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We’re all here, everyone came back after yesterday India’s doing a presentation about The Comfort Monster.
Presentation about Rational Emotive Behaviour Therapy (REBT). India’s asking clients their worst fears.
India is teaching us how to work out our core fear which lies beneath our ocd spikes.
India asked group if they’d find it easier to carry out yesterdays exposure tasks today, and they all said yes!
Core beliefs – we all hold different sets of beliefs.
Back from break. We are learning about the REBT Theory: ABC model. ABC model is based on our belief system.
Finding out clients Critical A and irrational belief, and then disputing the irrational belief.
Each client has written down their longterm goals, which include being in a happy relationship, become a parent, and work with animals.
This part of the course, working through ABC model based on clients core beliefs/ocd worries, is always emotional. But it is key.
Ex intensive client Rob is here giving an inspirational talk about his therapy journey. Rob is managing his OCD really well now.
Rob has had therapy from India here at the ocdcentre. He has learnt therapeutic skills for life.
Rob’s speech is truly inspiring. He explained his OCD spikes and how he overcame them. Gives current clients hope. Thanks Rob!
group is emotional after Robs speech. It’s really inspiring 2 see a person like Rob who has overcome his ocd & lives a productive life.
But Rob and India stress that there’s no quick fix, its a long and difficult journey and takes hard work. the journey begins here.
Today is exposure therapy day. Out in London. India is giving clients exposure tasks. Everyone’s nervous there’s already been some tears
In natural history museum. India is giving clients individual tasks now, based on contamination ocd and self worth.
India’s just given everyone a tough self worth task
But some fun tasks too. One involved dancing!
Having a spot of lunch, but India and Lorraine are still dishing out exposure exercises. No rest for the wicked!
India is talking to clients about self worth.
India’s just given everyone a tough self worth task.
The group are giving each other exposure tasks now
We are in a church…what’s India going to make us do?
So far today – a client with contamination ocd has had to sit on tube station floor and pick up dirty things from pavements
The clients had to say negative comments each other
Everyone’s been sent off alone to carry out individual tasks
We are in Harrods. Just did task in shoe department…now up to toy department…
An inspirational day! Difficult but so worthwhile. The clients have all done so well! They faced many fears today & should b so proud
Everyone meets. There’s 4 clients, 1 carer, Therapist India Haylor, and
helpers Lorraine and Nicola
India’s set the first homework – everyone has to wear the same clothes
tomorrow, & phone India tonight & insult her
India’s doing presentation on ocd education – ocd sufferers think A LOT
& think/talk about the problem rather than solution
Introducing 5 day intensive prog – its beginning of journey, and
learning based, to teach skills for life
We use our own therapeutic techniques, & rational emotive behaviour
therapy, CBT, acceptance & commitment therapy, mindfulness
Group are watching hard hitting video clip about a little girl dying in
a Bulgarian orphanage. Emotional.
ocd is a condition which is ultimately harmless. We don’t have a
terrible life, compared to some others in the world. We have choices
Intensive expectations – likely to see improvements in next 6 weeks but
be patient – consistency is the answer. It’s ongoing
India and the ocdcentre will help everyone on intensive course to
continue to improve after course. We’re in it together
What determines ocd therapy success? Willingness to tolerate discomfort
Group have now been put into pairs to work on their behavioural plans
The clients look apprehensive. No wonder. They are facing the unknown.
Sometimes there is nervous chatter, but not today.
They are pairing up with someone in the group to find out about that
person’s OCD, separating the obsessions & the compulsions
For all, it’s the first time they are face to face with another
sufferer. I can see them listening, putting themselves in another’s shoes
They have been painfully honest about their commitment to doing the
course/managing OCD. The range is from 60-150% committed.
When they come back they are going to having a first try at setting each
other tasks to challenge their OCD. Wonder how tough they will be?
Pairs are back in session. They’re reporting on each other’s ocd
manifestations. India’s asking for more detail 2 get to the ultimate core fears
Clients 1 & 2 are working together and both have Harming-others-ocd
In new location now ready to start again after a break
Client 1&2 going to set each other behavioural tasks based on each other’s
ocd. Manageable tasks – nothing too scary today
Relationship-ocd is coming up a lot today
Really proud of everyone. All clients are being really open about their
Second pairing – client 3 & 4. Types of ocd addressed:
Responsibility-ocd; Contamination-ocd; Pure-O
India is really pleased with everyone’s work
India’s giving everyone phrases which will upset their ocd and trigger
anxieties. she is testing peoples boundaries
People are getting anxious now, as India continues to push their
boundaries by using words connected to their ocd worries
Moving on from words, we are now seeing how images effect the clients
Home time! Great day! We’ve been told to wear comfy shoes tomorrow…?
Hmmmm…. See y’all tomorrow morning
We want to increase transparency and demystify the therapy provided at the ocdcentre. Starting this Friday, join us on our Blog, Twitter and Facebook for Day 1, 2 and 3 of the monthly ocdcentre Intensive (5 day intensive therapy programme), as we will be regularly sharing with you snippets of what goes on.
Having just published nutrition recommendations for our intensive clients attending the January Intensive Course, I thought others would be interested in hearing about these too. Below are our recommendations exactly as we make them to clients. We make these suggestions two weeks before our clients embark upon the Intensive Course. In all cases, these are recommendations and should not be followed without consulting your own health care practitioner.
Food: Our most helpful advice regarding food is to base your regular diet on the Glycemic Index. Have a read about this here. Essentially you want to be cutting down on highly refined carbohydrates (sugar, white flour, etc) and concentrating on smaller, more frequent meals that don’t send your sugar levels rocketing. It’s not a fashion diet, it’s common sense, scientific advice based upon your body’s chemistry and also, a foundation for anyone who is a diabetic. Please note that we need to be informed if your BMI (body mass index) is lower than 17. This is due to the fact that this is generally accepted as the cut off rate for the point at which it is difficult for your brain to make the cognitive changes required. We may need to liaise with your doctor regarding your suitability for the course.
Drink: Please try to steer away from caffeine in coffee and tea. Be aware of hidden caffeine in soda and energy drinks. Getting any alcoholic intake down to a minimum is also ideal. Sugary drinks fall into the previous category of high glycemic foods and hence milkshakes, coca cola, ribena, etc. are all culprits.
Supplements: Although this area is gaining momentum, it is still an under-researched area whereby the best advice seems to be word of mouth. The pharmaceutical companies aren’t too happy about natural supplements, for obviously commercial reasons, so it’s pretty much up to people like us to forge the way ahead. Please do seek advice if you are concerned in any way or currently taking medication for OCD or another condition. Also we encourage you to do your own research on the internet etc. so that you can form your own opinions regarding risks and efficacy. However, in our experience and based upon client feedback, we have found the following supplements to be helpful with OCD.
1. Omega 3 and 6 oils. No surprise here. I think the best form for these is Flax Seed Oil which bypasses the fishy aftertaste from fish oil derivatives. Benefits of flax can be read here. The best flax oils are the ones found in a fridge in your health food store. This means they are fresh. Failing this, freshly ground flax seeds are just as good and can be mixed into joghurt, smoothies or food. At the moment I’m using Chia Seeds in everything and they have similar properties and great fibre.
2. Vitamins B12 and B6. Following the amazing findings regarding B12 and 6 and Alzheimers, there is no doubt that these are crucial supplements for the brain. High levels seem to be free of side effects. I tend to prefer the B12 Sublingual drops which you put under the tongue. These offer a very high dose of both crucial B vits.
3. Evening Primrose or Star Flower Oil. This is great for our female clients. Seems to have a very calming, regulating effect. There seem to be great sources of these in most UK heath food shops.
4. Phosphetidyl Serine/Holy Basil. These work in a slightly different way to help anxiety. They carry out the same function of basically lowering your levels of cortisol which may have reached toxic levels if you have been anxious for a period of time. Cortisol can have a nasty impact on your mood and mental health in general. It has gained press due to weigh loss products since it directly targets the “executive stomach” that middle aged executives tend to get in response to stress, i.e., when we are stressed, cortisol encourages a particular stomach weight gain. But we aren’t interested in these properties, we are more interested in its benefits for anxiety in general. Most cognition focused mixed supplements now include PS. Some yoga retreats insist that their stressed attendees take Holy Basil for at least two weeks prior to the retreat since they say that it brings balance back to your focus and attention.
5. Passiflora. A nice, traditional and time tested antidote to anxiety without drowsiness. It does seem to work for most people. Available as NatraCalm in Boots.
6. Nootropics. Also known as Smart Drugs. This is really state of the art stuff!! An area which is very new in nutritional terms but seems very promising as an alternative to SSRI’s. They are difficult to obtain here in the US so I imagine they are near impossible to find in the UK. Nevertheless, have a look at the research. I have tried Centrophenoxine and Picamillon since I prefer to be a guinea pig, rather than my clients. I have to say that I did feel more alert and focused but then again, as a subject, I don’t tend to be as anxious or depressed (these days) as my poor clients who may feel an altogether more dramatic response. It’s a very interesting area for the future however. Some online suppliers do seem to ship to the UK.
7. Minerals. Don’t also discount the role of minerals in mental health. Magnesium is often cited as important, as is iron and selenium. There is a good article regarding minerals and other supplements here.
On a final note, I had a conversation with a carer who was concerned about the inability their OCD family member to digest food right now given high levels of anxiety. We came to the conclusion that a morning smoothie might be the answer. It is a great option and can take care of the day’s nutritional needs in one delicious serving which is easy to digest and palatable. I suggested a base of cold or iced soya milk or low fat diary milk with berries, preferably blueberries, but raspberries and strawberries work well too (frozen or fresh). Then add a tablespoon of flax oil or some freshly ground flax seeds (or Chia seeds) and either walnuts or almonds for brain benefits. I’m imagining that any of the above supplements could be added without problems.
Good luck and any comments or suggestions are greatly appreciated.
OK, this is your life and your future. It is also likely to be your money, your time and your hard work . In that case, try and ensure that you pick a therapist who is going to give you a strong chance of making the changes you want to make and achieving the goals you have set.
Here are some guidelines for choosing a therapist;
- Check their credentials. In the UK you are checking for a Diploma, Advanced Diploma, degree, masters or PhD in a cognitive behavioural approach. In the United States, a Masters or PhD is generally considered a minimum requirement.
- There are no OCD-specific qualifications, they will be psychotherapeutic approach specific. In our experience of OCD we only advocate Rational Emotive Behaviour Therapy, Mindfulness, Acceptance and Commitment Therapy and Cognitive Behaviour Therapy* or a combination of two or more of these
- Ask your therapist which approaches they are going to use in your treatment. If you are confused by the answer, ask them to be specific and clear
- Ask what tools they are using to assess your OCD and can they inform you of the diagnosis/results
- Ask how many people your therapist has treated with OCD. Are they a specialist in the OCD field? This is not confidential information and you are entitled to ask.
- Look them up on the internet. Are they part of an OCD community? Have they written articles? Are they affiliated with OCD charities or professional bodies?
- Ask if they have any testimonials? Are there reviews of their work on the internet?
- If your therapist tells you they can cure OCD, they are not the right therapist. Period.
- OCD is a chronic condition, however, the treatment should not be open-ended. Ask your therapist for a projected treatment timescale (100% accuracy is not realistic and more complicated issues may occur but you should be informed of this development at the time)
- Our guidelines for initial crisis management of OCD are 8-10 sessions for mild OCD, 10-15 for moderate OCD and 15+ for acute cases.
- Following initial crisis management, ask the therapist what follow-up programme they have in place? There should be a specific, structured follow up that you can both understand and see the potential for benefit. E.g. we have a 9 week and 10 month follow up programme depending upon individuals
What to look out for when you are in therapy (for OCD);
- What supporting materials and information sheets do they offer? OCD treatment is a learning and tools-based approach. The core work is done in the time between sessions when you practice the skills you have learnt. Supporting materials are helpful and can cover gaps for those parts of the session that you don’t remember (a client typically absorbs only 15% of any session).
- Sessions should be a combination of reviewing homework set the previous session, discussing progress, discussing coping skills and setting new homework
- Check that your therapist is practicing cognitive behavioural and acceptance-based approaches if you find that your sessions focus heavily on your history, general chit chat about how your week has been or in convincing you that your OCD fears won’t happen
- Expect to see progress! Yes, that’s right. Not in terms which cannot be measured, e.g., being happy, but in terms of achieving realistic, achievable, measurable goals, e.g., reducing compulsions to a discussed level, returning to work, showering for just 10 minutes, once a day, driving to work alone, etc. etc.
- OCD is a chronic, lifespan condition. Is there a structured follow up plan? One that is convenient for you?
- Does the therapist offer flexible formats? Some people with OCD have issues around their immediate environment. Is the therapist prepared to work in your environment, assuming it is safe for them to do so? Some people with OCD cannot leave their homes. Is the therapist prepared to offer telephone sessions, at least in the beginning so that the client can work towards getting out of the house?
- How much emphasis does the therapist place upon setting guidelines for your family, friends or carers? Do they realize that collusion can play a highly significant part in your recovery? Do they have facilities or offer treatment (with therapists other than themselves) for the people around you?
- Is the therapist prepared to be “hands on”? OCD commonly manifests as severely dysfunctional behaviour patterns. Is the therapist prepared to show you what to do, do it with you? Are they prepared to leave their office and show you how to help yourself in the situations which cause you problems?
*we fully support the scientific evidence behind the behavioural component of CBT but make sure that your therapist also knows how to work on your cognitions (thought processes) too.
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)
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
If you would like to take the OCDCentre assessment, click here.
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……..
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…………..?