Getting Help for OCD
Obsessive Compulsive Disorder (OCD)
OCD is more than just liking routine or order or being very precise about things. OCD can cause considerable disruption to an individual’s life and even that of those with whom they live and work. People with OCD typically recognize their thoughts and behaviours are excessive and unreasonable, but struggle to resist them. OCD affects around 1 in 50 people at some point in their life.
First things first: how do I know if I have OCD?
You may have OCD if you get awful thoughts coming into your mind, even when you try to keep them out, or you have certain rituals that you feel you need to perform such as touching or counting things, or repeating the same actions again and again like washing your hands or checking the front door is locked.
Although we speak loosely about people being ‘obsessive’ or ‘compulsive’ about things such as watching their favourite TV programme, eating or exercise, these compulsions typically give pleasure. The compulsions in OCD never give pleasure. They are intrusive and burdensome.
What causes OCD?
Most people will remember a time that as a child they didn’t like to step on the cracks in the pavement, or kept a count of lamp posts or road markers, or liked to organise their possessions ‘just so’. In time, this kind of obsessiveness diminishes and ‘adult OCD’ will not appear until a person is in their teens or early twenties.
Whilst a definitive cause for OCD still eludes scientists, it most likely stems from a combination of genetic, neurobiological, behavioural, cognitive or environmental factors, which individually or collectively can then trigger the onset of OCD. Below is a brief summary of each:
The neurobiological explanation
Neurobiology simply means the biology of the nervous system, which constitutes the ‘central nervous system’ (brain and spinal cord) and the ‘peripheral nervous system’ (all the other nerves and fibres that branch off it). The nervous system’s job is basically to produce and send messages from and to the brain via networks of special cells called ‘neurons’. However these cells do not form a single chain but have spaces between them. Think of them as a dashed line or, in order to get a clearer picture of how the communication between neurons works, you might like to substitute ‘single length of telephone wire’ with ‘people playing Chinese whispers’.
Messages are then passed from one cell to the next by releasing specific chemicals (neurotransmitters) in specific quantities into the gap between those cells. If the wrong quantity of chemical is either sent or received, then the ‘message’ might be heard wrong or not at all.
The neurotransmitter Serotonin is a chemical in the brain responsible for sending messages between brain cells and it is thought to be involved in regulating everything from anxiety, to memory, to sleep. Research into the neurobiological explanations behind OCD has found that sufferers of OCD seem to have an imbalance of Serotonin, though there is a lack of consensus as to whether the imbalance is a cause for, or the result of, having OCD.
Research has also focussed on a neuronal circuit within the brain which regulates primitive aspects of our behaviour and runs from the orbital frontal cortex, to the striatum, thalamus, and back to the cortex (CSTC circuit). When this circuit is activated (by the neurotransmitter Glutamate) specific impulses are brought to our attention and cause us to perform a particular behaviour that appropriately addresses the impulse such as washing our hands after going to the loo.
In normal circumstances, once the hands are washed, the impulse disappears. It has been suggested, however, that people suffering from OCD struggle to switch off or ignore these impulses, with the result that they will repeat the behaviour. Surgical interruption of the loop has been found to provide improvement of these symptoms (Higgins & George, 2011).
The genetic explanation
There has also been research into a genetic explanation for OCD, with focus on two key genes:
- hSERT, which has the instructions for making a Serotonin ‘transporter’. The transporter’s job is to mop up extra Serotonin after a nerve sends it to the next nerve cell in line. In some people with OCD, hSERT seems to work too quickly and may collect all the Serotonin before the next cell has even got the message. Think of it as their nerves whispering to one another rather than speaking out loud.
- SLC1A1, which is responsible for mopping up Glutamate, another key neurotransmitter (remember there’s only a problem if too little or too much is ‘mopped up’).
However, although research has shown that OCD (or a similar disorder on the OCD Spectrum) often runs in families, that does not automatically infer a genetic connection, and the research to date is far from conclusive. Furthermore, it has been found that identical twins with identical genetic material will not necessarily both develop OCD. Just because a behavioural condition runs in a family does not automatically mean that there must be a genetic reason for it, as many behaviours are learned. Importantly, much of the research to date has failed to take into consideration such environmental factors.
The psychological/ environmental explanation
Other research has focused on psychological reasons for OCD including behavioural, cognitive (thinking/ reasoning/ remembering) and environmental factors. Such reasons normally point to the individual’s thinking style and propensity to develop unrealistically negative thoughts and behaviours.
Intrusive thoughts are not the preserve of people with OCD of course; every human is subject to intrusive thoughts at some point. The difference between someone with OCD and someone without is that the person with OCD will lend an importance to those intrusive thoughts which is out of proportion.
The Cognitive Theory school of thought therefore holds that it is their misinterpretation of intrusive thoughts that leads to OCD. The overwhelming sense that something bad will happen leads the individual to develop ritualistic obsessions and compulsions in an attempt to block or neutralise the obsessive thoughts and minimise any catastrophic consequences for themselves or others. In so doing, of course, the sufferer is on a constant look out for those thoughts coming back. Given that we generally get what we look for, sure enough they find those same thoughts returning, thus continuing the cycle.
Stress (and depression) has also been linked to OCD though whether as a cause or simply to exacerbate the symptoms is unclear. As well as problems at school, work, university or relationships, major life changes such as taking on the responsibility for a new baby, job or entering into puberty can all be contributory factors to increasing the frequency and severity of OCD. Normally these changes can be dealt with but if left unaddressed may worsen the symptoms of OCD.
Can I and should I do something about my OCD?
One of my favourite phrases is that a problem is only a problem if you see it as such. It is not for me – or anyone else – to say whether you should ‘do’ something about your OCD. It’s also never a case of you’ve either got it or you haven’t; OCD comes in all shapes and sizes and is found on a continuum between a complete absence of OCD and a profound presence. And even when it is present, that does not always mean it is ‘bad’, indeed having OCD tendencies can be very beneficial in certain lines of work. If you are a naturally neat, meticulous and methodical person who prides themselves on having high standards then you may be more likely to develop OCD tendencies than someone who does not share the same attributes. These qualities can be seen as positive and helpful; it is only if they become extreme that they may become a problem.
So the answer really lies in what impact it is having on you and other people? Your OCD is only a problem if it is getting in the way of you living your life the way you want or need to, or if it is causing distress to you or others. Severe OCD can make it impossible to work regularly, to take part in family life and undertake other ‘normal’ day-to-day activities. The question you need to ask yourself is this: ‘Would my life and relationships be much easier and more satisfying if I didn’t have to constantly cope with OCD? If I was getting help for OCD?’
Getting better: how hypnotherapy can help
Whilst many people with very mild OCD can improve without treatment, those with moderate or severe OCD will normally benefit from treatment of some description. There are a number of different treatments available from medical interventions such as SSRI (Selective Serotonin Reuptake Inhibitors) medication to behavioural therapies (such as Cognitive Behavioural Therapy) to alternative therapies (amongst which hypnotherapy).
Hypnotherapy works with the subconscious to change negative thought patterns and unhelpful behaviours. It is also deeply relaxing and therefore works well to alleviate stress that often exacerbates the condition.
At Sharp Minds Hypnotherapy, I combine a hypnotherapeutic approach with a cognitive and/ or behavioural approach designed to bring about a swift improvement in the symptoms. Whilst Cognitive Behavioural Therapy has a good ‘pedigree’ and can help an individual change the way they think and behave, it is much more effective when combined with hypnotherapy which acts at a subconscious level and effectively acts to ‘switch off’ the conscious mind which often resists change.
As counter-intuitive as it may seem to someone suffering with OCD, giving in to the intrusive thought only perpetuates the problem. Unfortunately, so too does trying to ignore the intrusive thought. Every time you indulge in the ritualistic checking-avoidance behaviour, you are sending a message to your brain that it was right to alert you to the problem in the first place. And it gets better and better and better at prompting you to do the very thing you don’t want to do. Any such rituals (including using alcohol or drugs to cope) can therefore only ever bring temporary relief to the sufferer.
In your hypnotherapy session, I will work quickly to calm your thoughts and help you to put some distance between you and your thoughts. You are not your thoughts. When the mind is calm and relaxed it can also see other options much more clearly and mentally rehearse more effective and healthier approaches to dealing with problems. I will help you understand what is happening in your brain, make a safe space for your intrusive thoughts and feelings, and then diffuse them by ‘reframing’ your anxiety and fear. Hypnotherapy is about putting you in the ‘driving seat’ and getting you to control what goes on in your mind.