Are you sure? Unlocking OCD

Everyone experiences intrusive or unwanted thoughts e.g. “Did I lock the front door?”, “That glass didn’t look clean, perhaps there are germs on it” or even: “I could easily jump out in front of this car/off this bridge”.

It is the way we react to such thoughts that determines whether or not we might have a problem with OCD (Obsessive Compulsive Disorder). Most people are able to quickly dismiss the thought; it passes through their mind and they get on with their day. People with OCD attribute meaning to the thought and can’t let it go. They get stuck in a vicious circle of obsessions and compulsive rituals. For example, “did I lock the front door?” becomes “maybe I left it open…someone might burgle the house…It would be my fault …I would feel awful/responsible. I won’t be able to concentrate on my work unless I go back and check.” Such thoughts are often accompanied by severe anxiety and discomfort that originates in the primitive, danger-sensing part of our brain. This part of our brain struggles to understand logic and reason. You will feel that the only way to be sure, and to relieve the awful anxiety, is to go back and check. However, this action only reinforces the sense of danger; your mind flags up the door as something to worry about, because you’ve taken action in response to the intrusive thought. What’s more, the relief from anxiety is only temporary. The more you check the door the less you trust your instincts, the more you doubt whether you really locked it and the more anxious you feel next time. The vicious circle of OCD is established.

So, how to respond once in this vicious circle? There are three options:

1. Follow the compulsive urge to maximise certainty and relieve anxiety. Examples include behaviours such as excessive checking or cleaning, avoidance (e.g. throwing away sharp utensils for fear of harming someone), reassurance seeking from others (e.g. did I lock the door?), asking people to repeat or clarify things, or mental rituals such as counting or saying a particular phrase, often to prevent ‘something bad happening’. Often the compulsive behaviour or mental ritual has nothing to do with the danger one is trying to prevent e.g. avoiding stepping on cracks on the pavement to prevent something bad happening to one’s mother. The problem is that if you give the OCD an inch, it will take a mile. You will be stuck in a vicious circle of increasing anxiety and debilitation. So, to escape this trap, I really recommend a zero tolerance approach. Here are two options for that:

2. Don’t act on the compulsive urge. Make space in your mind for uncertainty, doubt and unresolved ‘loose ends’ and sit with the fear. Allow the anxiety to be there. Therapy can help you to develop strategies to tolerate uncertainty and imperfection in your life. Your anxiety will reduce to a manageable level. This IS achievable.

3. Do the opposite of the compulsive urge. This is the quickest way to interrupt the vicious circle. For example, instead of washing your hands after seeing a stain on the sofa, deliberately touch the stain and don’t wash your hands. This option (which probably doesnt feel like an 'option'!) will likely feel terrifying and it can take enormous courage to face the ensuing fear and anxiety that such ‘risk-taking’ will cause. However, although perhaps hard for you to believe, it is amazing how quickly logic and confidence can replace suffocating anxiety and doubt if you react in this way.

I have worked with many clients with OCD and have a good understanding of this complex, but common, issue. If you suspect you may be struggling with OCD, or have a diagnosis, please feel free to contact me to discuss how I may be able to help you. OCD Action have compiled a useful checklist for what you should expect when receiving therapy for OCD, with which I fully comply: http://www.ocdaction.org.uk/support-info/have-i-had-cbt-my-ocd