Obsessive Compulsive Disorder (OCD)
What is OCD?
Obsessive Compulsive Disorder is an anxiety-based condition. The person obsesses on perceived harmful events that they believe will happen, and in an attempt to prevent those events from happening, carries out repetitive behaviours (compulsions). Although the person usually knows rationally that these compulsions will not prevent the events they fear will happen, they don’t feel they can risk not carrying them out.
OCD is broken down into five main groups, listed on the ocduk.org website as:
- Checking
- Contamination / Mental Contamination
- Symmetry and ordering
- Ruminations / Intrusive Thoughts
- Hoarding
Why does OCD occur?
There is no one definitive answer to this question, but there are a number of factors that may contribute to this condition https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/
- If one of your parents has OCD, there is a 15% chance you will have it and if both parents have it the likelihood increases to 50 %
- Lower levels of serotonin in the brain (which is why SSRI anti-depressants are often prescribed)
- Personality – if you are a perfectionist, neat and tidy, with high expectations of yourself
- Having experienced trauma, whether exposure to a one-off overwhelming event or to repeated and prolongued traumatic situations such as bullying, neglect or abuse
OCD gets in the way of living life fully
If you are obsessing on perceived harmful events, this can take up all of your time. It can make you irritable because when others ask you a question, you feel you need to be thinking about the worry instead. It can prevent you from wanting to see friends and family. You may feel you don’t have enough time to carry out all of the compulsions that you feel are needed to counteract the obsessions.
People describe feeling intense shame at having to carry out such behaviours because rationally they know that it is unnecessary. However, this does nothing to alleviate the fear that if the compulsions aren’t carried out, the terrible perceived events will occur.
How do I work with OCD?
In terms of Gestalt Therapy, OCD is an adaptation that has developed in order for us to manage in our environment. Our growth in the world is dependent on our making flexible contact with it https://www.gestalt.org/yontef.htm.
This flexibility enables us the freedom to interact with our environment and others, regulating ourselves by interacting more with that which works for us and rejecting that which does not work.
If you have OCD, you will be trying to regulate your external environment from within, playing out responses to perceived harmful events without making true contact with the world. This disconnects you from other people and the world outside. This process is a coping mechanism for an underlying anxiety which these perceived fears and compulsions work hard to mask.
These behaviours will have developed in response to events in the past or because of learned behaviour. In line with common personality traits of those with OCD, you will find it hard to express to yourself and others what is really going on for you. Rather than acknowledge difficult emotions as they come up, they are pushed away, and your focus moves to harm you might do to others or harm that might befall them.
Then your attention is absorbed in the compulsions that seem to prevent those events from happening. These behaviours will happen more at times of stress as they need to work harder to prevent you from feeling what is actually causing you dis-comfort.
We will explore what events may have necessitated your having adapted in this way and then explore whether this adaptation is still working for you. We will explore the feelings that are underneath the behaviours, helping you to express what it is you are worrying about.
We will work on the possibility of you expressing how you feel to others and look at what might be getting in the way of that. As you begin to understand more how your OCD is working for you and what it is helping you to avoid, you can begin to add in other less destructive ways of managing. We will be able to work on what is actually causing your anxiety and work to alleviate it.
