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What is OCD? and understanding ERP Therapy

This blog will provide an explanation of OCD, and an understanding of ERP Therapy.

What is OCD?

Obsessive Compulsive Disorder (OCD) can be incredibly frustrating to experience and really debilitating to day-to-day life. Most people will have had the first signs in their childhood or teenage years and by time they seek OCD treatment will have experienced a gradual worsening of symptoms over many years. OCD is a combination of being distressed by intrusive thoughts (obsessions) and engaging in behaviours (compulsions) to try to stop these thoughts or in efforts to prevent your fears coming true.

Types of OCD

There are lots of ways that OCD can occur, and it’s common for people to experience the focus of their OCD switching around over the years. The general public’s ideas of OCD is usually to do with cleaning and checking, but there are many other types of OCD as explored below.

Fear of harming self or others

Intrusive Thoughts of harming yourself or harming others is frequently present for those with OCD. This could be thoughts of swerving into traffic, thoughts of having accidentally run someone over, thoughts of stabbing yourself, thoughts of smothering a child, thoughts of jumping off a balcony, or thoughts of physically attacking someone with a heavy object as examples.
What’s important to know about these thoughts is the reason you find them so distressing is because they aren’t thoughts you’ve chosen, they are the opposite of your desires or intentions, and they don’t represent you and who you are at all.
Everyone, not just those with OCD, will experience intrusive thoughts like these, we have plenty of research that proves that. The difference is the average person will dismiss the thoughts as irrelevant, whereas someone with OCD will obsess over these thoughts, worry what they mean, and spiral into anxiety. Common behaviour responses are to try to block these thoughts, or to avoid the situations where you fear you might cause harm – e.g. avoid driving, avoiding looking after children, avoiding balconies or bridges, avoiding using sharp knives etc.

Sexual thoughts

This type of OCD has thoughts and images of sexual acts. A common one with this is thoughts of being a paedophile, or having raped someone you’ve had sex with, of being sexually attracted to someone inappropriate etc. Again, as said above, these thoughts are not real, although they may be highly distressing, and having them doesn’t mean anything is wrong with you. The fear that they could be true often drives behaviours such as avoiding being near children, avoiding having sexual relationships, avoiding being near anyone that is minimally clothed (swimming, beaches etc). It can also cause an avoidance of watching certain film or TV content.

Contamination

Fear of contamination is another type of OCD. There’s often a feeling of being dirty oneself, or of certain items being dirty. As part of this is an unrealistic idea of how germs can transfer and of how harmful they are. Hand washing is common in contamination fear OCD, as is using of anti-bacteria products, avoidance of bodily fluids, and of touching items others have touched. Hand washing or showering is often repeated excessively until a feeling of being clean is achieved. It’s also common to avoid touching items like bins, to avoid public toilets, excessively wash bedsheets, and have extra rituals for handling meat or diary food items.

Self-Doubt

Checking is another more well-known OCD behaviour. This is driven by self-doubt, of not being certain that you did do something, and that you did it correctly. Typical checking behaviours with this are doors, locks, plugs, electrical appliances etc. It can also come up as situations where you believe it’s possible that you’ve said or done something bad without realising it, resulting in trying to search back through your memory, or get reassurance from others.

Rituals and compulsions

Just like with contamination, there’s a repetition of a particular behaviour until a certain feeling is achieved – in this case something ‘feeling right’. Rituals and compulsions can vary greatly from person to person. Examples might include a very detailed order in which you have to do things in the morning or at night, the saying of prayers repeatedly, rewinding the actions done when an unwanted thought occurred, ordering options in a particular way, a process of counting or touching items to prevent something bad from happening etc.

Confessing

This compulsion can result from a range of content of unwanted thoughts. It’s often believing that lots of thoughts we have are wrong, that certain thoughts are cheating or disloyal, that any negative thoughts about a loved one make us a bad person. In these situations it’s common for those with OCD to confess these thoughts to others, to seek their view on if this makes them bad, to seek their forgiveness etc.

 

Symptoms of OCD and Signs of OCD

The information above talks about some of the intrusive thoughts that are common within OCD, and some of the compulsions that are often engaged in. But this is by no means a comprehensive list of signs of OCD. The content of distressing thoughts can be hugely wide ranging.
Because OCD is highly distressing, it can commonly lead to other symptoms of OCD such as difficulty sleeping, irritability, muscle tension, difficulty relaxing, feeling exhausted and much more.

OCD Treatment

Therapy for OCD is something that many avoid for years. There’s often a lot of shame in the thoughts they have, and therefore sharing them with anyone, even a therapist can be difficult. It’s normal to not want to tell your therapist about all your thoughts straight away, it often takes many sessions to feel comfortable sharing everything, and that’s okay.
CBT for OCD has been well researched and has good results. The aim of treatment is to look at changing how we respond to the unwanted thoughts, and to work to stop engaging in the unnecessary behaviours and compulsions that follow these thoughts.

ERP Therapy

The most used approach in OCD treatment is what’s called ERP – this is learning to tolerate the unwanted thoughts, whilst not engaging with the behaviour response. Lots of clients come to therapy asking for help in getting the thoughts that distress them to stop. But everyone has these thoughts sometimes, the difference is that because those with OCD are fearful of them, judge themselves for having them, and engage in behaviours because of them, these thoughts get fed and therefore appear more and more frequently in a vicious cycle.
Lots of clients by time they seek out therapy will have multiple types of OCD impacting them, and therefore therapy may take a while to work through all of these. It’s not uncommon for clients to have 20 sessions of OCD Therapy.
It is recommended that if you are seeking therapy for OCD that you go to an accredited Cognitive Behavioural Therapist – you can check that they are accredited with the British Association of Behavioural and Cognitive Psychotherapists (BABCP).

Support for OCD:

There’s 2 main charities in the UK focusing on OCD, both offering a wealth of information and advice, and also providing support groups. Follow their links here:
OCD-UK | A national OCD charity, run by, and for people with lived experience of OCD (ocduk.org)
OCD Action

My experience as an OCD Therapist/OCD Specialist:

I have been working with OCD for over 10 years now, and have had lots of clients with quite severe cases who were really struggling to cope. OCD is something I’m experienced in working with, and my straight talking approach to therapy gets good results. Clients also often report that they find it easy to feel comfortable with me which makes opening up much easier. As I’ll explain to lots of clients, my role is to get you better as fast as possible, that means you won’t always like me, and I’ll push you at times, but that’s what will give you the best chance of recovery.

Get in touch at hello@hannahpaskintherapy.co.uk

 

Other relevant blogs:

Therapy for Men | Hannah Paskin (hannahpaskintherapy.co.uk)

Am I worrying too much? Understanding Generalised Anxiety Disorder | Hannah Paskin (hannahpaskintherapy.co.uk)

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