Mental health questions

“I thought OCD was just about constantly washing your hands or having to keep your desk tidy all the time.” Daniel sat in the chair across from me in my clinic, talking quietly, looking highly uncomfortable, eyes glancing nervously around the room. “I never knew it could ruin my life like this.”

Lots of people experience intrusive thoughts or worries, or find themselves preoccupied with tidiness and wanting things to be “just so”. While it’s common to hear this kind of behavior described as “acting a bit OCD”, genuine Obsessive Compulsive Disorder is far more severe than simply placing a high value on orderliness, and can have a far more damaging effect on your life.

Recognizing Obsessive Compulsive Disorder

Daniel initially came to me thinking he was losing his mind. For the past six months he had been experiencing recurring homosexual thoughts. As a straight man with a long term girlfriend he was terrified of anyone finding out about these uncontrollable thoughts that would pop into his head dozens of times each day.

These intrusive, uncontrollable thoughts or obsessions are the first part of OCD. This can be anything from fear of contamination to recurring worries about your safety to superstitions about order and routine. The second half of the condition is the thoughts and actions, or compulsions that the person does in order to remove or “scratch the itch” of the obsession. For Daniel this meant going through a mental list of times he had been attracted to women and not men in order to prove to himself that he was not gay. This is also where the ritualized hand washing, door checking and desk-ordering can come into play — the person with OCD feels that they have to perform certain actions to silence the constant stream of obsessive thoughts.

Managing OCD

Those who have struggled with OCD know that it’s no joke — the constant thoughts can be extremely distressing and the resulting compulsive actions can take up a huge amount of time and mental effort. For Daniel the constant dread of having his thoughts exposed and the worry that there was something deeply wrong with him meant that by the time he came to me he also needed treatment for depression.

For me the frustrating thing is that despite the severe suffering it can cause, OCD is such an easy condition to treat. If a few basic principles are understood there’s no reason you can’t learn to manage and reduce your OCD symptoms and rid yourself of a constant source of stress and worry. The most effective treatments for OCD are Cognitive Behavior Therapy. More specifically, the most effective treatments are a type of CBT called Exposure and Response Prevention (ERP).

These immediately actionable tips form the basis of all good OCD treatment.

  1. Accept That It’s Just an Illness

OCD isn’t a sign of something deeply wrong with you — it has nothing to do with repressed sexual urges or dark impulses or an “unclean spirit” or any other self-critical belief you may have about yourself because of it.

OCD is a medical condition, just like the flu or a broken leg. That’s all. You can examine its causes in terms of chemical imbalances in the brain or previous experiences if you like but the point is it’s just an illness. Thinking it’s anything more is incorrect, and will only increase the anxiety you feel about it.

  1. Challenge Thoughts

Once you understand that your condition is just a case of faulty mental links between thoughts and behavior, you can start to experiment with those thoughts a little. Try examining your belief about what will happen if you don’t do your compulsive actions and see if they really hold up to scrutiny.

Worried you’ll get sick or contaminated if you don’t wash your hands? Is that really a rational conclusion to draw? Do other people manage to stay healthy while washing their hands far less often than you? These kinds of questions will help you see that the link between your thoughts and the resulting actions is based on incorrect beliefs. In Daniels case this meant accepting that if he just let his intrusive thoughts about homosexually happen there would be absolutely no negative consequences at all. They’d just appear and then disappear, little switching a light on and off.

So every time you notice your obsessive thought, try to mentally question it, and slowly chip away at the belief that something terrible will happen if you don’t compulsively set it right.

  1. Delay Your Compulsion Until It’s a 5 Out of 10

A lot of the therapy you could go to for OCD revolves around Exposure and Response Prevention — exposing yourself to your obsessive thoughts without doing the corresponding compulsion in order to un-learn the link between them. There’s no reason you can’t apply this principle yourself.

One technique that I’ve seen a lot of success with is delaying your compulsive reaction until it reaches a 5 out of 10 intensity level. So when you feel the need to wash your hands or go through your mental checklist, wait until the need to do it has increased to a significant, but not unbearable, level. That way you’re slowly training yourself to resist the urges without putting yourself under more strain than you can handle. In this way you should see the time it takes for you to reach a 5 out of 10 level increase and your need to perform your compulsions get less and less.

This “find a 5” technique sounds simple but is surprisingly effective in reducing compulsive behavior- I’ve seen clients go from washing their hands in excess of 250 times a day to only needing to a couple of times a day in the span of a few weeks of treatment. Daniel was able to reduce the frequency of his unwanted thoughts down from several dozen times per day to under ten after just a week of delaying the compulsion in this way.

  1. Don’t Hate Yourself for It

The most damaging part of OCD isn’t always the thoughts and the compulsions themselves — often it’s the resulting feelings of shame and embarrassment that come from having “given in” to your compulsions.

It can be hard to learn to let go of this mentality, but it will really help in reducing the effect of OCD on your life. Instead of analyzing and criticizing your thoughts and tearing yourself up over them, just let them happen and move on. For Daniel the rather personal nature of his obsessive thoughts was a real source of anguish. But by learning not to hate himself for experiencing these thoughts, they went from being a source of real pain and fear to simply being something of a nuisance.

  1. Look After Yourself

Finally, it’s important to look at your life holistically to see if there are any areas that anxiety can be working its way into your thinking. Stress and worry can increase the severity of OCD as well as causing all kinds of health problems, so learning to take good care of yourself is a fundamental part of any treatment. Some basic tips include:

  • Get enough sleep
  • Eat properly
  • Cut down on excessive caffeine and alcohol
  • Make time for fun and relaxation
  • Talk about worries with trusted friends or loved ones
  • Exercise regularly

Conclusion

OCD can take all kinds of forms, but the key principles in managing it remain the same. Start questioning the beliefs your cycle of thoughts and actions is based on, and at the same time work on breaking the cycle by extending the time between the thought and the action.

When Daniel came to me the idea that, he was suffering from a simple, treatable condition like OCD was unthinkable, but after a few short weeks of treatment his symptoms had all but vanished and his mood and life were back on track. OCD shouldn’t be able to ruin your life, so follow these simple steps to put your intrusive thoughts back in their place.