What OCD really looks like – Harm OCD

A mum, deeply in love with her newborn baby stands at the top of the stairs holding him close in her arms and suddenly has an image of her throwing him to his death. She becomes tearful, feels guilty and horrified and quickly hands him over to her partner before telling herself ‘I love him’ over and over again. She then spends hours filled with shame and doubt, wondering how she could have such an image and avoids her son for the rest of the afternoon.

A shop assistant is in a constant state of anxiety after watching a documentary about sex offenders because they fear they may be attracted to the young children that queue at their checkout. This idea horrifies them and leads to images and thoughts of being alone, an outcast from society. As a child comes into view they try not to look at them, monitor their body for arousal and search their memories to try and figure out whether or not they are a paedophile. They feel such shame they dare not tell anyone about this fear and consider quitting their job.

A city worker is driving home down a quiet country road at 11pm on the final stage of their commute and has a sudden thought they may have knocked someone over. They look in their rear wing mirror and cannot see anything so drive on. However that night as they lie in bed, they are haunted by thoughts they could have killed someone, did they feel a bump or was it a pothole? They drive back to check the road at 3am and find nothing, but continue in a high state of anxiety to read news reports the next day, and into the following week to see if anyone was involved in an accident that night.

The above is the reality of OCD. A disorder that is estimated to affect between 1-3% of the population at some point in their lives, and this is likely to be under-reported due to the shame and guilt many sufferers experience.

When we hear these three letters we have been socialised to think of it as an adjective used to describe those liking order, or cleanliness. That’s the story the media portrays for easy clicks and programmes around cleaning. However, many people with OCD suffer in silence due to these ego-dystonic obsessions; thoughts, images, urges and sensations that are the complete opposite of what they would wish, around highly stigmatised topics. It is exactly because the person finds their obsessions so horrifying, that they have such an impact. Those with OCD then feel an inflated sense of responsibility for preventing anything bad happening, and a need to be absolutely sure whether their obsession means anything; OCD is often referred to as the ‘doubting disease’.

The efforts those with OCD then make to try and be certain or prevent bad things from happening then become part of the problem, and these are known as compulsions. They lure the sufferer in by reducing anxiety in the short-term, but actually serve to worsen it in the long run as they become more and more addictive and make them less tolerant of uncertainty. Common compulsions include:

-Avoidance - if we avoid a feared situation then nothing bad can happen.

-Rumination - thinking about something over and over again to try and find an answer.

-Mental argument and review - trying to convince ourselves the feared thing won’t happen, or searching through memories to try and remember whether we did something in the past.

-Reassurance seeking - unhelpful self-talk that tries to tell us things will be alright, 'testing' ourselves to see what happens, or checking with loved ones that we are a good person.

*Crucially, well intentioned loved ones, or even therapists, can end up feeding the OCD through offering reassurance or trying to help 'challenge' the OCD obsession.

The problem with the compulsions is they end up giving the obsessions too much significance; by avoiding situations we never give ourselves a chance to find out what happens, and this maintains our fear and doubt. By spending a long time trying to work something out we are telling our brain the threat may be real or important – the same goes for re-assurance which only ever provides temporary relief. If obsessions are just mental junk, they don’t deserve our time or attention and certainly don’t warrant avoidance of things we'd normally be doing.

We know that 90% of the population report intrusive thoughts/images of some nature, many may relate to standing waiting for a train at the station, and as it pulls up thinking about what it would be like to step out. However, the vast majority of us are able to not pay too much attention to these intrusions, or see them for what they are, random mental junk that may feel momentarily strange but does not deserve our attention. However, those with OCD read significance into their obsessions, they think they may mean something and feel compelled to understand whether the threat is real.

To understand OCD we need to understand anxiety. This universal human emotion stems from our ‘fight’ or ‘flight’ response. This is our inbuilt survival mechanism that evolved to keep us safe from danger: those early humans that could run or fight survived and thus this alarm system was hardwired into us. Crudely it is located in our ‘old brain’ and we can all relate to the physical symptoms such as a fast beating heart or butterflies that signify our body preparing us for action, when we are confronted with more ‘modern' perceived dangers such as waiting for a job interview or being about to take an exam.

However, when it comes to OCD it is our interpretation of these intrusions themselves that sets off a ‘false’ alarm. This is the double edged sword of our human ‘new’ brain. We have an amazing ability to plan and create that separates us from animals, but we also have the capacity to bring about much unecessary suffering through simply imagining threats (if you don’t believe me just try vividly imagining sucking on a juicy sour lemon). This sense of urgency and alarm can then trick someone with OCD into thinking the danger is real, what we call emotional reasoning (if it feels dangerous, it must be dangerous), and this results in them engaging in compulsions such as those listed above to reduce anxiety or adopting a ‘better safe than sorry’ mentality. The sufferer then gets stuck in a vicious cycle that ends up growing and growing. In this sense OCD can be a highly disabling condition – at its worst someone with OCD may think the only way they can be sure they do no harm is to stay inside and do nothing trying to figure out whether they really are a danger to others or have done some past terrible act.

OCD has a habit of taking a subject someone cares about most and turning it against them and this is what makes it so cruel. It can also hop from one topic to another - causing harm, going crazy, past moral transgressions or doubting one's sexuality or relationship are just a few of its many guises. The stigma of the topics of the obsessions often prevent people from seeking support, or even knowing what it is they are going through. Therefore the first, and perhaps most important stage, is increasing understanding and awareness of the condition to empower people to come forwards and seek support. Those who do so exhibit amazing courage in trying to seek help for a problem that has often been with them since their teenage years.

If you, a relative or friend suffer from OCD or have recognised any of the themes within this blog, please get in touch for a free 15 minute consultation.

My next blog will talk more about treatments to help break the cycle of OCD.

Dr Doug Hobson is a Clinical Psychologist working in the NHS and private practice