Obsessive Compulsive Disorder (OCD): A Clinical Perspective and Overview
From the experience of working with patients who have Obsessive Compulsive Disorder (OCD), it has become evident in my practice that there is a pattern of behaviour closely tied with an anxious response.
Common knowledge of anxiety is that it presents itself in the body as a result of a fight or flight response. However, one small element is overlooked, in that this ‘anxiety’ has either been created subconsciously to fill a void in one’s life or to allow the body and mind to focus on one primary response; anxiety. The body opts for this response rather than drowning the mind and body with a multitude of different painful emotions. Simply put: ‘Would you prefer to focus all your attention on one painful emotion or focus on many painful emotions all at once?’ My answer would be to focus on one emotion at a time, because the fear and worry associated with pain is a deterrent in itself.
Once understood that this ‘new anxiety’ prevents someone from dipping into the well of pain and emotions stored away in the body. Resulting from a lifetime of suppressed emotions, one then begins to look at the anxiety from a different perspective. Anxiety then becomes an emotion rather than a feeling or response.
One aspect overlooked for the OCD sufferer is the role of trust. This is not only the inability of the OCD sufferer to trust his/her surroundings and other fears, but moreover the inability to trust oneself and ones perception of situations. In most OCD cases, the belief from another individual is highly beneficial, but equally a trap. Despite this belief being a positive reinforcement, OCD sufferers may become dependant to it rather than trusting ones own ability to self soothe and challenge the fear one has created. In many respects, due to the painful feeling, this anxiety is seen as something to get rid of. Hence, many individuals seek out assistance with OCD.
This anxiety has become a mechanism to keep the OCD sufferer safe, as a protective mechanism and something to be thankful for. I know this may sound strange, but “why would we create something that causes us pain?’ Well, our bodies have a natural ability to heal, which works on a sub-cellular level and is a completely unconscious process. So, it is not that strange for our bodies to have found a new way of protecting itself from all the painful emotions. This process allows us to ‘focus’ on one emotion, which seems more manageable. Food for thought?
By understanding more about the different states an OCD sufferer finds oneself, will allow the sufferer to identify when the self-state (different states in which one finds oneself, depending on person or situation) will arise. The sufferer will then attempt to create not only a different pattern of relating to a scenario, but also a more beneficial and affective exit out of the OCD cycle. This process will pull the sufferer out of the experience; into a position where one can face up to the emotions and sabotaging thought processes. Moreover, to create and maintain a new way of relating to ones own world and fears.
A commonly used word in OCD literature and treatment is acceptance. A definition of acceptance is the mental attitude that something is believable and should be accepted as true. There is a clear difficulty with this definition, especially when one is struggling with ones own perception and understanding of the world. Also, having to face the statement that ‘there is nothing to worry about and you can stop the OCD behaviour’. On the contrary; the world is not safe, and we are all in essence trying to establish a life that feels a bit safer than average. The quote ‘If you do not face your death, you never live’ comes to mind, as many of the OCD patients I have worked with (if not all) have shown some degree of OCD behaviour related to death; be it protecting someone from death or protecting themselves from death and tragedy. This indicates that this individual is stuck in a cycle of fearing ones own death and/or the death of others he/she cares about.
Death unfortunately is completely out of the sufferer’s control, but yet it is so terrifying that the striving for control has a great urgency to establish some sense of gravity in one’s life. Based on the quote above, would it not be useful to accept and come to terms with the fact that everything comes to an end (death) so that one can truly live a fulfilled life?
No wonder OCD thinking becomes so urgent and needs to be played out in the individual’s behaviours. There is an undertone of constantly needing to protect oneself or another person from something tragic happening, as well as using such behaviours to prevent difficult experiences from reoccurring i.e. a loved one passing away and feeling something could have been done save him/her.
The therapeutic relationship is a valuable tool in creating trust or a solid foundation in which to face the world of OCD. This is from the perspective that there is another human being who truly believes and sees the OCD sufferer’s ability to face the world, as well as the willingness of this person to struggle with the OCD sufferer through the behaviours and processes so that OCD doesn’t remain an isolating experience. Moreover, to assist the OCD sufferer in finding ways to put one’s new skills and ways of relating into practice.
Action is as important as processing the issues. Sometimes we all need a gentle nudge in the right direction. This process will allow a new mode of acceptance, especially in creating the belief in oneself to let go of old OCD behaviours and to focus and trust in the new effective modes of relating. This is not a process that an OCD sufferer needs to go through alone…one must take the necessary steps and make contact to stop suffering.