This is the blog of India Haylor, writing on behalf of OCD First Aid.  OCD First Aid is a treatment centre based in London which offers highly effective treatment programmes for OCD. Uniquely, the treatment is designed by clinicians with OCD to provide tangible, lasting relief and is based upon cognitive behavioural and third generation techniques. OCD First Aid has 14 years of experience as specialists in treating OCD, supporting families and carers and raising awareness.

OCD as a condition is very manipulative and darkly seductive. It draws clients inwards to focus on thoughts, feelings and emotions. As they withdraw mentally (and often physically) they become increasingly insular and narrowly focused. Spontaneity and natural characteristics melt away and these are replaced with what I’ve come to recognise as ‘the OCD stare’ – that glazed expression which allows the person to be present but entirely absent, locked in thoughts and constant analysis, evaluation and comparison. That process of relating every internal and external event to how it will impact upon them means that they can only be present in the physical sense, rarely the emotional or mental sense. The constant ‘How do I feel now?’, ‘What does that mean for me?’, ‘How do I get rid of this?’ and ‘If only I could be certain about…..’ leaves no room for much else.  As the world continues around them, there they are, thinking, thinking and thinking.

There are a number of tools and traits that OCD uses to facilitate and maintain this process. Cleverly, it finds existing traits and adapts them to be unhelpful and self-sabotaging. OCD particularly likes detail, feelings and strict rules. It can survive very nicely in the presence of all three, as follows:

Detail: I always say ‘OCD gets you on the detail’.  OCD ruminations, problem-solving, descriptions and questioning are very detailed.  The more detail, the increased opportunity to generate more thoughts, more obsessions and more emotional discomfort. The more detail, the more ‘What if’s?’. The more detail, the more real the thoughts become. The more detail, the longer it takes to problem-solve and thereby keep clients on ‘lock down’. The more detail, the more difficult to describe the obsession to anyone else, making help less accessible.  The more detail, the longer it takes to describe the obsession, prolonging the problem and delaying effective solutions. OCD uses detail to keep clients cruelly trapped in their head for years. 

Feelings: in the case of OCD, feelings are not one’s friend. OCD implies that feelings can and should be relied upon. Just look at all those other people using their feelings to make decisions, direct their lives and assure their safety? This isn’t true for OCD. They are not a good indicator of risk or safety and don’t serve clients well. The brain scans of people with OCD suggest that they are emotionally hypersensitive and this is perfect for OCD.  Emotions and accompanying physical feelings can render clients rooted to the spot, unable to move or function. Added to that, OCD confuses thoughts with feelings, producing a horrid, nasty mess which a therapist has to untangle before work can begin. Clients will repeatedly say:

  • I don’t feel as if I can recover.’ (a thought not a feeling)
  • I feel as if I’m a bad person.’ (again, a thought not a feeling)
  • ‘This feels real and not OCD.’ (never in my experience has this been the case)
  • ‘I don’t feel I can trust myself.’ (a thought based on the need for certainty)
  • ‘I feel as if this is genuinely dangerous.’ (anxiety or a thought or both)
  • ‘I feel that this will make me worse.’ (a thought – effective therapy can trigger discomfort but the ‘severity’ of OCD is a long-term combination of many factors)

    However, feelings, correctly identified, are also not one’s enemy. Fighting, avoiding, and diminishing them doesn’t work consistently over time. They are at, worst, meaningless/habitual, and at best, interesting. Changing the relationship with feelings from engagement to observation is the way forward and dis-empowers the bully of OCD who is slapping clients round the face with them all day.

Strict rules: OCD loves strict rules or beliefs. It works like a heat-seeking missile, the heat being those rules or beliefs which must be upheld at all costs. As soon as OCD finds a rule, it will use this to form the basis of an obsession. These rules are embedded in phrases such as, ‘I’m not that sort of person.’ Or ‘I would never do something like that.’ Or ‘What would people think of me if…..?’.  Strict OCD rules can vary widely but they centre around the themes of being in control, being a good person, not suffering, having certainty, being approved of or to a lesser extent, other people behaving well.  Generally, the stricter and more inflexible the rules, the more severe the OCD. Hence, in those cases where religion and morality become fused with OCD, progress can be slow and tough. Strict rules are a fertile bed for OCD to grow and regenerate itself as different guises of the same issue. Very handy.

Don’t reassure me!

Questions to ask yourself before starting psychotherapy for OCD