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MENTAL HEALTH: THE DIARY OF A BROKEN MIND
Obsessive Compulsive Disorder
written by: Steve Pearson
I think most people will have their own number. Mine is three: most miles away from home that is, before I've had to turn the car around to check whether I had locked the front door and turned off the cooker. I have done it many times, though it is still thankfully rare, and usually only when leaving home for several days, and to be honest, usually at the behest of my wife, which I laughingly, dutifully do, while secretly beginning to doubt myself. That intrusive 'have I or haven't I' thought and the infuriating compulsion to drive back home to check is essentially the topic I want to discuss. Obsessive-Compulsive Disorder (OCD) isn't a simple matter of that uncomfortable insecurity we all get from time to time over the 'did I, or didn't I' that we probably all occasionally feel, but it is at least a similar mechanism. However similarity ends there because OCD can be a crippling treadmill of terrible obsession and irresistible, unreasonable, repeated compulsions used as a means of controlling obsession. Those unbidden thoughts, urges or mental pictures can range from a terrible fear of germs, to insistent urges to do themselves or others harm and/or terrible images that pop into the unguarded mind. Again and again an obsession impales the sufferer leading to their compulsive responses, often as a repetitive action, such as repeated hand washing, in an effort to drive away a germ obsession. Yet, the compulsions can ruin a life just as surely as the unwanted obsessions, with increasingly intricate routines dominating the day.
Hollywood loves OCD for its superficially comedic rituals such as in "As good as it gets" where Jack Nicholson's Melvin Udall in spite of his condition finds love in the shape of Helen Hunt, whilst undergoing a miraculous transformation during the course of the movie. Entertaining though the movie is with fine performances all round (7.7 on IMDB!), Melvin is miles away from the experience of real sufferers. Treatment and recovery is usually a long and bumpy road. Whilst medication can be prescribed, particularly for the depression that can be concomitant with OCD, in the majority of cases the most common and the most effective treatment is Cognitive Behavioural Therapy (CBT).
Though the symptoms will commonly come on slowly usually a pre-teens child or as a young adult, a psychosocial accelerant such as the stress brought on by traumatic life episodes may result in an almost sudden appearance of the condition. Whether the condition appears slowly or suddenly, the first step for all sufferers is to have OCD diagnosed, which in itself can be tough as the condition can be very difficult to pin down, with similarities between OCD and other mental health conditions, such as obsessive-compulsive personality disorder, anxiety disorders, etc. Added to that, many may at first be reluctant to discuss the full panoply of their symptoms, feeling shame and embarrassment at their rituals, and finally the usual societal stigmas attached to any mental illness, particularly here with what can be a very visual, very obvious condition. So access to a simple diagnosis can be a problem.
However, once diagnosis has been secured, a treatment plan will be put into place. It's important to say, right away, that a complete cure of the condition may not be possible for everyone, and in fact is rare. Some seventy percent of sufferers will have to spend the rest of their lives sporadically in some form of treatment: though with greatly diminished symptoms and only episodic returns to their worst case scenarios. Before a sufferer can reach that relative peace they will typically have a course of CBT, or more precisely, a course of CBT with Exposure and Response Prevention therapy (ERP). In CBT the sufferer is essentially taught to recognise their anxiety, producing obsessions, and to change them at source, so to speak. The intrusive thoughts cannot be blocked, or stopped as we all have them. It is the perception of those thoughts that go awry in OCD and it is this perception that CBT seeks to change. The special process of ERP is where the usual response to the rising anxiety of an OCD trigger is deliberately not engaged. What this means in practise is that the compulsive behaviour is explicitly removed. This isn't a step that is taken right at the start of ERP, but rather after much work is done to identify how the sufferer sees their compulsions as helping their obsessions. Once the therapy has helped them to achieve an understanding of compulsive response, they will begin to experiment with dropping those compulsions. Over time the sufferer learns to self regulate perhaps with the help of medication.
A bright untrammelled future it may not be but for many it is at least a future that they once might not have been able to contemplate, and all because they had drawn from somewhere the courage to share their condition with someone. And that is the key: sharing. Imagine yourself behind a closed door and it is hard to share what goes on in that room, but imagine yourself behind a window with a sympathetic, understanding person on the other side of the glass. They don't and won't see you as you fear they will see you. They will want to help you. Go talk to them, and tell them you need their help.