Obsessive Compulsive Disorder – You Can’t Always See It

 

What is OCD?

Obsessive compulsive disorder is an anxiety disorder that’s characterised by rituals and compulsions used to rid the sufferer of distressing intrusive thoughts. There is a common perception of OCD (not helped by TV shows like, ‘Obsessive Compulsive Cleaners’ and others similar), that it’s just an enjoyment or obsession with cleaning. Cleaning can become an obsession or a compulsion for a sufferer of OCD, but many people diagnosed with OCD find it affects them in different ways to that. As it can be complex, it can be hard to imagine obsessive compulsive disorder treatment is possible.

 

Examples of OCD

For example, recently I spoke to somebody who had experienced harm OCD. Harm OCD is when you experience intrusive thoughts about harm you might cause to yourself or other people. It can lead to avoidance behaviour. In a mother or a father, this might mean they avoid holding or being near their child because they worry they might harm them. It can also mean things like driving down a road several times to check that you didn’t run somebody over without realising. Another person I have spoken to that struggles with OCD has spent up to 6 hours performing compulsions (checking every single thing in his house), and during this time everybody in the house has to remain completely silent – if they make a sound, things don’t feel ‘right’, so he has to start all over again, or face a panic attack. The severity of these cases makes you wonder if obsessive compulsive disorder treatment could help.

 

What are intrusive thoughts?

Everybody has intrusive thoughts. It’s completely normal to have thoughts ‘appear’ that could be something you don’t agree with. However, people with OCD become very anxious or distressed about these thoughts. They doubt themselves and ruminate over them, and in a lot of cases they convince themselves that they are terrible people because of their intrusive thoughts. If everybody has intrusive thoughts, how does obsessive compulsive disorder treatment help?

 

What’s different about intrusive thoughts when it comes to OCD?

With OCD, intrusive thoughts lead to compulsions or rituals that may help the person relieve their anxiety for a short time. These rituals and compulsions can be obvious, like the ones mentioned above, or other things like compulsive hand-washing. However some compulsions are a lot less noticeable. A common compulsion would be reassurance seeking – somebody with OCD might steer the conversation in a direction that will end up reassuring them about their intrusive thoughts. Counting and checking can also be done mentally – checking thoughts, checking memories etc. The worst part is that all of these things only lead to further self-doubt and anxiety in the long run.

 

Treatments

Obsessive compulsive disorder treatment is available. Most people with OCD have obsessive tendencies, meaning that even when the condition is manageable or nearly ‘cured’, it is possible to become worse again. This is why treatment for obsessive compulsive disorder includes coping mechanisms that can be used in every day life, whether it be through exposure response prevention therapy or cognitive behavioural therapy. Some patients require antidepressants (usually SSRIs) alongside their treatment, as treatment can be quite intense and raise anxiety levels for a while. However, antidepressants alone are not usually the answer to obsessive compulsive disorder, so it’s important when visiting a GP to request to be referred to specialist services.

Psychological Defence Mechanisms

 

What are Psychological Defence Mechanisms?

Everybody has psychological defence mechanisms. They're the body's way of protecting itself from psychological pain. There are a few different kinds of psychological defence mechanisms. The easiest one to explain would be denial. This is something that most people experience when they're going through a bereavement. We show examples of this in our programme about psychological defence mechanisms. A widow has just attended her husband's funeral, but she feels like he is still around and could walk through the door any minute. She doesn't want to believe he is gone because it's too painful for her. Another example of denial would be a smoker not being able to accept that they're addicted to nicotine - 'I'm not addicted, I could quit any time, I just choose not to.' Another well known defence mechanism is regression. In our programme on the subject, we introduce a young boy who, at the age of 5, has started to wet the bed at night. It is found that this is due to home stresses caused by his parents' divorce.

Can psychological defence mechanisms cause harm?

The strange thing about psychological defence mechanisms, is that although they're the unconscious mind's method of defence, they can still end up causing harm. Psychosis can alter a person's perspective on reality, causing delusions and sometimes hallucinations. An example I can think of more recently would be somebody I came across on youtube. She told the story of how the death of her dog during a very stressful point in her life triggered psychosis - her voice changed (she was speaking like a child), and she spoke about trying to go into the forest at night to be with her dog. After a few weeks, she started to come out of her psychosis. It was a very scary ordeal for her and her family, as she couldn't remember much of what had gone on.

Other Psychological Defence Mechanisms

 The mechanisms mentioned are only a few of the defence mechanisms that we know of. There are others, such as dissociation, repression, displacement, and sublimation. Dissociation can be anything from a mild detachment from everything around you, to not being able to engage in any experience. It occurs as a result of stress, conflict or in some cases even boredom. Most victims of abuse have issues with dissociating, and develop dissociative disorders as a result of their trauma. Displacement is a very common defence mechanism. An example would be if somebody felt a lot of anger towards a person, and expressed their anger by breaking something (rather than hitting or yelling at that person). Sublimation is similar to this, but instead of doing something unacceptable to satisfy the anger, the person puts their negative feelings/energy into something more constructive and socially acceptable.

Our Programme on Psychological Defence Mechanisms

A few of these mechanisms are explored in our own programme, called, 'Psychological Defence Mechanisms', which is currently available to watch on our website. There are also many other programmes on various mental health problems, including depression and anxiety, schizophrenia, OCD and eating disorders.

Eating Disorder Treatment In The UK – How Does It Work And What Needs To Change?

What Is An Eating Disorder?

An eating disorder is a mental health condition that revolves around food, and using food to cope with uncomfortable feelings and sometimes other situations, such as trauma. This can mean eating too little or eating too much, worrying about weight or specific parts of the body and what they look like, and compensatory behaviour e.g. using laxatives to ‘get rid of’ food that has been consumed, or over-exercising.

Types Of Eating Disorder

- Anorexia Nervosa – Controlling weight by restricting food intake, over-exercising or a combination of the two.

- Bulimia Nervosa – Struggling to control the amount of food eaten and then taking unhealthy drastic action to ‘reverse’ this.

- Binge Eating Disorder – Regularly eating large amounts of food until past full, and struggling to control this behaviour.

Who Is Most Likely To Develop An Eating Disorder?

Eating disorder treatment in the UK isn’t as accessible as it should be. An eating disorder can affect anybody, but are most likely to develop in the teenage years. They can continue into adulthood if left untreated, and can put the sufferer at risk of many complications, such as diabetes, liver problems, heart problems, osteoporosis, and death. Eating disorders are often thought of as a teenage girl problem, however, many boys and men are also affected by eating disorders. Stigmatising the issue often leads boys and men to feel more shame about their behaviours and so they are less likely to seek help.

Eating Disorder Treatment In The UK

If you think you may be suffering with an eating disorder, you should visit your GP to address your concerns. Your GP should take you seriously and refer you to specialists who will be able to help with a diagnosis and treatment for your eating disorder. Eating disorder treatment in the UK varies depending on the disorder, and the severity of it. For example, someone with Bulimia Nervosa may require regular meetings with a therapist and see a lot of progress using a self-help book and eating plan which helps them repair their relationship with food and increase their self-esteem. Alongside this, blood tests should also be taken to ensure that there are no health problems as a result of the eating disorder behaviours. Somebody with a very severe case of Bulimia Nervosa may need constant supervision and therefore it would be better for them to be admitted as an in-patient so that they can be supervised through recovery.

Therapies

Therapy is a big part of eating disorder treatment in the UK, and elsewhere in the world. Depending on the eating disorder, the therapies that may be used are cognitive behavioural therapy, cognitive analytic therapy, interpersonal psychotherapy, and family interventions. Someone struggling with an eating disorder may also be referred to a self-help support group. 

Barriers To Treatment

Unfortunately, with mental health services being stretched and eating disorders being highly misunderstood by many, there can be barriers to treatment for those with eating disorders. One barrier is weight. For some eating disorders, like Anorexia Nervosa, being underweight is often a symptom. Depending on whereabouts in the United Kingdom you are, BMI may be taken into account when admitting somebody with an eating disorder. Sadly, this means a lot of people who are overweight but suffering with an eating disorder struggle to get treatment for it and aren’t taken seriously. It reinforces the idea that somebody can’t have an eating disorder unless they are underweight, which is not true at all. As well as this, sufferers may feel that they are not ‘sick enough’ to seek treatment, which may worsen disordered eating behaviours and put them at more risk.