OCD & Me, OCD & Me, OCD & Me, OCD & Me...

And Perhaps You?

Today has been one of those shit days where I can't seem to escape the place I live; my own head. Do you ever get that? At times it seems that no matter what I do my brain only wants to focus its attention upon one painful thought and examine it in all it's wonderfully glorious detail.

I wasn't sure how to start this but I knew I wanted to write about my experience with OCD and to try to give you a genuine insight into the reality of a Mental Illness. Not just the usual fluffy horse-manure involving vagueness, generalities and buzzwords. When I had read before I'd wanted detail, I'd wanted specifics. Most importantly I'd wanted something I could relate to.

And look I know some of you may wonder why I want to speak so candidly about it in the first place. Do I really just want sympathy? That maybe I'm writing this because I long for a connection and that I want some of you to read this, feel sorry for me and then magically make me better. Maybe I'm writing this because I'm hoping that saying it out loud takes away some of the shame that I feel about having it. Maybe I'm writing this because I don't want anyone else to have to feel alone and that they have to deal with it by themselves. Maybe I don't want people to think that I'm perfect (unlikely if you know me, I know), no matter what face you see upon your social media screens.

Maybe all of those are true and that nuance is a part of understanding Mental Health and perhaps we shouldn't always look for such simple reasons every time. Or maybe you're right and I just want that to be true when the reality is much simpler.

That isn't for me to decide. Take from this what you will.

So let's talk about how I got to know that I had Obsessive Compulsive Disorder. After all, that's just that condition where you need to incessantly clean things, wash your hands a thousand times or keep the volume at 15 or 20, right?

Maybe Not

I'm going to talk about my experiences, how I went about getting treatment, what I still struggle with and where that leaves me today. I will be talking about me a lot during this and for that I apologise but I think it may be the best way for some of you to relate . If you find you do and you just want someone to talk to please feel free to message or email me anytime.

Yeah,  don't tell me mental health is a willpower issue - I don't have a problem with willpower

Yeah,  don't tell me mental health is a willpower issue - I don't have a problem with willpower

My journey into OCD began a couple of years ago during a 3 month prep for a fitness shoot. During this time I'd found myself feeling almost constantly anxious and depressed; I would frequently excuse myself in the middle of client sessions (I'm a Personal Trainer) to take a quick trip to the toilet, not because I needed to go but because I needed to cry and the disabled toilet upstairs was oddly spacious and would let me crouch by the bin. I'd often turn the tap on so no-one could hear if I happened to make noises akin to a birthing whale. The three months passed and this only got worse but nonetheless I dragged myself to the photo shoot relatively successfully- see the pic attached.

Most people close to me thought that my mood was a result of prep - you know, being hungry, tired and stressed can result in you being a simply sterling asshole. But I knew that wasn't right. And so a month after the shoot, which was in April, we arrived at my birthday; May 8th if you wanted to send a Card. About 25 people; friends, family, clients and an array of loved ones came out for dinner with me. And yet again, I found myself popping off to the toilet to cry again and again and again. I felt lost, pathetic and helpless. It was during this period that it occurred to me what Suicide really was; that it had nothing to do with wanting to die and everything to do with being unable to live. If this was life, I simply didn't want it anymore.

And so after a night of crying on my bedroom floor and being comforted by a couple of friends I was taken to my Dr. It was a Saturday and happens to be one of those moments I will remember forever. Sitting in the waiting room thinking "What do I say? How do I start this?"

"Ummm, Hey Dr. So I can't seem to stop crying, I hate living and I'd like you to solve all of my problems. Now if you wouldn't mind excusing me while I continue to sob uncontrollably that'd be great."

It didn't feel like the greatest moment of my life. And so I went and in and as soon as my ass hit the seat I just blurted it out, and yeah I cried again. So the frustration, anger, confusion and constant hurt led me to walk out with a prescription for Citalopram and onto the waiting list for Cognitive Behavioural Therapy.

If, as you read this you share that deep-in-the-pit-of-your-stomach fear of having to say you have a problem, man I feel for you. I get it and honestly no matter what I say here it just plain fucking sucks. BUT the only thing that I can think of that may be worse than that feeling is accepting that the way you feel right now is the way you will feel forever. I can't believe that it is, no matter how unending it seems at times. If you've ever smiled at any point in your life then there exists the possibility of it happening again and that thought is worth persevering for. But it has to start with being terrified of opening your mouth and doing it anyway.

And so it was I started on Citalopram, 10mg to begin with. Interestingly it initially made me physically anxious, not mentally, like someone was twitching around inside my body. In other words; it was weird as fuck. But after a couple of weeks I adjusted to it and stopped having that twitching feeling, my heart still occasionally felt like it would leap out of my chest but that is anxiety anyway so it's hard to say. But other than that Citalopram helped, at least a bit. At least as much as to have made it worth doing.

But I struggled with something. And that thing was because I was taking a medication that affects and alters your brain. And to do that is to accept that I wasn't fully in control of myself, and therefore that I never really had been. It's a bitch of a thought. Especially to a control freak and part time narcissist. By narcissist I mean that I have a sense that I should be able to do almost anything if I really apply myself to it. But to take this medication was to accept that who I was as a person, that intrinsic concept we have of ourselves, wasn't completely true.

And if you flesh this out further you realise that it becomes almost impossible to truly define you. If you were to take any one quality you have and remove it, be it your hair colour or your taste in music, you would still be you. But if you remove all of them, are you still you? So what quantity of qualities make you, you? Make me, me? By taking this medication, will I still be me?

Honestly I don't know but every time I took that pill I had to continually attempt to accept that I was not and am not fully responsible for the person I am. This doesn't relinquish me from the responsibility of my actions (remember the nuance). But it does mean that if I'm not completely responsible for how my kidneys are doing, I'm also not completely responsible for how my brain is doing. I could write on and on about the difficulties I had and honestly still have with this concept, but as I hope will become clear, it is something you will have to accept.

If you're still not there, then consider these brain scans (OCD, Depression & Alzheimer's) and then tell me that these people have the same condition. I don't know anyone that is claiming that Alzheimer's isn't a very real and horrible condition. If Alzheimer's is characterised by the loss of brain function then why, if we see a very real change in brain function in other disorders, are we not treating them seriously? Why do we still think it's a case of just snapping out of it? Just man up. Cheer up, plenty of people have it worse. It's simply not that simple and my proof is above. 

But first - Cognitive Behavioural Therapy

What is it?

Put simply it is a treatment that tries to change your Thinking and Behavioural patterns. Your thoughts affect your behaviours and your behaviours can reinforce and influence your thoughts. If you do these for long enough, they become your habits, and we all know how powerful those can be.

There is something unique about the Human condition, something that no other animal does, and that something is self awareness. We ponder our own existence; what that means, why we're here, how long we have left. We can think about thinking. And if you follow that premise it leads to the idea that perhaps we have the capacity, not just to react to a situation, but potentially to choose our response. I'm going to propose something that sounds counter-intuitive at first reading. That no action, no matter how shocking, inevitably leads to a given reaction. Even if we were to take some of the most abhorrent ideas we can imagine; Genocide and Paedophilia. We have to recognise that for many these ideas are not just unpleasant, they are actually positive. If this wasn't the case the Holocaust simply wouldn't have occurred. Yes it may take years and years of conditioning to get to these outcomes but clearly millions of people can be made to have a positive reaction to seemingly horrifying realities.

And so you and the paradigm through which you interpret your world has been shaped, by the genetics you inherited and through every interaction you've ever had during every moment you've existed. As a result, we so rarely stop to question whether the World we see is a fair reflection of reality. If we do, we are left with a question; what do I mean by Reality?

Reality is your brains ultimate construction

Your reality is a construct of your brain; an interpretation of the World around you. It is not an objective reflection of what is truly there. Don't just take my word for it. I'll show you a few examples. And then I'll try to bring this back to the topic at hand; mental illness.

Should you trust what you see?

Our eyes do not just see what is in front of us and feed information that the brain passively receives, it actively creates the World we see. Check this out:

To be honest anything by David Eagleman is cool as hell and is well worth a watch. Seriously go watch his series on The Brain - found here.

Should you trust your memory?

What if I told you that your brain reconstructs memories each time you visit them and that they are not precise recall devices; that they are subject to influence and degradation and that every time we remember something we are actually remembering the last time we remembered it! And just like Chinese Whispers these change over time; the detail fades, we create false parts and fill in blanks - we construct a narrative that may not be accurate, no matter how real it feels to us.

Just because someone thinks they remember something in detail, with confidence and emotion, does not mean that it actually happened...False memories have these characteristics too. - Elizabeth Loftus

If you want more information on this finish the article, come back and try this talk by the aforementioned Elizabeth Loftus from TED:

 

Should you trust your observation?

We have a problem; there is so much information around you that your brain has to pick out the parts it thinks matters in order to form a view of the world for you to operate in. But that means that lots of information simply gets missed. In other words - We see that which we look for. Try this quick video test: 

I promise you'll laugh - if you've done it before, don't spoil it for those who haven't.

 

Ok that's all interesting and all but how does this relate to Mental Health & OCD?

As stated previously, we see that which we look for. Every one of us does it. It allows us to navigate life, make quick decisions and function in the world around us. After all no-one wants to spend 30 minutes weighing up Coke Zero versus Diet Coke. But a decision must be made by your brain, you just happen to be unaware of the process going on beneath the skull. Large parts of our life are under unconscious control. So how often do we stop to question whether the reactions (that we feel) we impulsively have are actually appropriate to the circumstance? Perhaps we've jumped to conclusions and filled in blanks. Our brain is forever creating our reality and feeding us a narrative, an interpretation, of the world around us.

So why do some of us turn into crack fuelled Hulks in a traffic jam while others sit as peacefully as Ghandi in a coma? Our paradigm, our interpretation of the world around us drives our thoughts, and in turn, in a fraction of a moment this leads us to our feelings about something. A.k.a. feeling sad about something means you think the event was saddening. You may be right. But:

  • What happens if the way you interpret the world is actively causing you harm?
  • Could we start to rewrite a different response?
  • Could we interrupt that response and begin to gradually change our thoughts and behaviours?

The above is known as Hebb's law and it tells us that when neurons in your brain fire together, the more that pathway is reinforced and the quicker you become at using it. This is how you learn to write your name, kick a ball and ultimately, see and interpret the world. It allows you proficiency and mastery without requiring conscious control. It also changes the structure of your brain. Your brain and therefore you, are not static but evolve and change over time. This is known as plasticity. As a quick example, Black Cab drivers in London have increased Hippocampus sizes (an area of the brain associated with spatial memory) compared to controls, and this area has been seen to grow as they go through and complete their training a.k.a "the knowledge". 

As a result, your brain and you can evolve and change over time. Your reality and mine, though sharing many experiences, may be different. The feelings you have may be different to the ones I have and thus it becomes difficult to have shared conversations about a subject. We are possibly talking about different experiences. This is one of the reasons that saying "Just get over it" is insulting to a person with a genuine mental health problem. We assume that because we have had a similar thought or problem to the one being described and we found that the solution was to "forget about it" or know that "others have it worse" that therefore the person with an illness should also be able to do those things. But this fails to understand that their reality (their brain response) is not the same and therefore the solution that worked for you may well not be useful at all to them.

CBT attempts to rewire a different response to a particular situation (trigger). It is a slow and intentional process but one that has been shown to be very effective. The combined approach of drugs plus CBT is current best practice. If you are suffering, you have to know that it can get better so here is a brain before and after treatment and you can clearly see the change in activity.

This means in a very real sense that their reality is different; to me this is hope in a picture.

 

How do you know what is a normal reaction and what may be indicative of something more?

After all, sometimes your reactions are entirely normal and appropriate; the grief, sadness, anger and helplessness we feel at the death of a loved one is a normal response to reality. Being upset, sad and depressed are normal parts of the human spectrum of life. We all have them. And yet there is a difference between being depressed and depression; to the point that I've often thought we need different words to describe these two things. There is a difference between worry and anxiety. There is a difference between having a bad time and a Mental Illness. The differences may be subtle at times and they may not have a neat dividing line at which point we can say "And now it is a problem". Remember the nuance. One of the problems is that they are all different (unsurprisingly) and so have their own criteria - if you are unsure or want to know more - start here.

Here's what we do know:

Around 1 in 4 people will suffer from some form of Mental Health issue in the UK each year.

Any problem that causes people to take their own lives needs to be spoken about. It needs our attention. It needs talking about. It needs to be shared. It needs research. It needs to be de-stigmatised. It needs to be accepted. Only then can we begin to understand how to really help. It's hard to conduct the necessary research if half the people it affects are too scared to come forward.

It may not always be simple, straight forward or easy to understand. But so what? That shouldn't be enough to stop us. Let's elevate the conversation, I don't care if it's difficult for some people to grasp. it's happening so let's face it honestly. After all:

If your kidneys can fail, so can your brain. It is a phenomenally complex organ so perhaps it is unsurprising if the ways in which it can fail are also complex.

So what happens if your brain, as for me, sets you up to seek out problems where they do not lie? And then if it does, how do you know the exact point that you have a problem?

Honestly I don't have a clear answer. But if something is dominating your life, if it is ruining who you are and who you want to be, if you have been robbed of the joy of living then I'd say that's as good a sign as any.

Back to Me

CBT has a waiting list on the NHS that isn't the quickest; around a few months. Note - I'm not complaining about the NHS, they have an unenviably difficult position and are a wonderful institution. But one of the tenants of a Mental Health problem is that you'll damn sure wish you didn't have it. That you'd give anything in the world to not have it because your problem seems to bend space/time; it turns minutes into months. And that constant constancy of being an ever depressed me becomes simply untenable. I enjoyed that sentence and yes I realise that makes me a Wanker.

I couldn't bear the thought of just waiting for the phone to ring for months on end so I went and bought every CBT book for Depression I could get my hands. and devoured the damn lot of them. Otherwise I was just waiting, which didn't help the helplessness feeling all that much. 

So I started doing CBT by myself - if you're curious here's how that process goes. Every-time I had an intrusive, upsetting, anxious or depressing thought I had to write it down in my oh-so-fun, always worth a read:

You can get apps for this now, go here.

You can get apps for this now, go here.

 THOUGHT DIARY

  • I would have to write down where I was and who I was with.
  • How I felt - anxious, paranoid, scared, jealous etc
    • And then rank that feeling out of 10. A 10 is akin to being mentally eaten by Tigers. Fuck those tigers.
  • What was I thinking that accompanied the feeling
    • I'll cover this more when we get to the OCD bit as it will make more sense - A lot of the thoughts were that I wasn't enough, that everyone was going to leave me or how pathetic I was for not being able to get out of bed or stop crying. Just man up after all, right?
    • And again rank how strongly I believed that out of 10.
  • Then (the fun part) presenting the evidence I had for thinking and feeling the way that I did.
    • What had actually happened to make me think and feel that?
    • And if I were to present this to a Jury of my peers would I be able to draw the conclusions I had? Or would I have to twist the evidence more than Steven Avery to get a Guilty verdict.

What was my evidence?

Usually the answer was bugger all. Sweet FA. So how did I go from nothing happening, other than in my imagination, to this feeling that it MUST be happening and then feeling traumatised about it? Piss poor reasoning and accepting that my view of the world was an objective reality! We all do these and this process was actually quite useful in forcing me to question myself more. Something I think we should all be open to doing. There's a laundry list of potential errors you can make (here's a few of the frequent ones):

  1. Emotional Reasoning
  2. Black or White Thinking
  3. Negatively Predicting the Future
  4. Discounting the Positive
  5. Catastrophization/Minimisation
  6. The Fortune Teller Error

There are loads of these and you can check out more here to see which ones may apply to you. What you'll tend to find is that you make the same ones quite a lot. And that shapes part of your paradigm. For me I hit these ones with unerring accuracy and frequency:

Emotional Reasoning

  • I feel something therefore it must be true.
  • Nope. That doesn't work and definitely wouldn't hold up in front of a jury.

"I knew he was going to be a murderer so I poisoned his soup, your honour."
"How did you know?"
"I felt it."
"Are you a Jedi?"

"No."
"Then you're definitely going to prison for murder."

Negatively Predicting the Future

  • A fun one where the only future you imagine is a really really shit one. You only ever think of all the ways things could go badly and hurt you. It never occurs to you that it could actually go well. This is odd because you'd never do that to anyone else. If depression or anxiety were a friend you'd punch them in the face if they kept doing this!

Discounting the Positive

  • Any positive action that goes against your wonderful hypothesis of shit gets disregarded. If 12 people tell you that they like your face (don't ask why) but 1 person says it reminds them of gone off ham, you'll forget your 12 happy disciples and focus on the one Judas.

Personalisation

  • An interpretation that an act happens because of you. That someone behaved in a certain way as a result of what you did.
  • One of the traits of OCD is a sense of responsibility - that you have the power to affect the thing that you worry about.
This never occurs to anyone...

This never occurs to anyone...

Then, in theory, comes the change. After about a month of doing CBT I was a little better but I was still struggling quite frequently and being better still didn't mean that I felt like me yet. I'd started to have a troubling thought; would I or could I ever feel like myself again? Who was I now? Was this issue going to be a part of me forever?

This was something that drove suicidal thoughts, if life was always going to be like this, then it had no happiness and I wasn't sure I was strong enough to keep doing it and achieve anything with my life. And that idea of never achieving anything and feeling a failure compounded the depression and emptiness. I want my life to have meaning and to tick off the list of things that matter to me. And if I can't do that, then what's the point?

And somewhat upsettingly, I can't know. Not really. But then I can't know whether the next car trip I take will be my last. The future isn't and cannot be known. There is an inherent level of uncertainty to the future. That answer is upsetting to me but it gives an insight into the reality of treatment for OCD.

So finally after 6-7 months of this lovely state of affairs I got my first phone call with a professional. One of three that I would have with this person. Someone who was such an integral part of me getting the help I needed.

And I can't remember her name.

I feel bad about that because without her I'm not sure I'd have gotten this far. And that isn't fair on her. So for anyone that works in that particular field and may occasionally be forgotten at least in name, I promise you, you are not. Should you ever read this I want to say thank you. You make more of a difference than I think you could ever know.

What's the call like?

I was Maguired all the way up

I was Maguired all the way up

These conversations start with a description of yourself and your problems and then a boat load of questions to attempt to ascertain the particular issue. It's mental triage.

The only thing I really remember about that first phone call is doing the kind of crying where you sound like an asthmatic donkey. I don't know quite why I couldn't seem to control myself but I think it was because this was the first stranger I'd had to be completely honest with and that felt vulnerable. And vulnerable to me felt pathetic.

I so desperately wanted people to think that I was this cool, athletic, intelligent, articulate person. Really what that means is that I wanted people to admire me. But doing this, having this conversation meant that I wasn't those things. It meant this person was damn unlikely to admire me. Unless she happened to have a penchant for tears and sadness, in which case I was in. But it was real, it was true and so I had to say it. All of it.

A quick side-note - I tried to hang onto the thought that most people didn't seem to have this issue and that I hadn't always been like it, so there had to exist the possibility of life without it.

So what was I experiencing?

Where's the detail I promised?

I've mentioned that I would often have 200+ intrusive emotionally traumatic thoughts a day and couldn't seem to get them out of my head. No matter how much I tried to focus on other things or tell myself they weren't real or seek reassurance that they weren't happening, no matter how much I tried to look for all the good things in my life, how many walks in nature I took, how many times I turned off my phone and tried to "reconnect", no matter how much poetry I read, guitar I played, monologues I recited, gym sessions I hit NOTHING helped me escape my head.

I think I really understood, for the first time why some turn to drugs, sex or food; they are immediate pleasure. I felt a constant need for something to help escape the quite dreadful present. Literally anything that would provide, if only for a moment, some respite. I don't even mean happiness, I just mean not pain.

There's one thing I've left out of this story so far and that is that during all this time I had a girlfriend. I won't add names or details as that is her story and this is mine. But she spent about half the year here and half the year living in Dubai. This was something I found difficult.

And this is when the unnamed Therapist on the end of the phone suggested that I may have OCD. To say I was surprised would be an understatement as that had simply never occurred to me. I'd considered Bipolar to be the most likely as I could go through periods of actually being quite happy only to go straight back to where I was in a surprisingly short period of time. At that point OCD to me meant that you had to flick a light switch on and off and on and off and on and off for some unknown but crazy reason. Well I was pretty ill informed and it's one of the reasons I wanted to talk candidly about the reality of OCD and what it is and isn't.

It turns out I have something called Rumination OCD, in particular a subset called Relationship OCD. And yes, I realise this makes me a hell of a catch.

First off - let's define OCD

At its most basic Obsessive Compulsive Disorder is an Anxiety Disorder that creates behavioural or mental rituals to deal with and soothe the originating anxiety.

In other words

  1. An Obsession can be any thought that jumps into your head that happens to cause you Anxiety - and all the emotional problems and traumas that go with that. The signifier of Obsession is the Frequency and Severity with which you have this thought.
  2. A Compulsion can be any act or ritual that you undertake that temporarily soothes that Anxiety.
  3. That Relief feeds the cycle and the need for it to be repeated in the future to undo the Anxiety.

For example:

  • If you thought you'd left your hair straighteners/welding iron (obviously everyone has one of those) next to some wonderfully flammable material in your home/next to your sleeping child (an anxious thought - I'd hope anyway) you would be pretty irresponsible if you didn't go back and check to make sure that that wasn't true.
  • If we were to sit down to eat and the table had pulsating green gunks of unknown material, murky dark fluids and an unvaccinated measles infected child in the corner we might be as wise to really clean the hell out of the table or move for fear of getting infected by something pretty hideous.

The top one would be an example of Checking OCD. And the bottom would be an example of Contamination OCD.

At this point you may notice that the examples I've given seem like normal reactions to those situations. And you would be right. But what if you have these reactions and constant thoughts regardless of how clean the table is or how many times you checked the straighteners? An interesting thing happens when you check things, you actually become less confident in the outcome. It's the Who Wants To Be A Millionaire effect. When asked "Is that your final answer?" we become less confident and start to wonder about what we may have missed, left out or overlooked. We look for the holes in our argument or assessment. So each time we check we actually need to check more and more frequently to help satisfy our worries.

At this point you may be wondering whether OCD sufferers have fundamentally different thoughts to "normal" people?

In the 1970s researchers carried out experiments where they asked some people with OCD and some people without OCD to list their intrusive thoughts. They could find no difference in the types of thought reported by those with and those without OCD. The difference is that people with OCD have more frequent and distressing thoughts than others because of the meaning they attach to the thoughts and the way they respond to them. OCD is maintained when you interpret intrusive thoughts as a sign that is there a serious risk of harm to yourself or others (over-importance of thoughts), and also believe that you can prevent the harm by what you do or don't do (overinflated responsibility).

They took a group of OCD sufferers and Normal people and got them to write down all the intrusive thoughts that jumped into their heads across the course of a day, jumbled up the answers and got a team of OCD specialists to see if they could identify the "crazy" ones. And no is the answer. We all have unpleasant thoughts that jump into our head at various times, in the same way that we all have pleasant, or sexy time thoughts jump into our head. The point is you don't get to pick what jumps into your head and for some people, whether it's genetic, environmental or because of Professor Charles Xavier, these random thoughts take on extra meaning. 

The actual content of intrusive thoughts comes from your values - the things that are most important to you. The thoughts represent your deepest fears. So, for example, a mother might have intrusive thoughts about stabbing her baby, because he is the most precious thing in the world to her and she would be devastated if anything happened to him.

Which leads me to my personal brand of brain-fuckery;

Rumination OCD

Rumination OCD doesn't have a physical manifestation in the same way as Checking or Contamination does. As such it is sometimes referred to as "Pure-Obsession" or "Pure-O". So for me this means I have thoughts that need soothing through mental checklists or rituals that don't have a particular physical compulsion such as flicking a light switch.

Let's be specific then, I have relationship OCD. This means my brain has a preoccupation with the thought of being cheated on, left, abandoned, that I'm fundamentally not good enough for someone else and why wouldn't they want someone other than me, etc. Again, yes these are normal thoughts which nearly every one of us has. Remember it's the Frequency and Severity that denotes OCD. So if you're up there with me and can have a couple of hundred of these a day, then yes you may also have OCD here. Rumination OCD has two phases:

  1. The Spike - Having the random thought that makes you feel anxious, physically sick or emotionally troubled
  2. Rumination - The amount of time spent thinking about the originating spike and how to solve it or get rid of it.

It is not uncommon for a Pure-O to spend 8 hours or more a day ruminating over a problem trying to find a way out.

The next section is taken from the following website, and sums up a lot of Rumination OCD (should you relate to any of these) http://www.ocdonline.com/#!rethinking-the-unthinkable/cbqk

"With “Pure-O”, it is the threatening, nagging, or haunting nature of the idea, which compels the patient to engage in an extensive effort to escape from the thought. Most likely, it is not the intrusive idea, per se, that drives the response, but the associated emotional terror. The following are some illustrations of these types of “Pure-O” situations.

1. A man is involved in sexual relations with his female lover. Just prior to orgasm, the thought of his friend Bob pops into his head. This is the fourth time in a month that this has happened. In response to this, he becomes very upset and wonders whether or not he is gay. His sexual activity is terminated in order to avoid having to deal with this concern.

2. A mother is changing the diaper of her infant. As she lovingly looks down at this helpless child, the thought occurs to her to "take a pillow and smother him." In response to this thought, the mother panics and runs to another room to diminish the possibility of acting on this thought, because she feels that having the thought is tantamount to acting on it.

3. A student finishes a conversation with his favourite professor. For the next three hours the student reviews the conversation mentally to ascertain if he said anything that might have been offensive.

The mental ritual (rumination) is the volitional effort to shut off the anxiety, either by attempting to gain reassurance, solve the question, or avoid having the thought recur. The tormenting thought (spike) typically entails two parts. The first is the idea that the thought, in and of itself, is deviant and signifies something horrible about the person who has it. “I must be a sick, mentally unstable person to have had this thought occur.” Or, “Only a ‘bad’ person could think such a thing.” The second part is the great emotional and physical discomfort accompanying the intrusive idea. The symptoms of anxiety can include, but are not limited to: rapid and heavy heartbeat, upset stomach, excessive perspiration, muscle fatigue, mental thoughts and/or muscular tension. These symptoms are what make people with OCD “feel” that the spike is so problematic. It is during the rumination phase that the person's mind becomes extremely preoccupied and distracted. It is not unusual for someone with the “Pure-O” to spend endless hours trying to “escape” from these thoughts. The perceived need to stop these thoughts is tremendous. A common misconception among “Pure-O” sufferers is that there is a way to turn off the obsession, and that they just have to keep obsessing until they hit upon that way. If they can find “the answer,” the right thought, then the obsessing will just vanish completely. Most sufferers realise this is an impossibility, but they cannot give up the search." - Steven J. Phillipson, Ph.D.

It is worth pointing out that to your brain and therefore you, there is no difference between perception and reality. As we touched upon earlier, your perception is your reality. So whether or not the event that you are worried about is TRULY real or not makes ZERO difference to the feelings you have about it IF you perceive it to be real. This also means it is not just a case of telling yourself that it isn't real either. Here's why:

"...attempting to suppress thoughts has the effect of a mental boomerang whereby the cognitive backlash is actually stronger as one makes more efforts to bury the thoughts. Becoming upset over a thought places a mental marker on it and, therefore, increases the likelihood of the thought recurring." - Steven J. Phillipson, Ph.D.

This means that by telling yourself it's not true you are giving the thought credence or that it is something that needs dealing with.

Oh and if at this point you're still not with me that these things are dealt with differently by people with this disorder - here is a couple of snaps showing the difference in glucose metabolism (and therefore brain activity) in people with OCD versus normal when shown things to trigger their OCD.

So we can see that there is a very real difference in the two brains - that the experiences are truly different. So it isn't just a case of "Well I'm "normal" and I've had those thoughts and I got over them so why can't you?" This is an insulting thing to say as I can swear on every God in every fathomable existence that the person suffering with it has gone through that process more times than you can imagine. If that worked, it would have worked a long time ago. But that said Mental Health doesn't just happen to you, even though it can feel like an abyss of loneliness at its joyful best. As such we have to think of how this affects the people in our lives as well. I'll try and touch on that towards the end of this.

Back to Me - Again

So by now my mind would be almost constantly imagining that my aforementioned Girlfriend would be cheating on me - you know cause 2pm on a Tuesday in a coffee shop is a good enough reason to think that was happening. And obviously this would be happening because I wasn't good enough, so of course that would be something she'd want to do. It's worth noting that the thoughts I was having are in no way a reflection on the person, I could have had these thoughts had I been going out with a blow up doll. It was my distortion that was the problem not the way that person was truly acting.

Here are a few examples of the worries I would have, which would then result in some of these fun moves or compulsions:

  • If I said I love you, and she just said "You too" instead of "I love you too" then obviously she didn't and it was confirmation of the fact I was about to be left.
  • If I was worried about being left or something not being right I would do some or all of the following:
    • Be overly loving and sweet - why would you then want to cheat on such a wonderful boyfriend
    • Be a little aloof - then you would notice and be nice to me and I would know that you cared. Or if you didn't then I would know that you didn't care and confirm the thing I worried about.
    • Try and be subtle (It is likely that I was the least subtle person on Earth) and find out what she was up to and make sure it wasn't a threatening situation.

Yes I was very smooth. And again, to reiterate - the thoughts are normal, the frequency, severity and meaning that I attached to these thoughts are the reasons they become debilitating. Even if you're normal if you were to really in great detail live out that imaginary scenario, it isn't pleasant. Now do it hundreds of times a day for months on end and get back to me.

Really nothing else mattered to me during this time. This was so constant and so real to me that although to begin with it, it was just annoying, it kept building to the point that I would occasionally cry by the toilet in the gym and after several months I had lost the resolve to get out of bed most days - I just had nothing left.

There are a few other things that had happened during this that I won't share online as it would intrude on someone else's privacy but safe to say that without some of them I'm not sure I would have ended up in the position I did and my inability to cope with all of this.

Treatment Time

 Was it too much to ask for this....

 Was it too much to ask for this....

Now the real shit-kicker is that the treatment and solution for OCD lay within my very worst fear - To have to sit with the fears, anxieties and all the crap that tears you apart and just let it be there until it passes. This means no arguing with the thought. No telling it, it is right or wrong. No looking for holes in it or ways it could be wrong. Just letting it exist, feel the shitness that it makes you feel and try to refocus on something else. 200+ times a day. For 8 hours plus a day. And when you find yourself about to say "No but…" attempt to stop, breath and refocus on something/anything else.

I spent months fighting this concept, I kept wanting it to not be true. I still wanted to just find that one perfect answer that I needed that would make me feel sure instead. If I got that perfect answer I would surely feel great. I still feel that way at times. But I have to accept that it doesn't exist. I can't be 100% certain about anything in life, not really and I shouldn't need to be. If you relate to what I'm writing about then I know how hard that thought is to sit with. The problem is that the evidence tells us this is the most effective treatment. And if we have accepted the way in which OCD continues to manifest itself we understand how and why we must move forward with this difficult treatment.

I then started seeing Dr Elizabeth Forester for a few months of OCD CBT (she did her PhD in this issue so that was very useful - in fact she worked under the person who wrote the book I worked through - see pic). I would highly recommend her should you be interested in it. Each week we worked and worked the issues I was having. And I was given homework to do each and every week.

And honestly by the end of it I was much, much better.

What do I mean by much, much better?

Well from 200+ thoughts a day I was down to between 3-10 a day. A.k.a a piece of piss! Bring on your 10 thoughts a day and I will laugh willingly in your face. I got this. Less than double figures is manageable. And the more you do this the less frequency you experience them. In the same way that OCD becomes a little self-fulfilling, the treatment, if you can truly engage with it (by not engaging with it - ta da) becomes easier and easier as the amount of ignoring you have to do becomes less and less.

I finished CBT with Liz around November 2014, nearly a year after starting my journey into OCD. For some of you reading this a year is nothing and you'll have had it for much much longer. For others of you the thought of living like this for a year will feel a dauntingly long time. It doesn't matter how long you have had it - every day that you live with something that takes away the joy and meaning from your life is a tragic waste of the finite days we have. Get help and fight the fear that nothing can be done. It can. It is terrifying and it without a shadow of a doubt the hardest thing I've ever done. Getting shredded is laughably easy compared. But without it my choices were getting narrower and narrower. I'm saying that no matter how hard it may be, it is worth it. Maybe this bears repeating:

No matter how long the journey may seem, start. The time will pass anyway and you'll either be closer to it or you won't.

So am I out the other side?

Nope - remember at the start of this article I said I was having one of those days where I couldn't escape my own head. I still have those every now and then. I am not perfect. But I don't have to be, and nor do you.

For me one of the hardest parts of living with this is knowing what is just a normal reaction to bad things, the break up of a relationship for example, and what is my OCD. I know it's normal to dwell on things when they end. That is to grieve. I know that the passing of something that mattered to me and the knowledge that I will not have it again, hurts. It is time consuming and neither you, nor I, can rush it. Your brain will think about it, it will remember it, it will explore it; and it will hurt. This doesn't have to mean the OCD is back. But I will still worry that it might, that maybe I'm going back to that place.

The idea of what doesn't kill you makes you stronger reminds me of this:

Because of all that has happened I am not as strong at defending against this. Scars last. The effects of all the things that have happened to you last. Being endlessly positive that it may never happen again and that you'll always be fine simply doesn't help, in the same way that being endlessly negative that you'll never be better doesn't either. Neither of them reflect reality. You can't know which future you will have, but you can attempt to engage in behaviours that help rather than hinder your path. Happy can't exist without sad so we shouldn't be ashamed of our reality, whichever one we happen to be living at the time. 1 in 4 people will be in the same (or at least a similar) boat as you. So let's talk about it.

And of course I do still get ashamed about the way I am. And the way I feel. Sometimes I'll still take a day off if something happens and I can't seem to get my brain to focus on anything else. I'd still rather hide than go into work and see clients because I can't face the idea of losing it in front of them. Often I'll still say "I've got a cold." or something other than the truth because I am still embarrassed by it. I don't want to be and I can still talk about it in spite of my embarrassment but that doesn't mean I'm ok with it.

I will likely always have a disposition towards this kind of problem. I will likely always have OCD (at least the potential for it) but maybe I won't. There is no way to truly know. I do know that taking care of my mental health comes above everything else because without it, I am nothing. For me and maybe you, everything is contingent upon it and so of course I aim to try and catch myself before I making similar errors in the future.

As far as advice for you, the person reading this goes, all I would ask is that you be honest with yourself. And if you need it, seek help. Professional help. It will be the best thing you could ever do and could even save your life. I say that with no sense of embellishment, it is a simple fact.

And if you don't have this but you know someone who does struggle with problems, on their behalf thanks. They may not be able to be thankful at the time, but having people around matters. They will drain you, frustrate you and it will annoy the crap out of you that almost no matter what you say, you can't seem to help them. This can ruin relationships if you're not careful. You have to look after yourself as well, if you need to walk away and take some time, do so. Try to tell the person in your life that you still care, that you still love them, but make sure you aren't being dragged down the whole time. The person you loved is still there, somewhere but they need help rediscovering that. That help cannot come from you, it needs to be professional. Read up on the condition they have. Learn what to say and what not to say. Just get over it is not helpful in the slightest, they will have tried that many times over. Others have it worse than you doesn't change their reality. If anything it makes them feel guilty that they still feel shit when so many others have problems that look bigger than theirs. The "If I can't get past this small thing while those guys seem to be able to deal with huge issues, how pathetic am I?" just reinforces the helplessness.

Please start with this video. It truly is a wonderful resource. As is all of the Black Dog series.

I don't really have a great way of wrapping this up. Mainly because that suggests a clear end and I don't think I want to do that. It wouldn't be reflective of the issue. Instead I want to end on a suggestion that no matter what, we have the capacity to choose. Not that it will be easy and not that you'll want to but that you can. You can try at the least.

I hope reading this gives you an insight into the realities of OCD and perhaps helps some of you relate to something and maybe feel a little less alone in your struggles. My take away point, if I have one, will always be to seek help and to try not to be ashamed - you really shouldn't be. 

And maybe this: I promise you you are loved and cared about, that your life has meaning and is to be cherished. Get help and realise this again for yourself.

If there is anything I can do, please feel free to email me here, even if it's just to share your stories and hard times. I will always be there to empathise and listen. One of the aims of Body By Control is to create an open community of people who walk the path and help each other along. We can't do that if we're not honest with what we face upon our path. There is no judgement, we simply want to help you in the best way we can. This is your life after all.

Thanks for taking the time to read this. I really, truly appreciate it.

Paul x