Obsessive Compulsive Disorder (OCD) is a term that we frequently throw around when referring to our messy homes or unorganised files. Unfortunately, pathological OCD is far more intrusive than we typically experience in everyday life.
According to the World Health Organisation (WHO), OCD is categorised as one of the most commonly diagnosed psychiatric mental illnesses in the world behind phobias and substance abuse. It can present in many ways but the underlying communality across individuals is the cycle that it follows to create obsessive and compulsive behaviours. As seen in the image below, the OCD cycle follows a very strict process which starts by triggering a false alarm in our reptilian brain (e.g., amygdala) which is responsible for responding to threat. These brain regions were critical in our development as a species to respond to incoming attacks from lions and cheetahs, however they are not required for this reason anymore. OCD is a very clever intruder who sets off these false alarms, triggering an obsession and tells the individual "you have to follow a very specific set of rules before the alarms are turned off" resulting in a compulsion.
Obsessions present initially as an intrusive thought. Some of us may have experienced this when we hold an item out of a window and think to ourselves "I could drop this" but our brain tells us that there is no benefit of this and we refrain. When OCD is present, this restraint is not present and we are convinced that by holding any item out of any window will result in me dropping it intentionally, both right now and at any point in the future. In these circumstances where we feel these alarm bells ringing, a compulsion or ritual is started to stop OCD from taking full control.
A compulsion is something that OCD tells us to do in order to avoid bad things happening (in this case, dropping that item out of the window). A compulsion or ritual will occur to produce an immediate sense of relief and reassurance that we dont have to drop the item out of the window. A compulsion can present as a series of words, patterned behaviours or "checking" with ones self and others that they aren't capable of doing what OCD is telling them.
Breaking the OCD Cycle
The false-alarm that was set off by OCD was just as powerful as if we were being attacked by a wild animal or were in immediate threat. This will cause a genuine sense of fear for that situation in which the alarm was triggered. From here, a client with OCD will avoid that situation at all costs. As we have learnt in previous blogs, avoidance only causes pain to resurge and continue to exist. In the case of OCD this is experienced tenfold.
OCD is best described as a separate entity that lives in ones own mind. During treatment, it is incredibly important that you draw a clear line between the client and OCD to make it as if OCD is an intruder in your mind instead of a part of you. You have to first find a point in the OCD cycle to target as a weak point to "break" the cyclical behaviour. Normally, this is done at the point of reassurance seeking. If the client approaches a family member or their own thoughts for reassurance that they weren't at danger of dropping that item out of the window, this is the point where they should sit in their discomfort until they realise that they are not in any immediate danger. Practise grounding techniques such as recognising sounds and smells in the air, recognise the breath at the base of your nose as it enters and exits.
You are stronger than your OCD and if you are able to break the cycle, you will soon see that what set off your alarms previously, no longer affects you.
If you are interested in discussing any of the points further, we would be more than happy to hear from you. Feel free to send an email to email@example.com and we will answer any questions you may have.