What is OCD?
Obsessive–Compulsive Disorder (OCD) is a serious anxiety-related condition where a person experiences frequent intrusive and unwelcome obsessional thoughts, often followed by repetitive compulsions, impulses or urges (definition taken from ocduk.org). Everyone experiences intrusive thoughts, images and impulses. In OCD however, people interpret these as important and assign meaning to them, and so the associated anxiety is higher, which then leads to them feeling the need to do something (physically or mentally) to either stop the intrusions, prevent the intrusions from coming true, or to lower anxiety associated with them.
How to ‘treat’ OCD
There are different ways to work with OCD. This includes medication to lower anxiety levels, as this can lead to less focus on intrusive thoughts and also make someone more able to resist the compulsions that reinforce it. Self-help resources can also help by building an understanding of what OCD is and how it is maintained, so people fear the intrusions less and know how to break cycles that keep OCD going. Therapy can also be really helpful and within this, there are many ways to work with OCD, both across and within therapeutic approaches. It is important that there are lots of ways to treat OCD as it is so varied and because we are all individuals with different goals and factors that have contributed to, and reinforced, OCD, so it isn’t a ‘one approach fits all’ thing.
Can OCD be ‘cured’?
This depends on what you see as ‘cured’. We all experience intrusive thoughts so if you aim to get rid of these then this isn’t a likely outcome. I can say that through a recovery journey, the fear of intrusions can go away and this changes the response you have to them and therefore stops an OCD pattern. In addition to this, the less we fear these, the less our brain notices and hones in on the thoughts, which makes it feel like we have a lot less of them.
OCD is also a natural anxiety response pattern for a lot of people (based on their personality types, beliefs, experience and genetic factors). This means that when experiencing high levels of stress in the future, your brain might offer you the option of falling back into an OCD cycle to feel better. However, a big part of getting ‘better’ from OCD should be gaining insight into this, challenging contributary factors, and creating alternative ways of coping, which means you may never fall into this cycle again. For some people, OCD patterns may always be what their brain initially offers up as a way to manage anxiety, but this insight should allow them to get help quicker if they can’t resist falling back into it initially.
Considerations and tips for help
Within my years of working with many types and presentations of OCD, and my training in it, I have worked with many people who have tried a variety of things to help themselves. Based on this, here are some general takeaway tips from research and anecdotal evidence I have gathered for different types of help:
- If you are following guidance and self-help resources to challenge your OCD, try not to mix and match. A lot of the advice will contradict each other as they will he following different understandings and approaches to OCD so you will likely undermine what you are doing. Find one approach that fits with your experience and how you feel comfortable tackling your OCD and give this a try. If it doesn’t work after a while, review and then try a different approach.
- If therapy, make sure your therapist is very knowledgeable about OCD with experience in working with this specifically. Uninformed therapy can be damaging and make OCD worse. Challenging OCD can be really scary and you need to trust the therapist and feel confident in investing in their approach. This means you should absolutely ask them for their background in working with OCD and ask them how they might approach working with you (side note- this is applicable for working with any difficulty as a key factor in the success of therapy is a client’s confidence in the therapist and their approach). You will be encouraged to confront some things you’re anxious about in therapy at times so it is important that you feel comfortable with the person who you are working with. If they don’t have the correct knowledge and experience or you feel uncomfortable, find (if private therapy) or request a change (if NHS or charity).
- If therapy, don’t follow a treatment that is designed for a different type of anxiety. Although OCD is a presentation of anxiety, there are a lot of things that help with other types of anxiety that can actually make OCD worse. This includes really standard techniques in therapy such as engaging with and challenging anxious thoughts. Make sure the approach is OCD specific, which is why the previous point is particularly important.
- If you take medication, keep in mind that you might also need to do therapy or look into ways to help yourself. You will likely still get intrusive thoughts but the anxiety associated with them might be less. It’s a really good opportunity to get insight into what usually keeps the anxiety going so you can be aware of new responses to do when not as anxious, in case the anxiety ever builds again.
- Don’t engage the thoughts. This includes pushing them away. The more you delve into the thoughts or get defensive against them, the more important they feel. This can really reinforce them. Instead, aim to acknowledge they are there but then redirect your attention.
- Think about what you’re aiming for and make sure its realistic and isn’t feeding into the thoughts. When I ask what people are seeing as a recovery goal, they talk about not having intrusive thoughts. Intrusive thoughts are completely normal, it is our interpretation of them and then how we respond to them that makes an OCD pattern. By having a goal of ridding these thoughts, we get more anxious when they occur and this makes is feel worse. Goals such as being able to do things that OCD has interfered with, or not following compulsions can be more helpful goals.
- No matter how you approach your OCD, always incorporate general anxiety management techniques and building self compassion. General anxiety or stress increases can make OCD harder to manage and harder to challenge. If you have a way to manage this, it means you will struggle with OCD less. It will also make you more successful in challenging compulsions as you can handle a temporary increase in anxiety without falling into compulsions. As for self-compassion; the key fears behind OCD often feed on self doubt and worries about being a bad person. If you learn to treat yourself like a good person and increase your self-esteem, those OCD beliefs have less to latch onto.
- Look at the positive side of what leads you to struggle with OCD. There are certain personality traits that make you more susceptible to OCD when anxious. These can turn really unhelpful and include; perfectionism, a sense of responsibility for others, wanting to help people, and being overly risk aware. If you are experiencing OCD, these factors are likely on overdrive and being unhelpful. The idea of changing these things can be hard and they might actually be really important parts of your personality and have actually helped you in life. For example, you might need to be responsible as a parent or be a perfectionist in your work. Try to identify when these traits are helpful and when they are not. In working with OCD, you aren’t aiming to change yourself, just honing these traits so they remain when helpful but don’t go into overdrive.
- Gain insight; no matter what you try when it comes to helping your OCD, try to reflect on things that make it better and worse, and also what any changes mean about what the OCD is telling you. For example, if you resist compulsions and feel better, reflect on this and also whether what the OCD said came true (so did making yourself hold those scissors lead you to go on a stabbing spree? Did touching that toilet make you unwell?). This means that the OCD beliefs can shift but also give you more confidence in not falling back into an OCD pattern next time you are anxious.
- Keep an eye on what you are researching and question if it is useful. Getting information initially about OCD can advise you where to get help and help you to feel less alone. Try not to then keep researching it as it often turns into an unhelpful compulsive behaviour. The same can be said to most thing you research. The first time to find specific information can be helpful but continued research on the internet (Google and also things like Instagram accounts) can play a big role in compulsions.
- Try and ensure your support system is aware of what you need. A large factor that often reinforces intrusions is our support networks. Our loved ones want to help us to feel better and so naturally provide reassurance and help us to deal with anxiety but they can accidentally feed into unhelpful habits. When you are working on challenging your OCD, ensure they are fully informed and on board so they can change their approach to you when you discuss your anxieties too.
The most important thing to do for OCD is to recognise it so that you can start to gain insight into it and know that what you are experiencing is something that is not your fault and that it can be helped.
Where to look for help
Below, you’ll find some helpful resources that will include places where you might be able to access some support. This includes charities specifically knowledgeable in working with OCD, such as OCD UK, who can direct you to helpful self-help information in addition to therapy and other sources of support.
You can also reach out through the NHS for medication and/or therapy, and this might be by talking to your GP and specifying that you would like help for OCD. They can often prescribe medication to help anxiety and refer you to your local mental health service for any therapy. Remember to ask about their training and experience with OCD and see whether you can request a therapist with the correct experience. If you are pregnant or have a young child or baby, you can also ask for help with OCD from your midwife or health visitor. Perinatal OCD is common and not talked about enough, have a look at my blog post on this.
You can always access therapy privately if you are able to afford this, although some therapists do offer a sliding scale based on income. Check out some therapy directories (listed below are a couple of options) but I would advise you look for those accredited with a relevant body if you are looking for a specific type of therapy (such as the BABCP for cognitive behavioural therapy) and check their experience and training in OCD specifically. You can (and should) always shop around and speak to a few therapists when accessing help privately, to make sure you find someone who you are happy with.
Your work place or private medical insurance may also be able to help you to access support.
Helpful resources
Thankfully, there are some people and charities that have been making great progress on increasing research and understanding around OCD. Hearing others’ stories and connecting with one of them can help you know to reach out for support. Here is a good place to start when it comes to getting help and support with OCD:
https://www.ocduk.org/ocd
https://iocdf.org/about-ocd/
https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/
https://ocdaction.org.uk/
Some therapy directories;
https://www.psychologytoday.com/gb
https://www.counselling-directory.org.uk/
https://babcp.com/CBTRegister/Search
Current guidelines in the UK for OCD treatment can also be found here, so you can check you are being offered what you should: https://www.nice.org.uk/guidance/cg31/chapter/Recommendations#steps-3-to-5-treatment-options-for-people-with-ocd-or-bdd
Above is general information and non-specific advice about how to help your OCD. As I work with this a significant amount and am always receiving enquiries who would like to know how I approach OCD, I am also releasing another blog shortly that details how I tend to approach it therapeutically, so have a look at this too in case you find it helpful. My previous blog post also has some more resources and information here: Am I Living With Obsessive Compulsive Disorder (OCD)? – Reimagine Therapy