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OCD ~ Caught in an endless loop

Obsessive Compulsive Disorder is characterised by worries that something terrible will happen (obsessions) and a series of disruptive behaviours (compulsions) carried out, often ritualistically, to try to alleviate these anxieties. What causes it, and how can it be helped?

The psychology behind OCD Obsessive Compulsive Disorder

Maybe you like your breakfast prepared in the same way every day, or you follow a certain route to work that passes the corner shop and the park, and you’re comforted by the familiarity of it all. Maybe you don’t like sitting on the sofa until you’ve plumped the cushions just right, or you check the car door a couple of times after locking it, just to make sure.

The mental health charity Mind says that something like 80% of us have minor compulsions like these, almost always ones which don’t affect our everyday life in any major way. But someone with OCD–perhaps two to three per cent of us–can feel forced to perform certain actions in the same way, maybe many times, usually every day. Not doing so can cause them great anxiety and preoccupation.

One example might be the woman who cannot set off for work or even leave the house until she has made a cup of tea in her own way. She starts by lining up kettle, teapot and teabag, in a precise formation, wiping the kitchen counter with a clean cloth, disposing of the tea bag with a spoon kept for the purpose, and then wiping everything down again with another fresh cloth — possibly repeating this several times, until she has done it ‘right’. She may need to get up earlier and earlier, because the ritual may become increasingly complex, with more aspects of it liable to go ‘wrong’.

The fear that something terrible will happen

Often, the compulsive actions involved in OCD are related to cleanliness, and fear of contamination. So someone might need to wash their hands, in a particular, ritualised way, over and over again. If something interrupts the process, they have to begin the whole cycle again. Or someone else might check they have locked the doors, switched off the lights, and turned off the oven in a pre-set way, dozens of times before going out. These are connected to obsessions; a preoccupation with these behaviours with a conviction that, if not performed correctly or at all, something terrible will happen.

Not performing certain actions can cause great anxiety

Many compulsions involve a ‘negative’ action as part of the sequence, so the hand washer feels compelled not to touch the basin, but only the taps. Or the tea-maker doesn’t permit herself to touch the teabag with her fingers. These negative strictures make the ritual more difficult and use up more thinking — and researchers speculate that ‘filling up’ the working memory part of the brain with ritual might help quieten other, anxious thoughts.

Peak times for OCD behaviours include pregnancy and early motherhood. New fathers, too, have been found to develop the behaviours, linked to fear of something happening to the baby. But they can occur at any age, too.

There’s an irony with OCD, in that not performing the ritual, and even the idea of not carrying it out, can cause serious anxiety. Yet the ritual itself is not really ‘calming’ — the net effect is an increase in anxiety in the longer-term.

Evolved precautionary vigilance

Some psychologists point to how over millennia, we evolved to be vigilant for our safety and well-being. Normally, we enact this ‘precautionary vigilance’ without a problem — checking the savannah for marauding lions, for instance, and then deciding it’s safe to walk on. Or in modern days, checking we have locked the back door before going out to catch the bus. We get an anxiety-allaying signal into our brain after this, and all is well. But with OCD, the signal saying ‘you’re safe now’ is interrupted, and has an increasingly reduced effect. So the precautionary behaviour is continuously repeated — until it begins to make a normal life virtually impossible Zurich Prime app.

OCD is an issue that can be resolved. The first challenge for some clients is to acknowledge the impact of their behaviour, and to seek help. The evidence for the success of a number of therapies is very promising indeed. Cognitive Behavioural Therapy (CBT), for example, has been shown to help approximately 75% of people with OCD to recover, which is why it is the treatment of choice recommended by the National Institute for Health and Clinical Excellence (NICE) and specialist centres such as the Centre for Anxiety Disorders and Trauma (CADAT).

The House Partnership, 28th October 2015


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