4 minute read
Habitual behaviour
CRIPPLING REALITY
Overzealous handwashing or fastidiousness is only part of the picture when it comes to obsessive compulsive disorder
WORDS CLAIRE BURKE
Imagine being so fearful of losing control that you can’t be left alone with your child, and having to say “I love my daughter” over and over in an effort to convince yourself you will not hurt her.
Or driving through an intersection and thinking, “Did I just hit a pedestrian?” and needing to check the rear-vision mirror and circle back to make sure no one has been hurt.
Not just once, but repeatedly, for up to an hour, or more.
Or wondering, “Do I have lung cancer?” and needing to obsessively check the symptoms online, call helplines and consult doctors to reassure yourself.
These are typical of the distressing thoughts someone living with obsessive compulsive disorder (OCD) might battle internally each day, according to clinical psychologist Andrea Wallace.
“People with OCD experience obsessions which are unrelenting, unwanted thoughts or urges which are distressing,” says Dr Wallace, who specialises in OCD.
“They then perform compulsions which are repetitive, or ritualistic behaviours that are intended to alleviate the distress or prevent a dreaded outcome.”
Fear factor
An anxiety disorder based on fears, Dr Wallace says common OCD themes for obsessions include contamination, harm, danger, sex and sexuality, religion, immorality or any doubt that conflicts with a person’s values.
“Compulsions therefore vary widely and include, but are not limited to, checking, seeking reassurance, arranging objects, touching, washing, cleaning and repeating; and mental rituals such as mentally replaying situations, replacing bad thoughts with good thoughts, counting and praying. There’s no limit to what the compulsion might be,” she says. “Therefore, they may think, ‘What if I give someone COVID-19?’ and may repeatedly wash their hands and sterilise surfaces in their home,” she says.
“Even though they don’t have symptoms, they may repeatedly get tested for COVID-19 and mentally scan their bodies for symptoms and repeatedly seek reassurance from family members that they have not acted irresponsibly by being around others.”
Identify and seek help
OCD will impact about 1 in 40 people across a person’s lifetime — but identifying the disorder isn’t always easy.
The impact can disrupt all aspects of life, including study, career and relationships. “It is highly distressing, exhausting and it can be so time consuming they can’t do the other things in their life that are important to them,” Dr Wallace says.
Under pressure
Stress is not a cause of OCD but a stressful event or trauma may trigger symptoms for those predisposed to it, according to the Anxiety and Depression Association of America. Meanwhile, a recent Danish study found young people with OCD reported their symptoms worsened during a crisis such as COVID-19.
Dr Wallace says an underlying belief for people with OCD is an overdeveloped sense of responsibility for others.
As OCD often plays out in someone’s head without physical signs, it can be hard to recognise. Further, Dr Wallace says people with OCD can feel shame around their compulsions and may feel reluctant to admit to their obsessive thoughts.
The good news is OCD can be treated and managed. There are effective medications, while cognitive behaviour therapy using exposure response prevention (ERP) may help people to learn to tolerate the uncertainty around a thought and not act to negate it.
“They learn to just let the thought be, and the thought then loses its power and the anxiety goes away,” Dr Wallace says.
Penny Moodie, 33, began experiencing
OCD-related anxiety as a young child.
“OCD is a really complex mental illness. It’s having a fear and not being able to tolerate any uncertainty around that fear. Then having that fear playing in your head over and over again.
I have memories of obsessive thoughts from about age seven. I was worried for so long I had AIDS. I think that was triggered because my dad worked in the area; and it was the ’90s, it was all over the news. Any time I would see something on the news I would be triggered.
When I was a teenager Mum thought I needed to see someone. I would constantly seek reassurance. I would take Mum aside, maybe 10 times a day and say, ‘OK, I’ve got this going through my head’ ... just to get her to say, ‘It’s fine, it’s all OK’. That soothes you for a while, but then the doubt creeps back in.
As I got older my obsessions became more about relationships. If you’re living with your partner, you can be triggered all the time. You’re constantly thinking, ‘Is this the right person for me, am I feeling how I should be feeling?’; it becomes a loop tape in your head.
Everyone has questions around relationships in general. But when you have OCD that uncertainty becomes intolerable and it becomes all you think about.
Before I went on medication it was pretty intense most of the time, but I was very good at hiding it. Exposure response prevention therapy for me has been really effective, because it’s about living with the uncertainty. I had to learn to be OK with not knowing.”
