Understanding: Obsessive Compulsive Disorder

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OCD is a disorder that tends to get diluted by jokey references. It could be that a person likes to keep their house tidy, always has to triple check they turned the oven off, or enjoys watching videos where people arrange things by colour; you’ll find them, or others, saying it’s “so OCD!”.

We know by now that casually diagnosing ourselves for a laugh is harmful – it makes things harder for people who are actually suffering. And oftentimes, our perception of people with OCD is wrong. It most likely comes from misrepresentation in the media over the years; overblown caricatures instead of complex people struggling with a sensitive issue. So what really is OCD, and how does it affect the people who live with it?

Obsessions and Compulsions

OCD stands for Obsessive Compulsive Disorder. It’s defined as a long lasting disorder where a person experiences uncontrollable and recurring thoughts (these are the obsessions), engages in repetitive behaviours (the compulsions), or both. The HSE explains that there’s generally a four step pattern experienced by people with OCD, which can help us to understand it a little better.

First is the obsession; that could be a distressing thought, image or urge that repeatedly comes into your mind. It could be to do with an action, like “I feel like I might drop this dish”, or to do with contamination after touching something; “I think there’s germs on my hands.” The thought could express ideas about yourself, “I’m a bad person”, or concern for others welfare, “my family members are going to get sick.” The thoughts are just that – thoughts, but for people with OCD they can feel completely absolute, more like facts.

The second step is the anxiety your obsession brings. You might be worried about the nature of your thoughts, concerned about what they mean, and struggling to make sense of them. “If I keep thinking that, then it must be true.”

 

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The third step is compulsion.This is a repetitive behaviour or mental act you feel driven to perform. Even if you can recognise that your thoughts aren’t rational, you may want to follow through on the compulsion, just to relieve your anxiety.

It could be forcing yourself to clean something really well, or rearranging something until you think it’s ‘perfect’. Or it could be that you feel compelled to count to a certain number, think specific thoughts that will ‘offset’ your bad ones, or seek frequent reassurance from your loved ones. “Am I a bad person?” “Is everyone healthy?” “Is this person mad at me?”

This can be surprising to a lot of people – that OCD might be more thought orientated than a physical action. We’ve come to expect OCD to be this really obvious, tangible thing you can spot in a person (like someone repeatedly switching the lights on and off or frequently washing their hands).

And while it does manifest that way for some people; it’s not that way for everyone. There are many different kinds of OCD, and they don’t all present the way you might expect.

The fourth step outlined by the HSE is temporary relief; the compulsive behaviour you’ve ‘completed’ relieves anxiety for a little while. You might get a break from your obsessive thoughts, and feel like they’ve run their course, or that everything will be fine now. Unfortunately, compulsions aren’t the answer to addressing obsessive thoughts, and the cycle soon starts again.

Living with OCD

Áine, 24, tells me that she’s been struggling with OCD for years, but that she didn’t expect her diagnosis. Her OCD came in a form that she wasn’t familiar with but one that is common with those who struggle with the disorder.

“I was constantly imagining these weird, disturbing scenarios that wouldn’t go away…the harder I’d try not to think about them, the worse it would get.” This had a significant impact on her life, she says. “I stopped going out with my [friends] because I was convinced I was going to act on the thoughts, and I got obsessive about quieting my mind.Once I was on the bus, and I had this particular thought…and I actually put my hands over my face and kind of groaned to stop the thought. It was mortifying and so scary too. People were watching…it felt like I was losing it.”

Áine sought help from her GP after finding intrusive thoughts debilitating, which she says made a difference in helping her cope.

“I’m still on [my] journey to getting better…it’s been really helpful to name it. I’m opening up to people way more, now that I can explain it better.”

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Finding answers

Psychotherapist Gosia Freese, who works with MyMind, tells me that the thoughts a person might experience with OCD don’t reflect who they are as a person.

It can be frightening when you repeatedly think something taboo or disturbing that doesn’t align with how you really feel – and when you don’t know where these thoughts come from, you might wonder if they’re some kind of subconscious message about who you truly are. In reality, this couldn’t be further from the truth.

Gosia quotes the psychologist Gianni Francesetti, who says that there are three characteristics that distinguish obsessions from other recurrent thoughts. “They are not desired, they are incongruous with the person’s value system, and they elicit resistance in the person when attempting to eliminate them or tackle the consequences.”

So obsessive thoughts that present in people with OCD are often the exact opposite of how the person feels; they’re at odds with who you are. Which is what makes them so frustrating!

So, what should you do if you think you might have OCD?

It’s best to chat to your GP, who can point you in the direction of the right treatment options. There are different therapies, like CBT or ERP, which can make a huge difference in your quality of life. It always helps to open up to someone you love, and to try not to judge yourself!

Gosia tells me that what people get wrong about OCD is that it “becomes the person.” “The common misconception is that one is an ‘OCD person’ rather than one has or suffers from OCD symptoms.”

This is important to note!

Struggling with something like OCD can be extremely demoralising. You can feel like your own thoughts are against you, and that your disorder is consuming your life. But you are not your disorder, and it doesn’t have to be that way – help is out there. Visit www.hse.ie for support.

*Name changed for Áine

This article originally appeared in the January/February 2024 issue of STELLAR magazine.

• OCD
• Understanding