Cognitive behavioural therapy is a robust approach for treating a wealth of common mental health issues. Our latest 101 blog explores some of the key features of CBT and their application.
We all know that person who we consider to be “a little bit OCD” because they have a preference for neatness or are more germ-conscious than most. But obsessive-compulsive disorder - which causes significant distress for up to 4% of people globally - is possibly one of the most misunderstood of all common mental health problems.
OCD is not just about contamination or counting: it’s an anxiety disorder that’s underpinned by a fear of causing harm, either to oneself or others. It’s characterised by “obsessions” that provoke high anxiety, followed by “compulsions” which are designed to alleviate that anxiety.
OCD begins with a fundamental misinterpretation of an everyday human experience: intrusive thoughts. Almost every single one of us will experience intrusive thoughts and these are often very useful, for instance, suddenly remembering that you need to buy milk on the way home, or that it’s your friend’s birthday tomorrow. But they can also be bothersome. Many of us have had the experience of getting halfway to work and suddenly doubting whether we locked the front door, or having a random sexual thought pop into our mind during an important meeting.
Most of us can dismiss these thoughts as odd or even annoying and get back to what we were doing, but what differentiates people with OCD is the meaning they place upon them.
People who are prone to OCD tend to feel overly responsible for preventing harm, meaning they place extra importance on things being right and safe. So while many of us can quickly dismiss the doubt about having left the door open, or let go of that unwanted sexual thought, people with OCD will tell themselves that the thought carries important meaning, and will be driven to find a way to “neutralise” it, reduce their anxiety and prevent their worst fear from happening.
These “compulsions” might be observable, for instance, someone who has an intrusive thought about contamination might be compelled to vigorously wash their hands, while someone with an intrusive doubt about having locked the door might go back and check it. Compulsions can also be quite covert (or hidden), for instance, someone with an unwanted sexual thought might recite a silent prayer to make the thought go away, while someone with an image of harming their child might count to a certain number or perform an elaborate mental ritual to bring their anxiety levels back to baseline.
The exact nature of someone’s OCD is unique to that individual and often plays into the values that a person holds most dear.
For someone who has just moved into their own flat for the first time, OCD might tell them that they’ll leave the iron on and burn down the building. And for someone with a new baby, OCD might tell them that they’ll violently harm it. Because the worst-imagined outcome is often so devastating and the associated fear so strong, it can feel almost impossible to ignore the obsession and resist the ensuing compulsions. It’s easy to reason that spending a few seconds on a compulsion seems like a small price to pay to prevent something catastrophic.
But it’s also easy to see how these compulsions could escalate.
The act of performing a compulsion (even if that’s a cursory check of a plug to make sure it’s switched off) creates a wave of relief, which is immensely reinforcing. The person who checks their iron once suddenly finds that they’re checking it twenty times, the person with fears of contamination might find that washing their hands once isn’t enough, and the person worrying about locking their front door might find that they have to perform an elaborate ritual before leaving the house each day. These obsessions and compulsions can quickly become debilitating, taking up huge amounts of time and interfering with a person’s home life, work and relationships.
So, while there might be someone in your workplace who takes pride in their perfectly aligned desktop, do look out for those who might be quietly battling against obsessions and compulsions.
There are now very effective treatments for OCD, both in the form of talking therapy (usually CBT) and medication. So if you, or someone around you, recognises these symptoms, then it might be worth connecting with someone who can help and support.
Tackling OCD is one of our many psychoeducational series aimed at addressing anxiety issues. To find out more about our Series and platform, click here.
Professor Myra Hunter explains what impact the menopause can have, and what to expect from our new Understanding Menopause series.