this, and somewhere in my mind I thought I could inadvertently harm people I care about or myself, through germs, yes, it is better to clean, just in case it is true.
The contamination fear can result in cleaning,
- Yourself – before you get in the shower, cleaning your products before and after you use them, the shower before you get out, and if you touch something or it doesn’t feel right you start again.
- Objects or surfaces around you.
You may avoid many public places or crowds due to fear of contamination. It can be extremely difficult to use the loo outside your own home, and many people don’t. You may not be able to touch many things that you have not made sure are clean and probably carry disinfectant gel with you.
The cleaning, especially of yourself can be extremely difficult, as your skin can hurt and burn.
Intrusive Thoughts – Pure O
Many people see this as only having obsessions without the compulsions, but I often find, if you look hard enough, the compulsions are there.
Typical intrusive thoughts are concerns relating to your sexuality, your relationship, your faith and concerns that you could cause harm to yourself and/or other people.
If you would like my help
Signs and symptoms of OCD
What are the obsessions in OCD?
Obsessions are those thoughts and images that come into your head such as
- Did I turn the lights off?
- Did I send that email to the right person?
What are compulsions in OCD?
The compulsions are what you do to help you cope (and get reassurance about) your obsession, for example, if you were worried that you left the lights on (this is the obsession) and the compulsion is when you go back to check. I shall give more detailed examples now.
Obsessions and compulsion in relation to cleaning
If you have this, you might have come across contamination OCD, I am not big into labels, so I shall just explain how this works.
Let’s say you were about to prepare dinner and you had the thought “is my kitchen counter clean?” This is the obsession. I’ve been working as a psychologist a long time and specialise in anxiety disorders and OCD, and you probably know this already, but it is much more than wanting the counter to be clean.
If we dig deep enough, more often than not, what is behind this obsession is a fear that you could cause harm to either yourself or others. You, not cleaning something correctly could, for example, result in the spread of germs and make someone you care about ill, or worse.
If what I have just said does not sound familiar to you, you might not have done any work yet on your OCD to see what is really behind the things that you do.
This thought that you could make someone ill will result in your carrying out your compulsion – the cleaning as you will not risk harming someone that you care about.
There is always a reason behind the things you do in OCD
You don’t need me to tell you that it is not just a quick wipe with dettol. Depending on how severe your OCD is, the cleaning is almost ritualist and can take a very long time.
To recap quickly, in this instance the obsession is ‘is this clean?” and the fear of unintentionally causing harm could be behind this, and the compulsion is to clean.
I am going to choose a more obscure element of OCD, one that you might not be familiar with, but it can still fall under the umbrella. There are so many examples, but I can only choose one or two.
Obsessions and Compulsions in relation to doing something wrong – eg did I send that email to the right person?
If you don’t have this, you probably hit ‘send’ without doing a basic spell check. If you are concerned that you might do something wrong, sending an email is a long and difficult thing.
The obsession might start with something simple like “have I got the email address right” and similar to what I said above, there is always a reason behind this, so I shall take an educated guess that it might be a fear of not wanting to do something wrong, or a fear of making mistakes.
The fear that you might get the email address wrong will lead you to carry out a compulsion – check the email address, but if only your compulsions were that short! You might also have to carry out the following if you have a fear of making a mistake;
- checking the email address many times
- proof reading the email many times
- not sending it after you have done the above, as you may have missed something
- once you send the email the anxiety can start, and you have to go into your ‘sent items’ and start checking again.
I can certainly see why you would carry out compulsions as they help you to cope, and the manage the doubt and uncertainty that comes from having OCD. The problem is they are only a short term fix, as in the long run they become problematic as it is the compulsions that keep your OCD going.
The point I am trying to make is this, regardless of what form your OCD takes, they all share obsessions and compulsions. This bit is important; the problem is not in the initial obsession or fear, the problem is due to what you do with the obsession and carrying out of compulsions, which I shall talk about now to help you to understand what is happening a bit better.
As with all anxiety disorders, you were not born with it, so something must have happened along the way to make you acquire it – not on purpose of course.
Let’s start with the brain, as that is where I first look when I meet someone. It’s a pretty good place to start as it provides most of the answers you are looking for!
Your brain is a super duper learning machine, and it really does not filter out what it learns; at no point will it stop you mid track, and say ‘hey, I don’t think this is a good thing to be teaching me.’ It just learns. Your brain learns to create efficiency. It works so well, as it makes practically everything you do run on autopilot (regardless of whether it is helpful or not to you) to allow you to focus on one task at a time. No matter what you read about multi-tasking, you can’t do it.
Of course you can do 2 or 3 things at once, but only 1 of these tasks take your full attention, the others are running on autopilot. Don’t believe me? Have you ever been walking and then were asked a tricky question or had to work out something complicated and noticed you either stopped walking or slowed down? This was your brain on overload, slowing you down while you focused on the task in hand!
Anyway, back to your brain. It learns, whatever you repeatedly do. Whether it’s ballroom dancing, Irish dancing or Japanese. The first time you try it, you’re crap. Your brain has no blueprint to help you speak Japanese nor make your feet move. You break it down, you practice, you repeat. Let’s going with Irish dancing as most of us has a step or two in us, even if it is only your 1,2,3’s. The more you practice the more connections are made within your brain.
Each time you hammer out something on the ground, these connections become stronger until you advance from the tongue out 3 year old that needs all their attention to focus on their 1,2,3’s to an adult that can dance without any conscious thought and carry out a conversation at the same time.
It is the same with anything you repeatedly do, driving, swimming, reading – the more you practice, the more your brain learns, until your skills becomes automatic with no conscious effort on your part.
Brilliant Elaine, you say, but what has that got to do with me and my OCD? Quite a lot, I say.
For the sake of helping me to make a point, think of your OCD as a habit, for the moment. The dancing, the Japanese, these are habits, in the sense that you have taught your brain to make connections and carry them out automatically. Your OCD is also a habit, in that you can think of it as a series of automated processed that can fire in your brain and take you on a path of fretting, checking, ruminating or whatever it is you do (and I shall list them properly in a minute.)
It’s a habit in the sense that you do not choose to do them, you don’t want to do them, although paradoxically you will not let someone stop you do them, for fear that something bad may happen to you (or people you care about) and you will be responsible for the outcome (that you could have prevented.)
So how does OCD start?
If you weren’t born with it, what happened? There are so many factors at play to answer this properly, so I shall try to give a brief overview.
Everyone is different. The people that I have worked with over the years, I can usually trace it back to an event that makes sense to the person – and no, don’t email me for an appointment to find out where it started for you, as it is not necessary.
Where it starts does not solve your problem – knowing how to fix it solves your problem.
There are two things worth pointing out in terms of a starting point
Your psychology, and
Your biological make up.
To explain this, I work best with examples. All of us have intrusive thoughts, even me! I was making part of a video series the other day and included one of my own recent examples. I was going to clean my teeth, and was about to put the toothbrush part on the spikey end of an electric toothbrush. I didn’t have a fully formed thought, but it was along the lines of, shall I stick this in my eye. Don’t worry, I am quite sane, and good at what I do, so you are safe to keep reading!
I am going to run with person A and person B. Person A is relatively easy going, not much stress and quite resilient. That thought; they could just dismiss, as one of those made thoughts we get. Also being quite chilled it won’t have created too much anxiety.
Person B worries about everything and tiny criticisms or doing something new, can create an anxiety spike, where their heart pounds, get red faced and they generally feel the full impact of their nervous system. When they get that thought or urge to stick the offending toothbrush in their eye, they get anxious and afraid. It is harder for them to let it go, and they might worry about it. They could well worry why they had the thought in the first place, what it meant, and what it said about them in the first place?
They give the thought more significance. Furthermore, i they worry enough, they may switch to a manual toothbrush.
Remember what I said a few moments ago about your brain learning? The more person B does this, the more connections are made in their brain and the more they learn until it becomes automatic. If someone buys them an electric toothbrush for Christmas, they might put it away, just in case they do something harmful with it. Which brings me back to what I said at the start of this article – the problem is not the thought in your head, the problem lies with what you do with that thought, how much significance you give the thought and the carrying out of compulsions keeps it all going.
Effective treatment focuses on neutralising your thought processes, lowering your anxiety levels, and eliminating your compulsions. That might sound a bit scary at the moment but it is done in a slow systematic way. You can read more about treatment for OCD here.