Information For OCD sufferers...

OBSESSIVE COMPULSIVE DISORDER
Obsessions are recurrent thoughts which are distressing and disturbing and which intrude forcibly against conscious resistance. The person experiencing them usually realises that they are irrational (as distinct from the implicit belief that people have in their delusions), but finds that fighting them only increases the anxiety. The obsessions are often accompanied by a compulsive desire to behave in a particular way which is almost impossible to resist.

Obsessions are often made more upsetting because they are associated with things that you find shameful. Thus, a religious person may feel an urge to utter blasphemous words whilst in church or be preoccupied with what he regards as unwholesome sexual ideas.

A common obsession is fear of germs and preoccupation with cleanliness. People with this obsession feel they must wash every time they touch something that may not be scrupulously clean. The action may relieve anxiety about contamination. Sometimes, a you will feel compelled to change your clothes constantly in case they are contaminated. Compulsive washing may develop into a ritual where you have to wash and dry your hands a certain number of times in a particular way and are forced to start all over again if you feel that the ritual has not been carried out properly. You will often occupy an entire day washing your hands until they become chapped and sore. People with obsessive compulsive disorder usually have a combination of obsession and compulsion.

WHAT CAUSES OCD?
We all have mild obsessions, particularly as children. They may take the form of superstitions like not walking under ladders, throwing salt over the shoulder or stepping only on certain places in the road. They can be seen as primitive ways of warding off disaster. Similarly, you may feel a need to check that you have locked the front door, posted an important letter properly or feel you need to count a certain number of times before a particular event. Healthy people may have occasional intrusive thoughts, sometimes aggressive or sexual.

The difference between this normal behaviour and that of someone with obsessive compulsive disorder is one of degree: the intensity and distress of the intrusive thoughts; the difficulty of stopping them; the frequency with which they occur; the duration of the symptoms; and the effect on functioning.

People with what can be called a "perfectionist personality" seem to be more likely to develop obsessional disorders. Such individuals are very conscientious, fearful of any transgression against the social code and have very high ideals for themselves and others. It may be that, on a particular occasion, such people have not lived up to their own expectations of themselves or have had thoughts and feelings which have caused anxiety and which have then been transferred into obsessions or compulsions. On the other hand, a third of those with OCD have other types of personality, and people with perfectionist personality are more likely to suffer from depression than obsession.

Once started, compulsions are fuelled by the anxiety created if they cannot be carried out. A depressive illness may sometimes bring out obsessional preoccupations which have previously been under control.

HOW IS OCD TREATED
OCD affects 2 or 3 people in 100 at some time in their life. It is more or less equally shared between men and women. About two thirds of cases improve or are cured within a year. Those which have not cleared up during this time may continue for many years but with lengthy remissions. The disorder may go into remission, almost irrespective of treatment. Behavioural treatment can substantially improve compulsive rituals (hand washing, etc.) but are not so effective in controlling obsessional ruminations.

Many doctors favour treatment with the antidepressant clomipramine (Anafranil) a serotonin uptake inhibitor which is very effective but has unpleasant side effects which are unacceptable to many obsessional patients, who are preoccupied with symptoms. Newer drugs, such as paroxetinc (Seroxat), are equally effective, with fewer side effects.

Many OCD sufferers have an over-developed sense of responsibility, and feel it is up to them to keep everyone and everything ok. Of course this is an impossible task! No-one can be expected to do this. But if you put this upon yourself, then use rituals or compulsions to keep people safe from harm, you unwittingly increase the onus on you (as you see it) to protect these people, thereby taking on unnecessary responsibility. So not only have you got to keep everyone ok, but you have to count things x times, etc etc. This as you know becomes absolutely exhausting! But the terror of not doing it and the possibility of thereby causing some disaster keeps you stuck in a vicious circle of obsessive thoughts and compulsive actions.

Regarding treatment of compulsions, Cognitive Therapy and Behavioural Therapy are very effective but may take a long time.

As an example, this is what my psychologist asked me to do and it did work although it was very hard at first:

When you are worried you get anxious. When you get anxious your body enters the ‘fight or flight’ state, where your adrenalin increases, your heart rate increases, your breathing becomes faster and shallower, and basically nature is preparing you to deal with an unpleasant situation either by fighting or by fleeing. This is a primal instinct we all have. Anxiety also causes lots of unpleasant feelings such as sweating, nausea, stomach upset and tiredness. The thing is that this will not kill you. No matter how anxious you feel.

Anxiety levels will rise when we come into contact with a situation we don’t like, and for a time keep rising unless we remove ourselves from the situation. BUT they do not keep rising indefinitely. Anxiety levels will peak and level off and eventually reduce back to normal. During this time you may well feel pretty awful as your body copes with this.

So the thing that is most likely to trigger these feelings is if you are unable to ‘counteract’ your thoughts with actions to ‘prevent harm’. What you need to do is to NOT do the counting, checking, whatever it is, and walk out of the room.

You will feel awful and frightened and panicky, but this is just the anxiety and it will not last forever. The trick is to ride this out WITHOUT going back and doing the counting. Eventually the panic will ease. This is your first step to combating the compulsive behaviour. As you keep doing this, what happens is that with continuous exposure to a frightening situation, your body and mind become used to it and it loses its capacity to frighten you. It is just the same as if you worked all day on the fairground – soon the rides would stop being exciting to you. Also if you eat the same thing every day, it soon loses its appeal. Similarly if you confront your fear often enough the fear will vanish.

I know this may sound like an insurmountable task, but it is possible. There are two things that will help you.

1. Keep a diary of each compulsive behaviour pattern (eg, washing, counting, etc) and mark it off each time during the day that you do each behaviour. Keep this diary for a month and after that month look back and see how much the exposure therapy (the task I have suggested) has reduced your need to do the compulsive actions, It will also tell you if there are certain actions you find harder to resist than others. Also mark off the times you RESISTED doing the action, and see how pleased you feel!
2. Another tip is to start with the compulsions you find hardest to resist, as by combating these you will probably combat the less extreme ones as well.

The sufferer needs a lot of support to help them deal with this and that will only be achieved if they can help people to understand what is wrong with them. Many people are frightened of mental illness (ignorance causes their fear) and the best way to get their support is by teaching them what it wrong with you. Especially the fact that it is a neurological disorder (a chemical imbalance in the brain) and nothing more.