What is OCD?
I have had Obsessive Compulsive Disorder (OCD) since I was 16. OCD is a disorder where a person has intrusive thoughts that cause fear which are then countered by compulsions (physical or mental). However, because the compulsions tell the brain that the obsession is important, it keeps the vicious cycle going and evidence shows that these neural pathways become strengthened.
The cause of OCD is not known; however, in my opinion it is likely multi-faceted including; genetic, personality traits, environmental factors and possibly physical influences (for example, studies have documented the onset of sudden OCD in children with strep throat infection). In my opinion, the most important point when differentiating OCD from general behaviours or quirks is that OCD is not an adjective for certain actions; if you are using it as an adjective then you are using it incorrectly. For example, someone who cleans a lot or likes an ordered desk is not OCD. The process behind the behaviours is where the disorder lies, and at its root this is a disorder of doubt and uncertainty. OCD, from a biological perspective, is the brain’s inability to move on from a perceived risk, however remote. The brain demands the impossible, 100% certainty. The “good enough” feeling disappears and you are trapped into an endless cycle of ritual and avoidance. People with OCD are sometimes said to have “sticky” brains, where thoughts become stuck, unable to be processed like other people. Dr Jeffrey Schwartz coined the phrase “brain lock” and from experience this is exactly how it feels. In fact sometimes I have “felt” the obsession physically lock into my brain and there was nothing I could do about it.
My OCD has presented itself in many different forms (or “themes”) over the years; some of the issues were just plain ridiculous (easy to say when you look back). However, my main obsessions have been blood contamination and religious OCD – these are the ones that have caused me the most distress. The truth about OCD however, is that ultimately the content is irrelevant – OCD obsessions can be about literally anything. Whilst treatment approaches are often tailored towards different themes, the process for recovery is essentially the same.
My Four Key Steps
OCD recovery is a long and hard path to follow, and the journey can be painful and lonely. These are some brief thoughts on what I have learned along the way:
Step 1: Acceptance
The first step is to acknowledge the problem. There is no point in wishing away the problems and challenges we face in life. Every human faces challenges in their life, whether that is mental, physical or spiritual. Too often we expect things to be easy, like there is some entitled position we can get to where pain doesn’t exist. This is an illusion. Suffering exists, that is axiomatic. It just so happens that one of my challenges is OCD. The concept of acceptance is a kind of spiritual realisation in itself, it doesn’t mean giving up and not taking action, quite the opposite – acceptance is taking action from a point of calm, and only from this point can we begin to heal.
Step 2: face uncertainty head on
Secondly, with OCD, the phrase ‘what you resist persists’ needs to become a mantra – you have to face the fear of uncertainty head on. Recovery from OCD is like an ultra-marathon, and if you start with particularly severe OCD, it’s like training for an ultra-marathon when you are extremely unfit and have spent many years eating junk food on the couch. With ultra-marathons the end distance can be anything beyond the traditional marathon distance of 26.2 miles. This is analogous to OCD because the end point is different for everyone. You will have a thousand setbacks, sometimes you might collapse with exhaustion. Some days you can’t move due to the pain. Often the terrain seems impossible to pass, and just as you come down a hill you see a mountain in front of you to climb. With OCD you need to be determined to keep pushing forward and understand that the road is long.
Step 3: Evidenced based therapy
To push forward on your OCD ultra-marathon, there are multiple evidenced based techniques that you can use to make yourself fitter and help you get to the end of your race. These techniques are the third step you must take, or you will almost certainly not get to the end. Cognitive Behavioural Therapy, Exposure Response Prevention and Acceptance Commitment Therapy are all evidenced based practices that can help you get to the end of the race. Medication can also help many; as can lifestyle choices such as diet, exercise and reducing or eliminating alcohol. Like in fitness, training packages are often tailored to the individual and professional help is often needed.
Step 4: ongoing commitment to recover
The fourth, and most important, step is making a strong commitment to manage this disorder. OCD is unforgiving and can stop you in your tracks very quickly, even after recovery. You can go from feeling great to crying on the bathroom floor before you know it. Taking recovery for granted is the worst mistake to make, especially when you feel well. Although OCD doesn’t define me, I do have to put ongoing strategies in place and partly base my life around ongoing recovery. This just isn’t a choice for me.
For most people OCD is chronic, even when you finish the ultra-marathon you will still have to run many shorter distances thereafter to keep up your fitness. Some days it might even feel like you are back under that mountain looking up in terror. For some people they recover fully and OCD disappears from their lives completely. I would argue this is the expectation rather than the rule, especially when it comes to severe OCD. So for most of us we have to manage the disorder, even when symptoms are “gone”.
Staying recovered takes ongoing discipline and sacrifice. For example, I take medication (certain side effects impact my life), I exercise regularly (I’ve found this has to be moderately intensive), I eat well (I track my foods), and I quit drinking alcohol (this was a tough one); I also have to sleep more than I would like which impacts my family. If I don’t do these things the potential relapse is much higher for me. Getting the right balance has taken a lot of trial and error over the years.
My obsessive thoughts still come back from time to time and at random points, especially when I am tired or stressed. Most of the time I can use therapeutic techniques to move on quickly from these, but sometimes they become stuck and I have to pull myself up from the ground and take further action. The last major OCD episode I had about blood contamination from toilet paper literally floored me. I picked my brother up from the airport, managed to drop him back to our parent’s, and then I lay in the spare room bed for hours in tears. I managed to make it downstairs at one point but the distress was so bad I collapsed onto the carpet and lay there watching the trees swaying in the wind through the window for another couple of hours. My wife picked me up as I was in no fit state to drive. I had to take a week off work and then engage in formal therapy. It took me two weeks to get back on my feet, and 2 months to get back to where I was at before the episode. The spike was almost certainly caused by being overly tired and stressed, and the OCD hit be full force. These are the stakes I live with when making choices in life – I actually fear getting tired.
Some words of encouragement
Whilst we cannot help or control obsessive thoughts, we can control our behaviours towards them. Easier said than done, but with practice (LOTS OF PRACTICE) it does get easier.
Importantly, and perhaps the most important part of all this, is that although OCD can be seriously debilitating, it doesn’t mean that you cannot have a fulfilling life and be successful. In fact, those with OCD are often some of the most intelligent, creative and caring people you will meet.
I have a family, a career, a masters degree in Sustainable Development (not entirely sure why), and most of the time I am happy (still get mild depression at times even without OCD). I have applied to do my PhD in social care (not bad for a high school drop out) and I am passionate about this blog and other OCD media involvement. The point is, if you feel OCD is dragging you down, do not lose hope. Keep fighting and find your own approach that works to get yourself better and stay better. You have worth, I promise you can get better with the right support.
Whilst it can be difficult to get the right OCD treatment professionally due to cost or access, there are many other useful resources out there such as books and websites. Jonathan Grayson’s Freedom from Obsessive Compulsive Disorder (book), and OCD Action (website) are a good place to start. There are lots of other great resources out there.
For me simply understanding what the problem was and getting a diagnosis was an important moment in and of itself. At least then I could start the race.
Thanks for reading. If you think you or someone you know might have OCD, this might be something you might want to explore with a doctor. Suffering in silence, or simply not knowing what OCD truly is, continues to be a major barrier for those who need help.