Culture, media and OCD
In the same way that the prevalence of eating disorders varies directly with the media-induced “ideal” of the perfect physical form, so too do the nature and focus of OCD obsessions and compulsions. Take for example the insatiable appetite for all things celebrity, developed, monitored and fed by the media. More specifically, the intensity of the media scrutiny of celebrity relationships which is distilled into print and TV into ‘expert comment’, on-topic articles, ‘real-life experiences’, surveys, questionnaires and media and public debate. Such interest appears to have fathered (sorry) a simultaneous ‘new’ subtype of OCD obsession involving intense scrutiny of one’s own intimate relationships. The person with OCD will become locked in attempting to problem solve various dilemmas such as: “Is this the right relationship for me?”, “Do I really love this person?”, “Is my partner faithful?”, “Could I be unfaithful to my partner?”. And before you think that this is the everyday stuff of supermarket checkout queues and teens on lunch break, you’re right, but not to the point where they might take every Tuesday off work to agonise about the question for 12 hours alone, in bed, writing notes, or track down a random stranger they can’t remember whether they kissed 15 years ago at a bar just before they got married. At the ocdcentre we have noticed a distinct upward trend in the number of young people (18-30 yr olds) seeking treatment for what we have come to call ‘relationship OCD’. We have no doubt that the proliferation of relationship experts, self-help books, magazines focused on the domestic dysfunctions of Angelina and Brad or Katie and Tom have contributed.
So, take this issue to your GP or Primary Care Physician and you’ll be hearing the phrase “that’s just part of being young!” echoing after you as you’re shown the door. Later you’ll go home and your friends, family and the lady at the bus stop who just love to talk about society’s version of current affairs will get heavily involved in your love life. And the slippery slope continues, day in, day out. Needless to say, many of these young people never make it to us for treatment or at best, show up later when their OCD morphs into something the neighbours concur is really obsessed (or wierd and not nearly as interesting to them).
Similarly, the paedophile, as the media’s latter day parallel of the serial killer has been the basis of many an OCD sufferer’s inner turmoil. Heavily linked to the sub-type of ‘responsibility OCD’, such a person with this type of OCD will fear that they might likewise harm or abuse children, so much so that they will avoid all contact with children and more seriously, consider suicide to protect potential victims. Locked at the basis of this psychophenomenon is incredibly low self worth (sometimes bullying) and the notion they might become the most abhorent member of society imaginable which is, of late, the tabloid paedophile. They are of course, nothing of the sort and I would sooner leave my children with such a sufferer than anyone else.
What is true for obsessions, is also true for compulsions. They have, in many ways, been shaped by culture, society and naturally, technology. Where technology is concerned, there is a clear divide. The avoidant sufferer will go to enormous lengths to escape the constant and conspicious deluge of information, shunning TV, mobiles (cells), the internet and even credit cards – much easier to do 10 years ago. In the other camp, the more compulsive sufferer’s peace of mind will be defined by the number of texts they receive/send and their accuracy (checked 20 times). Their anxiety levels will be assuaged by their access to reassurance from friends and family on their mobile phone and at least 20% of the global internet usage must be people with OCD researching health symptoms checklists, relationship surveys, local traffic accident reports, criminal and pathological traits and food additives.
Since compulsive behaviour is self-medication, OCD’s addictive idiosyncracies can be extrapolated to include Twitter, facebook, video games, TV, online gambling, online forums, discussion boards – it’s a long list. Then we have the shift from the people who re-write letters, words and whole sentences to those who have become super adept on the keyboard but still find that they are under performing at work because colleagues don’t have to redo the entire Excel spreadsheet because the 3rd row just didn’t feel right.
I’ll stop now as I could treat a dozen people in the time it will take me to cover 10% of this topic accurately, but I hope you get my drift. OCD has a nasty habit of staying current.
(next: Why there is a large-scale communal and societal tendency towards OCD)
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So, to summarise the last two posts, the diagnosis of OCD is not the exact science you might think. For me, it seems an exercise that is 40% clinical, 60% experiential. And even then, does one classify obsessive traits which aren’t unduly hampering a person’s life as OCD? The severity of OCD is a spectrum, it is also a multi-faceted condition with various themes, some of which are primary, some subordinate. It is a complicated matrix of obsessions and compulsions which can’t always be cross-referenced. It is a condition often characterised by the existence of co-morbid (existing alongside) other chronic conditions such as addictions, eating disorders and depression, among others. So, for my purposes, I’m going to re-phrase the question, “How would I know if I have OCD?” with “How would I know if I need treatment for my OCD?”. This is the question we are more focused upon and these are the criteria (mostly gained by experience) by which we, the OCDCentre, assess our clients:
- We look for at least one obsession AND one compulsion and it is not always easy to figure both out as clients often don’t know, e.g. a client may have 20 physical compulsions and then have no idea why they are doing them until we point out that the reason they are doing them is to avoid anxiety or panic, another may have obsessions but no physical compulsions yet they mentally negate the bad thought with a good thought (their compulsion)
- We ask the person why they think they have OCD? People with OCD are generally very bright and the reputed lead time between onset of OCD and seeking treatment is 11 years so most have a pretty good idea of what’s going on and how much it is affecting their lives
- We ask if the people around them are involved in their OCD? OCD is very lifestyle-invasive. Rarely do the people around them fail to notice, offer help, reassurance or collusion.
- We look for more than one OCD crisis in their life: some clients do come to us still shocked at the sudden attack of OCD from nowhere but very seldom can we not identify previous manifestations of OCD that they may not have recognized as such
- We look for various themes and subject matter: some of these are harm to self/others, loss of control, hyper-vigilance, contamination, perfection, certainty, intolerance of discomfort and many more
- We look at genetic links to OCD: even before research was published on the existence of a gene identified as significant in the development of OCD, we recognized that the occurrence of familial OCD was higher than might be expected
- We see how much of their day is spent on what they consider to be OCD: the DSM-IV criteria is more than one hour spent on an obsession or compulsion per day. I don’t want to sound patronizing but this seems a little naïve and the danger is that such a criteria could put doing your hair or fiddling with your scooter into this category. Truth to say, we haven’t had one poor client even close to this timescale. Would that this was the norm. We are looking for ratios much higher than this.
- We look at how well they are holding down their job and their significant relationships: as I said before, OCD is lifestyle invasive and these two criteria are critical in assessing the presence and severity of the condition
- We ask if they have been formally diagnosed elsewhere: healthcare professionals are becoming more aware of OCD, if still not sufficiently trained in how to treat it
- We have a checklist of the compulsions we consider to exemplify OCD (and they may not be what you think): because we have OCD and have recovered, we know the minutiae of the organized chaos that is OCD. I’m going out on a limb here but I’m not sure anyone who hasn’t got OCD will truly understand that multi-coloured thread that binds us together
- We look at co-morbid conditions: these are conditions that exist alongside OCD and complicate our diagnoses, e.g. depression, substance abuse, eating disorders, Autism, etc.
- We look at how they are achieving their goals and purposes in life: OCD isn’t like being pregnant or dead, it is actually a spectrum. Some people have mild traits that just show up when they are playing golf or reading the newspaper, others haven’t left their house for 4 years. If a person is getting their goals in life achieved and are not otherwise disturbed, they fall into the “OCD but not requiring treatment” category
- We ask them if they want to get better: yep, believe it or not, some people are “window shopping” or are encouraged to come by others and have no interest in getting better. Regardless of whether we think they have OCD or not and how severe, if they don’t think they have a problem they need to resolve, there is nothing we can say that will convince them
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Say for example that a female client with a responsibility obsession about harming/killing her husband displays classic responsibility compulsions. She seeks reassurance that he is safe and that she would never do anything to harm him. She calls his mobile phone repeatedly, she insists on sleeping separately with the door locked so that she can’t hurt him in his/her sleep and finally, she regularly confesses her imagined crimes as and when they occur to her. OK, no surprises here, we would be expecting this type of OCD symptomology. However, recently, she imagined that she could also harm her husband by infecting him with a contagious condition she recovered from years ago.
So now, she her compulsions change and she starts exhibiting contamination compulsions centered around cleaning and her own personal hygiene. Yet she isn’t worried about becoming contaminated herself, she is more worried about harming her husband. So she has responsibility obsessions that manifest with both responsibility and contamination compulsions, forming a cross matrix of responsibility category obsessions linked to various categories of compulsions.
The nature of OCD obsessions rarely remains consistent over time and often morphs into new fears and hence new compulsions. In our example, let’s say that, a year or so later, our client’s obsession changes again to her worrying about harming her husband by being unfaithful. Now she begins to analyse their relationship, mentally ruminates about whether she genuinely loves her husband and researches examples of infidelity in the media. To all intents and purposes, this could appear very much like relationship OCD (a sub-type we are coming across more frequently) but it is actually still based upon responsibility obsessions.
Phew, I hope you get the point about the complicated matrix of obsessions and compulsions. It’s not easy!
So now let’s add a couple of environmental factors into the mix to complicate matters further (since life is invariably like that!) and to throw many a therapist or doctor off the true scent. Let’s imagine that our client is a pregnant woman who five years ago contracted malaria under traumatic circumstances. What’s more, her husband, uncharacteristically, had a brief affair with a co-worker a year ago. Given her symptoms, suddenly you have a hormonally sensitive expectant mother with post-trauma related to a previous chronic illness constantly living with the danger of an unfaithful husband who is soon to become the father of her child, the latter issue being reinforced by her female friends who see the analysis and evaluation of relationships as a valuable pastime.
Except, in this case, this is not what you have. You actually have a woman with OCD who happens to have these life experiences and this environment. Hence environmental issues can cloud diagnoses and delay people realising they need to present for treatment.
Not surprisingly, culture, society and even technology hamper our ability to detect OCD. I have recently treated a young client whose major OCD obsession stems directly from the burgeoning media celebrity focus. She is obsessed with an incident where someone she used to admire said that a famous celebrity, featured almost constantly in the media, was much more attractive than her. The discomfort she remembers from this experience has led to her avoiding images of the celebrity, which in today’s culture, encompasses pretty much everywhere. She carries out rituals if she sees certain words, phrases, images and dates and can’t look in the mirror. She hasn’t washed her face for 5 years and if she touches her face, the touch must be symmetrical on each side. For years, her family assumed she was having an understandable adverse reaction to the over-exposure of this public figure in the press. And by the way, parents, relatives, partners and friends can be an important part of the diagnostic criteria. How much they are involved in OCD is a clear determinant of its existence.
Most of the OCD-aware general public consider OCD to be a matter of contamination and/or checking. The truth is that responsibility obsessions are as common as contamination obsessions but gain less media coverage due to the sensitivity of the obsessional content (harming/killing/abusing people) and the fact that it is often less physically compulsive or visual, i.e., doesn’t make great TV. The media particularly shys away from reporting on the common OCD fear about harming children or pedophilia which is ironic, since the media’s fascination with the subject is a key driver in an OCD sufferer’s fear that they will become something that the public most despise (personally, I’d feel safer leaving my children with an OCD person with these fears than a person without. It is so unlikely to be true). Similarly most people would never attribute some of the more obscure obsessions and compulsions with OCD; for example, an 11 year olds fear that his brother will “steal” his intelligence, a husband who is convinced that his newborn baby has been fathered by his own father, a woman who fears that she might sexually abuse her beloved cats and a man who fears that walking and sitting down will damage his vital organs.
Then there is a larger category of what I call the “social OCD’ers”. Those people I meet socially who quiz me, “I go crazy if my desk isn’t organized, do I have OCD?”, “I can’t help but align my cutlery to face the same direction, do I have OCD?”. I don’t really need to know further details since my first question to them would be, “How much is it affecting your life?”. 99.9% of the time they aren’t greatly hampered by their OCD traits. So the answer is “Probably!”, but they aren’t in need of my help. The more people I meet, the more traits I hear about, the more I believe that the 2.5-4% global prevalence rate is largely accurate. It is this smaller but still significant number whose lives are considerably impaired.
So, if you now feel even further away from knowing if you have OCD, next week I will outline the criteria we, at the OCDCentre, consider to be determining factors……..
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I get asked this all the time (by people who aren’t clients) and it is the most difficult question to answer.
It’s not that I don’t know what OCD is, having worked with the condition for years, and it’s not that I don’t understand the question, but it always strikes me that it is similar to asking “How do I know if I’ve behaved badly?”. The answer is: it’s not an exact science, there are degrees of behaving badly and you can change things pretty quickly either way.
The difference between behaving badly or not and developing OCD is that the latter is more of a one-way street. You can develop OCD suddenly but it’s difficult to undo. No amount of flowers or sorry cards will do the trick. Only self-awareness and hard work will suffice, and that’s if you’re lucky enough to know what’s going on. But doesn’t everyone? Ellen de Generes says “We’ve all got Attention Deficit Disorder or ADD or OCD or one of these disorders with three letters because we don’t have the time or patience to pronounce the entire disorder”
Er……that’s true. We all have elements of ADD or OCD, just as we have the capacity to behave badly however, from where we stand as therapists, OCD doesn’t really come into our field of vision until it starts to have a significant impact upon someone’s life. Just as you can behave badly but only start to catch the attention of the authorities once the misdemeanors have reached a critical point. In this blog we are only really going to be discussing OCD that is impacting upon people’s lives.
So how would you know if that is you?
Currently the term OCD is bandied about much like the phrase “I have issues”. This is a sure sign that an exact definition is hard to come by. When people think they have a condition en masse, it simply means that few understand what it really is. Even the professionals struggle and misdiagnoses abound. OCD has been mistaken for stress, PTSD, ADD, pre-menstrual syndrome, psychosis, depression, manic-depression, schizophrenia, bi-polar disorder, eating disorders and even Aspergers. In my experience I am convinced that post-partum OCD is as common as post-partum depression but is all too rarely diagnosed. It is hardly any wonder then, that the general public often fails to recognize it.
The problem with OCD is that it doesn’t conform to diagnostic criteria in quite the same way as most other mental disorders. Yet, like most, there is no biological test for OCD. Assessment tools such as the “industry standard” DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) and the Y-BOCS (Yale Brown Obsessive Compulsive Scale) agree that obsessions and compulsions must be jointly present to indicate the existence of OCD.
I would agree. However, it is often tricky to identify compulsions that are cognitive or thinking-based and it takes some experience to recognize some of the more covert forms of mental rumination. Nevertheless, both will exist and it is this very phenomenon which renders a definitive diagnosis so unwieldy and why some people slip straight through the net. By phenomenon I mean the existence of both obsessions and compulsions and how they interrelate.
The lengthy list of common obsessions and common compulsions form a complicated matrix (and these are just the “common” traits (we are regularly surprised by new and unfamiliar symptoms). As a treatment Centre we have developed our own assessment (www.ocdcentre.com) based upon our classification of OCD sub-types.
Next: Just how complicated can OCD be…………..?
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Tags: OCD, OCDCentre
Welcome to the OCDCentre
Hi and welcome to the first ever OCDCentre blog. My name is India Haylor and I am the founder of this Central London treatment Centre www.ocdcentre.com that specialises in obsessive compulsive disorder (OCD). And I know that I can speak on behalf of the Centre when I say that it is so much more than that to us involved. I knew that there would never be anything 9-5 about this role, but it’s true to say that the Centre really is our main focus in life. That’s because the distress of OCD isn’t limited to working hours or any one person. Like addictions, OCD is 24 hours (yes, it is possible to dream about carrying out rituals) and the “collateral damage” is widespread. From the epicentre of the person suffering, the impact spreads quickly to partners, children, siblings, parents, other relatives, colleagues, friends and healthcare professionals (therapists gain skills to cope but imagine a primary care doctor being visited 15 times by a patient enquiring about the same slightly abnormal benign skin mark who is never satisfied by the all clear diagnosis?). Our phrase at the Centre is that OCD is “lifestyle invasive” but we realise that this is, in many cases, an understatement (70% of our initial enquiries come from a carer and not the person with OCD).
Speaking as someone who manages their OCD well, the Centre is the only part of my life that I am happy to be obsessed about. Behaviour tasks occur to me when cleaning my teeth and the phone can often ring at 5am but this is small potatoes when I trade this off against the satisfaction of what I do, day in, day out. Even then, our benchmarks for success can be compared to very little else. I am quietly ecstatic when I help a bleach-disinfected client in a contamination suit to touch a door handle for the first time in 2 years or encourage another not to put the tell-tale tape across the closed door frame before they go to bed to signal in the morning whether they have left their bedroom and brutally murdered someone in the night. These are the sort of life changing events that we can neither discuss or relate to anyone elses notion of job satisfaction. Nevertheless, these are the things that we live for.
So, as a Centre, we have learnt to be unshakable in our conviction that change can happen in any circumstance given the willingness of the person involved, unconditional in our respect for our clients (and those in their immediate surroundings) and very, very flexible. We know there is no norm, no common pathology or symptomology, no OCD “type”. For us, the traditional scenario of client and therapist sat discussing a past week in the life of the client is a rarity. More often you will find us rolling our sleeves up with our clients, busily formulating plans and goals, holding boundary setting family sessions in homes, reviewing homework, using public transport together, sitting on sidewalks, leaving taps on and sharing food a day or two outside the sell-by date. And if we are not doing this in person during our London 5-Day Intensive Courses or In-Person Sessions, we are encouraging and supporting our remote clients during telephone sessions to work in the same way at home or training their carers to help them do so.
At the Centre we all have OCD, or very direct experience of it, e.g. an involved wife or father of someone with OCD. As far as I’m concerned there is a reason that the Alcoholics Anonymous model of recovered addicts helping recovering addicts is one of the most successful interventions in the world. Given the hard work our clients have ahead of them I’m not sure I could look them in the eye unless I’d been through that process myself. Additionally, the obsessions and compulsions of OCD are often so bizarre, so complicated and cross-referenced, that I believe it is more difficult for a non-OCD therapist to fully grasp the nature and scope of this disorder. I know that I have to sign my signature on both sides of the “contaminated” toilet tissue I give my client to carry around for a week in case they just swap it for a clean sheet when they leave. I know this because at one time, I would have done the same. Also, how do you fully explain that sense of things not being right when a client takes an hour to pass through a doorway from one room to another? I could never sit in my comfortable session room and ask my client to do anything I haven’t already done or would be happy to go out and do with them.
So my mission with this blog is to inspire others with OCD who stand on the verge of making the leap as we have been inspired by the amazing efforts of our clients. I hope to do this by discussing the methods and techniques we use everyday and the experience we bring to bear on our philosophy and programme. More importantly, I would like to leave people with the impression that people with OCD are exceptional in many ways. The emotional sensitivity resulting from their condition, if under management, leads to achievers who are incredibly intuitive, exacting, creative, empowering and articulate. And if not under management, at the stage we tend to see them, their basic characteristics of kindness, consideration, honesty and appreciation are evident. As I said before, I really love my job and I hope I can share some of the skills I’ve learnt with you.
To contact the OCDCentre: UK: +44 (0) 20 7096 0368 or 0845 226 3110 US: +1 646 216 8172 or email info@ocdcentre.com
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