Coping with Obsessive-Compulsive Disorder

A Step-by-Step Guide Using the Latest CBT Techniques

Jan Van Niekerk

• Publisher: Oneworld Publications
• Year: 2009
• eBook ISBN: 9781780740935
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Change your life with the very latest in CBT Obsessive Compulsive Disorder (OCD) is a condition that affects millions of people worldwide, afflicting its sufferers with obsessive thoughts and fears, and enslaving them to compulsive behaviours with which they strive to cope. Cognitive Behavioural Therapy has been clinically proven to be one of the most effective therapeutic treatments for OCD sufferers, and here clinical psychologist Jan van Niekerk draws on the latest research to offer a practical, stepby-
step approach to coping with the condition. This positive self-help guide helps readers understand OCD and the various treatment options available to them, and uses real-life examples, easy-to-use tools, and practical strategies to enable them to reclaim their lives. The Coping With Series Other titles in this highly regarded series of accessible guides for sufferers of common mental disorders address fears and phobias, anxiety and depression in children, bipolar disorder, and schizophrenia.

PART ONE

BACKGROUND

1

Do I suffer from OCD?

Types of obsessions and compulsions

The definitive symptoms of obsessive-compulsive disorder (OCD) are obsessions and compulsions, but what do these words mean? Let’s first consider what is meant by ‘obsession’.

The question is complicated by the ordinary use of the word; for example, if someone spends a lot of time gardening, or watching football, their friends may say that they are obsessed with gardening or football. However, mental health professionals use the term differently. Psychologists define obsessions as repetitive thoughts, images, or impulses that pester you and that you try to ignore or suppress or try to get rid of in some other way.

Usually people with OCD consider their obsessions to be irrational, and they may feel embarrassed or ashamed about having them but find it exceedingly difficult to ignore them because of the anxiety or other negative feelings they may cause. Obsessions can have many different themes, and the following will give you some idea of the range of obsessions experienced in OCD (this list is not exhaustive). Ask yourself which of these may apply to you and bear in mind that the experience of a number of different obsessions is common:

• Fears that you have been contaminated with dirt, germs, bodily secretions, chemicals, or other dangerous materials.

• Fears that you have not locked, closed or turned off something properly (such as your front door or the taps), or that you have left an electrical appliance switched on (e.g. the oven).

• Being very concerned about things being in order or symmetrical or ‘just right’ (such as that the rug should lie perfectly symmetrically, or an activity should be done exactly according to a set routine).

• Having unwanted thoughts about sexual activity, for example, being a paedophile, or having intercourse with a relative or a religious figure.

• Having thoughts which make it difficult to throw away useless or worn-out items and having strong urges to collect unnecessary or trivial items.

• Having unwanted violent or aggressive thoughts, such as stabbing a vulnerable person.

On the other hand, compulsions are repetitive acts that you feel compelled to perform. They are aimed at making the situation safe or setting things right and occur in response to obsessions. A compulsion may be behavioural (another person can see you doing it) or mental (you do it in your mind). The urge to perform a compulsion is usually overbearingly strong, and very difficult to resist. The term ‘ritual’ is sometimes used as a synonym for ‘compulsion’ and will be used from this point onwards. The following are examples of common compulsions or rituals – think of which of these may apply to you:

• Checking, for example, whether the door is locked or the gas heating turned off.

• Washing and cleaning, for example, scrubbing your hands or cleaning the house.

• Repeating your actions, for example, walking through a doorway twice.

• Quietly saying a prayer or thinking a special word (an example of a mental ritual).

• Carefully thinking thoughts that ‘undo’ bad or wrong thoughts (a mental ritual).

• Arranging items symmetrically or in an exact order.

• Buying or failing to throw away unnecessary or useless items.

• Counting objects or steps in an activity, sometimes to avoid unlucky numbers.

Who gets obsessions and compulsions?

The answer to this question must seem obvious – people with OCD! But, hang on, it’s not that simple. For many years it was thought that the experience of obsessions and rituals was limited to people suffering from OCD. However, we now know that this is not the case. In fact, recent studies have shown that experiences similar to the obsessions and rituals in OCD, but less intense and disruptive, may be relatively commonplace. For example, one study (Rachman and De Silva, 1978) found in a group of 124 students and health professionals, that 99 reported that they had experienced intrusive, unacceptable thoughts and impulses – this translates into almost 80% of the group! A group of 40 was questioned closely about the nature of the intrusive thoughts they experienced, of which some examples are provided in table 1 below. Consider which of these you may have experienced.

Similarly, in a group of 150 university students and employees, 82 (55%) reported that they performed ritualistic actions. In the group of 82, 27% reported checking, 16% reported washing, cleaning and ordering, 6% reported avoiding particular objects, and 51% reported performing ‘magical’ protective acts (Muris et al., 1997).

Table 1 Examples of intrusive thoughts experienced by people without OCD

Jumping onto the rails when the tube train is approaching

Saying something nasty and damning to someone

Acts of violence in sex

Something being wrong with her health

Doing something, e.g. shouting or throwing things, to disrupt the peace in a gathering

Harm befalling her children, especially accidents

That the probability of an air-accident to herself would be minimized if a relative had such an accident

An accident, especially a car accident, happening to a loved one

Buying unwanted things

That she, her husband and baby (due) would be greatly harmed because of exposure to asbestos, with conviction that there are tiny asbestos dust particles in the house

Harming, or being violent towards, children – especially smaller ones

Crashing a car when driving

Walking along a crowded passage and suddenly discovering that he is naked

Pushing people away when in a queue

‘Unnatural’ sexual acts

Wishing that someone close to her was hurt or harmed

Doing something dramatic like trying to rob a bank

Diagnosis of OCD

How do mental health professionals decide whether you have OCD? This is no straightforward matter. As we have seen most people will intermittently have odd, disturbing or unusual thoughts or act in an eccentric or ritualized way. So, when considering the obsessions and rituals you describe to them, professionals face the difficult task of deciding when the problem warrants diagnosis and treatment.

Their way of solving this dilemma is to consider the extent of your obsessions and rituals, how much they interfere with your life, and how upsetting they are to you. In the study described above (Muris et al., 1997), people with OCD found that their obsessions lasted longer than normal intrusive thoughts, and were more discomfiting, intense and frequent. Similarly, OCD rituals were more frequent and intense, were met by more resistance and discomfort, and were more often carried out in response to being upset, than normal rituals. Therefore you are likely to have OCD if these problems leave you feeling helpless and upset, and present an obstacle to getting on with doing the things you want to do. OCD sufferers find that the condition gains a foothold in their lives and increasingly demands more time and effort. You may sense that the OCD is slowly wresting control away from you.

Distinguishing OCD from related conditions

As we have seen, the diagnosis of OCD is not always straightforward. To clarify this further, I will next consider a few conditions that share features with OCD. Before starting treatment it is important to establish which diagnosis best explains your current difficulties. Sometimes a single diagnosis may be sufficient, but it is also possible that certain conditions co-exist. For instance, OCD and depression frequently go hand in hand.

Generalized anxiety disorder and depression

People afflicted with generalized anxiety disorder (GAD) worry disproportionately and anxiously about a wide range of issues for at least six months. On the other hand, the hallmark of a clinical depressive episode (Churchill’s ‘black dog’), is persistently feeling low and losing interest or not enjoying your usual activities. Typically, any number of the following symptoms add insult to injury in depression: reduced or increased appetite, weight loss or weight gain, difficulty sleeping or wanting to sleep all the time (insomnia or hypersomnia), restlessness or feeling slowed down, tiredness, feeling worthless or guilty, difficulty concentrating or indecisiveness and having frequent thoughts about death or even suicide. Sometimes depression may make it more likely that your OCD symptoms will flare up, and sometimes you may start feeling depressed when you notice how much the OCD has encroached on your life.

Persistent and sometimes intrusive worry thoughts can occur both in depression and GAD. However, the worrying thoughts tend to concern real-life problems, usually with the aim of trying to find a solution or helping to prepare for what can go wrong, or they may simply involve ruminating at length about what is already wrong. In OCD, the person tends to experience obsessions as intrusive and inappropriate. They usually try to resist the thoughts in some way, such as to ignore or suppress them. Or they cope with them in some other way such as by neutralizing them or performing rituals to reassure themselves. However, contrary to GAD or depression, these rituals or neutralizing acts are clearly excessive or extreme and need to be performed in a repetitive way and are not realistically connected with what they aim to prevent.

Health anxiety

People with health anxiety experience repetitive thoughts about having a physical disease based on the misinterpretation of sensations or perceived changes in their body as being evidence of a serious but yet unidentified medical problem. They frequently try to reassure themselves by checking their bodies or asking others, including their GP, for reassurance. However, usually their fears persist despite reassurance that nothing is wrong, or any benefit from reassurance is short-lived until their fears are triggered again. Health anxiety shares a number of features with OCD; for example, frequently there is ‘obsessive rumination’ about illness and repetitive behaviours (e.g. checking one’s body) as an attempt to reduce anxiety. Also, people tend not to be convinced by reassurance. However, the scope of obsessions in OCD tends to be much broader than just concerns about physical illness, and in OCD with germ contamination fears, the concern is about getting an illness, while in health anxiety the concern tends to be about having an illness.

Obsessive-compulsive personality disorder (OCPD)

The word ‘personality’ refers to enduring tendencies (or traits) in how a person responds in a variety of situations and in their style of relating to other people, and it tends to remain relatively stable from their mid-20s onwards. For example, some people may tend to be extroverted (vivacious and socially outgoing) and others may tend to be introverted (more quiet and don’t socialize as easily). In the case of personality disorders, a set of personality characteristics cause an excess of stress or disruption in a person’s life, and their ability to relate to others may frequently be compromised.

According to a widely used diagnostic system, people with obsessive-compulsive personality disorder (OCPD) are characterized by a preoccupation with orderliness, perfectionism and attempts at controlling their environment, as part of a pattern that starts in early adulthood. They think rigidly in black and white terms, and expect others to do things according to their rules. They may frequently be overconscientious and live their lives in a highly organized way to the point of ‘not seeing the wood for the trees’ and, rather than being a means to an end, sticking to the rules and being organized become an end in itself. They tend to control their emotions and behaviour, and others often experience them as somewhat cold and aloof. They prefer routine and predictability, and spurn spontane...

Table of contents

• Cover
• Title page
• Copyright page
• Contents
• Series Foreword
• Foreword
• Acknowledgements
• Introduction: Is this book for me?
• PART ONE: BACKGROUND
• 1 Do I suffer from OCD?
• 2 What causes OCD and maintains it?
• PART TWO: HELPING YOURSELF
• 3 Meet eight people with OCD
• 4 Preparing for self-help
• A. COGNITIVE TRACK
• 5 Tackling the obsessional doubt
• 6 Tackling your thinking about what would happen if the doubt were true and you didn’t do the ritual
• 7 Facing the situation without performing the ritual
• B. BEHAVIOURAL TRACK
• 8 Exposure and response prevention therapy
• PART THREE: STAYING WELL
• 9 Using a holistic approach
• 10 Taking stock and staying well
• Appendix 1. General resources
• Appendix 2. Thought recording form
• Appendix 3. Cognitive track worksheets
• Appendix 4. Behavioural track worksheets
• Appendix 5. Relaxation methods
• References
• Index