OCD – Mind Wellness
“Nine-year-old Marie is a typical girl: she loves music, netball and hanging out with her friends. But unlike most nine-year-olds, Marie needs to make 20 trips to’ her bedroom before she leaves for school, to check that her pillows are perfectly straight on her bed. If she doesn’t do this each morning, she suffers debilitating as she truly believes that straightening the pillows prevents her family having a car accident.
Obsessive-compulsive disorder (OCD) is a condition involving unwanted thoughts, images or impulses (obsessions) which cause the individual such distress that they are driven to perform certain behaviours (compulsions) to reduce the anxiety. It’s a common disorder affecting three in 100 people. Many people with OCD don’t seek treatment, usually because they’re either embarrassed about their thoughts or they don’t think they’re such a big deal, so this number may actually be higher.
OCD usually emerges in mid to late childhood or early adulthood and often the symptoms change over the course of the sufferer’s lifetime.
The common thread with sufferers of OCD is they place unusual importance on usual thoughts. In Marie’s case, she firmly believes that having the pillows straight is actually keeping everyone safe.
AVOIDING THE CRACKS
Most people tend to associate OCD with compulsive handwashing or avoiding cracks in the footpath, partly because of how OCD is portrayed in films like As Good As It Gets, Matchstick Men and The Aviator. However, in my work as a clinical psychologist specialising in OCD, I’ve seen numerous variations.
Sometimes the symptoms cluster around an aggressive theme. For example, Denis, 34, was fearful of driving his car because he was scared of hitting a pedestrian. Every bump in the road caused him such anxiety that he had to park his car and get out to see whether he had hit someone. The fear eventually became so bad that he stopped driving.
“Contamination” cases are another common type of OCD. Michael, 17, is an extreme case. He was concerned with being poisoned so he began wearing gloves and was unable to use any appliances because he feared he would poison himself. The fear became so bad that he was hospitalised because he was unable to eat or drink. Less severe cases involve an individual not taking public transport or eating in restaurants for fear of being contaminated by germs.
SOMETHING’S NOT RIGHT
Another type of OCD involves having to do something until it “feels right”. For example, university student Michelle was preoccupied with preventing her left foot touching the floor when she was seated. If her foot did touch the floor, her anxiety would be severe and she’d have to stretch out her arms to relieve the tension. She couldn’t explain why it was important that her left foot didn’t touch the floor, except to say it “didn’t feel right”.
Another client, Dorothy, explained her thinking: “My life is set into boundaries. I have to leave my home with my left foot, leave school with my left foot…and everything has to be in even numbers. If I’m about to go through a door, I check my watch; if it’s 12.47 I have to wait until 12.48. If I’m at the supermarket and the cost of the purchase is $17.30, I will have to buy something extra to increase the cost to $18.”
NEW WAYS OF THINKING
Cognitive behavioural therapy (CBT) has had great success treating mild cases of OCD, with more severe cases often requiring a combination of CBT and medication. CBT works to provide the individual with various skills to help them realise the intrusive thoughts characterising the disorder are not abnormal and the things they fear will not happen.
There are many clinics in Australia providing CBT programs. The “Freedom from Obsessions and Compulsions Using Strategies (FOCUS)” program at Pathways Health and Research Centre in Brisbane, for example, involves 15 weekly sessions with a clinical psychologist. The individual learns how to challenge their negative thinking and to start “bossing” the OCD.
The individual, their family and the therapist work as a team to fight the OCD and to take back those aspects of the individual’s life that are being controlled by the disorder.
The focus of the program differs from others in its emphasis on empowering the individual to externalise the OCD (to “boss it back”) and on the involvement of parents, partners, peers and family in the individual’s treatment.
A study conducted in 2004 by the director of the program, Professor Paula Barrett, found that 88 per cent of 77 children who participated in the program were diagnosis free (did not have OCD symptoms) at the end of treatment and at three-and six-month follow-ups.
The FOCUS program is conducted by clinicians who are passionate about helping individuals with OCD. Its success in treating children with OCD can be attributed to its strong emphasis on family.
It’s also an effective treatment for adult sufferers, particularly as it empowers them to conceptualise the OCD as a pest, a “former boss”, and something separate from and outside of themselves. They can therefore say, “It’s the OCD trying to make me think something bad will happen if…” rather than attributing the problem to a character flaw.”