keith fearns

UNDERSTANDING OCD

“The thoughts won’t go away. The more I try , the worse they get. If there’s the slightest possibility that it could happen , then I must do everything in my power to prevent it. It would be awful”

The OCD problem begins with intrusive thoughts. Examples of intrusive thoughts are:

“I thought about stabbing my partner.”

“When I change the baby’s nappy, I get a sexual thought.”

"I might have become contaminated when I touched that bottle of bleach.”

“I might have caused a car to crash on the way home from work.”

“I thought about having sex with my uncle”

“I thought about cutting off my finger”

Intrusive thoughts fall into several categories:

• Harming other people (often vulnerable, loved people)
• Sexual thoughts (with children, with inappropriate people, in unacceptable ways or locations)
• Blasphemous thoughts or acts
• Fears of contamination (of self or other people)
• Symmetry (feelings that things need to be in order)
• Hoarding (not being able to throw things away)
• Cleaning
• Checking
• Scrupulosity (the need to be thorough, completely morally correct or principled)

To take an example which is not necessarily to do with OCD: most people will at one time or another think about the possibility of developing cancer. The thought is obviously distressing. For most people, the thought is let go and does not persist in the mind.It is let go with a thought such as "There's not much I can do about it" or " I'll deal with that when it happens", then the distress the thought brings will be short-lived. lIttle attention is given to it and it is not regarded as important. Moreover, it is regarded as a thought and just that, no more.

To give another example; most parents or granparents will have intrusive thoughts about harm coming to their children or granchildren; " I had an awful thought about my son being run over by a car. He came out from behind a parked car and was hit." Again, this thought is very distressing.For most people, the thought passes and with it the distress. Sometimes people find it helpful to give advice to the child about the danger of road traffic, or it motivates them to take extra care when out and about with children. In this instance the distressing intrusive thought leads to an action that may lead to a reduction in the likeliehood of the feared event happening. So by minimal action, or no action, the thoughts go and with them the distress.

We need, therefore, to identify what kind of thoughts people with an OCD thinking style have in reaction to intrusive thoughts i.e. in ways that lead to problems. It makes perfect sense to pay attention to thoughts that we think are dangerous to us. It is likely that we are "programmed"to be vigilant for danger as a means to survival. But it is apparent that people with OCD perceive danger in situations that other people don't see as dangerous.

But people who develop OCD respond to intrusive thoughts in different ways. They find it difficult to simply let the thoughts pass. Here are some of the explanations why:

1) People who react in an obsessive way to intrusive thoughts in an obsessive way are generally "nice" people. They have high moral standards. They believe in respecting others and not causing injury or insult to anyone. My experience confirms this notion. All the OCD sufferers I have met and worked with I would describe as this kind of person.

2) The intrusive thoughts are offensive, disgusting and terrifying to them, because they are nice. If they were not nice , they would not find the thoughts so distressing. Take the example of a Catholic priest who has a sexual thought about a nun. To him , this thought is not only abhorrent but it challenges his vows of celibacy and religious faith. It would be difficult for him to ignore the thought or the feeling that he should take action to do something about the thought. He might go to confession or inform the bishop. To the priest , such a thought is inconsistent with his view of himself and offends his principles , or ,at least the way he thinks he should be. This inconsistency is labelled ego-dystonic".

3) If the intrusive thoughts persist, the person might interpret their persistence as evidence that they are losing control over their mind, or as meaning that the thought is an omen of a future event, or that the thought is becoming an urge.

"They keep coming back. I've tried to stop them, but they're getting stronger. I must be going mad. I can't stop them.It's going to happen"

The fact that the intrusive thoughts don't go away and that it appears that the harder you try , the more they intrude, may be seen as evidence that you are weaker than the thoughts , that you do not have the personal resources to resist them. It appears to be bigger and stronger than you.

When humans experience fear or sense danger, it makes sense to be on guard for signs of danger. In other words, we become vigilant. That very vigilance can become a factor in maintaining our fear and making us identify danger when it may not be present. A soldier on patrol in a hostile country needs to be alert for dangers such as roadside bombs, or suicide bombers, but his necessary high state of vigilance , may make him see dangers where they do not exist.

Susan had intrusive thoughts about being a paedophile. She avoided the vicinity of young boys to make it less likely that she might sexually abuse them. She felt that avoiding young boys would mean that she would find it easier to resist what she had come to believe was an urge to sexually abuse young boys. She was constantly on the alert for signs or evidence that she might be sexually attracted to them.

Her vigilance extended to monitoring her sexual arousal to mental images of young boys, which she tried to compare to measurement of her sexual arousal to mental images of women and mature males. She spent time scanning feelings in her genitals for evidence of sexual arousal in a search for confirmation or disconfirmation of her interpretation of the intrusive thoughts. Similarly, she searched the internet to find such evidence.

Susan's vigilance is reasonable when you consider the catastrophe she was trying to avert. But it is clear that the more her vigilance led her to search, the more evidence she would find that her interpretation of the intrusive thoughts may be valid. She was most unlikely to find evidence that she was not a paedophile, but was more likely to remain confused and uncertain.

Sometimes, people with OCD are very reluctant to give up their vigilance.

"I've not had scarey thoughts for a while now. But I still don't feel safe. If I let my guard down , it could take me by surprise, and it could happen. I need to be ready, prepared for when it happens"

It's as if the OCD sufferer feels that being at least partially prepared for the worst will result in it being less distressing when it finally happens. Contained in this concept is the feeling that the catastrophe inevitable. It will happen. You just don't know when.

Cognitive behaviour therapy (CBT) starts with the premise that intrusive thoughts are part of everybody’s everyday experience. The theory is that we all have thoughts that occur in our consciousness over which we have no control. The difference between people who develop OBSESSIVE COMPULSIVE DISORDER (OCD) and those people who don’t is the reaction to those thoughts.

But it has to be appreciated that we are all vulnerable to those reactions, and to the compulsive behaviours that can follow them.

To repeat: We all get intrusive thoughts and we all are capable reacting to them in compulsive ways.

For example: In a funeral, it would be a terrible thing if we forgot to turn off our mobile phones and if it rang during the service we would feel embarrassed to say the least. So, despite knowing that we have switched the phone off, we have intrusive thoughts that we may have not turned it off. This is because the social cost of it ringing would be so terrible. So we check it. Later during the service, many of us would check it again. In fact we feel compelled to check it. In fact we are unable to resist the feeling that we must check, despite knowing it has been switched off.

So we get intrusive thoughts and those thoughts make us uncomfortable. We want to alleviate that discomfort; we find ourselves doubting our knowledge or our common sense and checking that the phone is off. But the thought and with it the uncomfortable feeling may return and compel us to check again. The cost of making the mistake of not having turned it off is too high. And anyway, checking doesn't take more than a second.

These behaviours are perfectly normal, but they do illustrate that such patterns of obsession and compulsion are part of the lives of most of us.

Other features of OCD -style thinking are common in people without OCD. It is accepted that people with OCD are vulnerable to the belief that thoughts can become facts or that thoughts may be evidence of future events, particularly bad events. So if you think something that thing might actually happen. This is sometimes called magical thinking or thought fact fusion (TFF). This may at first sight sound strange and abnormal. But it is a common thinking style in people who do not have OCD.

I frequently deliver workshops or lectures on OCD and I ask the participants (who do not have OCD) to try an experiment.

I ask them to write on a blank piece of paper "I WISH THAT .......................WILL DIE A HORRIBLE DEATH TODAY" Then I ask them to write in the space the name of someone they love. Consistently, I find that the majority of the participants are too frightened to fill the gap with a name. Many of them express emotional distress. So what is happening here? It seems that they are afraid that writing a name may make that person die. They apparently believe that the action of writing a name may have some "magical" effect. They apparently believe that a thought may become a fact.

Remember the participants are not suffering from OCD.

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