Wednesday 26 October, 2016. Overview by Linda Wolfenden

A packed room listened intently to the words of experience and insight from these speakers and this was simply an overview of such an in-depth topic.

What is OCD?

OCD is, essentially, an anxiety disorder. It is made up of both obsessive, intrusive, repetitive, and fundamentally distressing thoughts, and the compulsions/behaviours developed by the sufferer to alleviate the distress caused by these unacceptable ruminations.

To allay any misconceptions about the triggers of OCD, it was stated that the condition can arise from any personal traumatic incident. In Martin’s case, he shared his own experience of being locked in a church at the age of 11. This has evolved into a fear of poisoning people and being locked up in prison and never being able to get out.

OCD can be multigenerational and there is evidence through brain pattern research to show a familial pre-disposition to this condition.

How Does it Present?

There was discussion around the very human condition of experiencing and challenging unwanted, repetitive thoughts and where each of us is on the continuum. As Yvonne says, “88% of people have intrusive thoughts, the other 12% are lying!”

People with OCD experience very distressing thoughts and develop repetitive behaviours as coping strategies to alleviate the distress. The behaviours temporarily cancel out the distress caused by the thoughts.

Clients may share feelings of being trapped by constant ‘what if’ ritualistic, superstitious thinking. They know the thought is illogical but cannot take the risk of anything bad happening, so feel forced to repetitively perform the behaviours. Avoidance is another common coping strategy.

Martin described it as ‘head versus heart’. “You know in your head you’re OK but emotionally, the fear, the consequence, is too great.”

People with OCD almost always have depression, so may present as such and then, as the relationship and trust develops, they may disclose the frightening thoughts and the often elaborate coping strategies they enact.

It appears that the ruminations are the worst part of the disorder for people with OCD. People may talk readily about the behaviours but are likely to struggle to share the thoughts/intrusions that accompany the compulsions because of the fear of negative judgements and perceived consequences. An example that was given was to consider our reaction to a client who discloses, “I think I might kill someone.”

Diagnosis

OCD is one of the ten most debilitating conditions. Diagnosis will help a sufferer make sense of the disorder and really helps to stop a person believing they are ‘bad’ or ‘mad’. As Martin stated, it helps to understand “the thoughts you get are not part of who you are.”

A clinical diagnosis considers the level of dysfunction and how much it interrupts or disrupts normal life.

Yvonne warned, as in all mental health disorders, misdiagnosis is possible and OCD has been labelled as psychosis, schizophrenia, etc.

Treatment 

Both speakers concurred; the therapeutic relationship is the key thing. Trust, not the technique, is the important element, you just need the right therapist.’

As people with OCD develop behaviours as a way of gaining control, hypnotherapy was not advised and even considered to make things worse.

Because the behaviours are very powerful maladaptive coping strategies, the client will be understandably resistant to change and fearful that therapy might involve taking those behaviours away.

OCD clearly impacts negatively on the self concept and opportunities to build self-worth within the therapeutic relationship are invaluable. There is evidence to suggest that sufferers are people of higher intelligence and more creative and these are particularly important points to make when working with an OCD client.

Martin stated, with a self-effacing giggle, “OCD doesn’t affect people who aren’t nice!” and this point was reinforced by Yvonne as she shared the fact that the unwanted thoughts are ‘ego-dystonic,’ so far removed from the client’s values or sense of self. If not, they would not be fought against so hard! Clients will benefit from hearing this.

For Martin, “the most powerful therapy is meeting other people with OCD and normalising the thoughts. The thoughts are not part of you.”

Yvonne agrees that normalising is a big part but “understanding is key” and that can be provided through therapy and working within the home environment, involving members of the family as co-therapists, trying to help the client understand that thoughts mean nothing and control is not necessary.

As expected, time beat us and the session had to be brought to an end with a grateful round of applause for such a packed presentation and I, for one, have benefitted greatly from attending.