- Physical acts are the most common forms of compulsion
- But 10-15% of OCD sufferers carry out their rituals entirely in their minds
- This form of the disorder is harder to treat and can go unnoticed for years
- Almost half the UK population think they have mild OCD
- The true incidence is between 1-3% of the population
17:58 EST, 4 November 2013
18:02 EST, 4 November 2013
Mental compulsions: David Bass is plagued by thoughts that he has said something offensive
The words ‘obsessive compulsive disorder’ usually conjure up a picture of someone constantly washing their hands, or checking they have locked the door or turned off the stove.
OCD, which affects one person in 100, causes obsessive, unwanted thoughts and images, which trigger compulsive, ritualistic behaviour.
Physical acts such as washing and checking are the most common compulsions, but 10 to 15 per cent of sufferers carry out their rituals purely internally, in their minds.
David Bass is one of them.
‘My OCD’s all going on in my head,’ says David, 25, who is from Bedfordshire and worked as a TV presenter before becoming ill.
David is plagued by thoughts that he has said something offensive – when talking to women, he panics needlessly that he has made sexually inappropriate remarks; when speaking to a black friend, he worries he has said something that could be construed as racist.
As a result, he scans over everything he has just said.
‘I feel compelled to replay everything I’ve said in my mind,’ says David. ‘Ironically, this means I zone out and may end up seeming rude anyway.’
This form of the disorder is harder to treat – and because it’s less recognised and there is no visible behaviour, can go unnoticed for years. Sufferers may not even realise they have it.
Studies show there are many misconceptions surrounding OCD. Research published last month suggested that almost half the UK population believe they have mild obsessive compulsive disorder, when the true incidence is much lower – between 1 and 3 per cent of the population (ie, nearly a million people).
Experts note that people frequently say they are ‘a little bit OCD’, meaning they like routine or need to double-check they have locked the front door – but this is to misunderstand what can be a devastating mental illness.
‘Performing such rituals is not pleasurable,’ says a spokesman for the National Institute of Mental Health. ‘At best it provides temporary relief from the anxiety created by obsessive thoughts.’
The form of OCD that David suffers from has been described as ‘purely obsessional OCD’ or ‘pure O’ because there is no visible compulsive behaviour (the ‘C’) – but this is another misconception.
‘There’s a myth that OCD can exist without the “C”,’ says Professor David Mataix-Cols, a specialist in the disorder at the Institute of Psychiatry in London.
‘A patient may suggest that they have only the obsessive part of the disorder, but we find they are doing lots of the compulsive behaviour inside their heads – for example, praying silently in an effort to calm their anxiety.’
The stereotype: Hand-washing is one of the more common compulsions, but 10 to 15 per cent of those suffering from OCD carry out their rituals internally
For these patients, such rituals perform the same function that handwashing does for others, adds Dr David Veale, a consultant psychiatrist and OCD expert at the South London and Maudsley NHS Trust.
He explains that they try to get rid of the obsessive thoughts by distracting themselves or ‘neutralising’ the thoughts by performing mental rituals to try to calm their anxiety.
‘But these ways of coping ultimately don’t work – or make things worse,’ says Dr Veale.
Doctors can’t explain why some people suffer only psychological symptoms, but Dr Veale says that such patients are often highly intelligent: ‘They are likely to be analytical types, trying to solve things in their heads.’
David Bass struggles with an exhausting range of mental compulsions. At the moment, he is suffering with an obsession that he may somehow end up in prison.
‘I keep worrying that I’ve knocked someone over when driving,’ he says. ‘I repeat, “You haven’t, you haven’t, you haven’t” in my head to try to reassure myself.’
He often attempts to suppress the disturbing thoughts that trigger his anxieties. ‘I’ve done this a lot in church, where I’ve been plagued by the fear that I would shout out something blasphemous, such as “Jesus is a demon”,’ he says.
‘It’s an unbearable thought so I try not to think it.’
Unfortunately, this fuels the problem. It’s a phenomenon known as the white bear effect, after studies in which healthy people were asked not to think of white bears, and found they could not help thinking of exactly that.
Indeed, David is so overwhelmed by the thought of blaspheming in church that he no longer feels able to worship.
We are all occasionally struck by unwanted thoughts. But while most of us can think of something else and move on, OCD sufferers become consumed by them.
What causes the disorder is unknown but stress, genetics and childhood difficulties may all play a part.
David, who has suffered with the condition from the age of 12, suspects that it runs in his family. His mother and maternal grandmother have both displayed compulsive behaviour.
‘My mum once went on holiday and had to drive 50 miles back to check she hadn’t left the gas on,’ he recalls.
‘I keep worrying that I’ve knocked
someone over when driving. I repeat, “You haven’t, you
haven’t, you haven’t” in my head to try to reassure myself.’
The disorder is generally very treatable. The standard treatments are drug therapy with antidepressants known as selective serotonin reuptake inhibitors, and cognitive behavioural therapy (CBT), a psychological method for helping people change their thinking and behaviour.
But OCD with purely mental compulsions can be harder to overcome, says Dr Veale.
This is because the standard CBT technique – gradually exposing patients to what they fear, and teaching them how to respond – is harder to apply.
David overcame an obsession with hygiene when he was a teenager using this approach.
‘I was particularly scared of dog muck,’ says David, who became so unwell that he would feel compelled to open doors with his feet and wash his hands until they bled.
As part of his therapy, he had to hold a shoe and not wash his hands afterwards. ‘It sounds strange but it worked,’ he says. He was well between the ages of 14 and 16. But then the illness returned, this time with purely mental compulsions.
OCD symptoms often change in this way, according to Dr Veale.
Unfortunately, David is struggling to apply exposure therapy to his ‘What if I’ve said or done something awful?’ thoughts. Exposing oneself to something tangible, such as dirt, is easier.
David is taking the antidepressant sertraline and being encouraged by his therapist to face his fears by, for example, telling himself that he has actually knocked over a cyclist, and picturing the scene in as much detail as possible.
He must then resist the urge to neutralise the frightening thought or image with his mental rituals of saying to himself ‘you haven’t, you haven’t’.
‘Being properly frightened, and learning that you can calm down on your own without ritualising is essential,’ says Professor Mataix-Cols.
Dr Veale says it’s also important to help patients understand the context in which the obsessions are occurring. ‘It’s usually at a time of great stress or linked to some emotional memory,’ he says.
Perhaps the most important therapy for patients like David, whose anguish has often left him unable to leave the house, is to try to lead as normal a life as possible.
‘It’s crucial to get out there and do the things that are important to you,’ says Dr Veale.
n For more information, see ocdaction.org.uk and ocduk.org
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London, United Kingdom,
1 hour ago
This is me!! Glad to see I am already doing what the doctors say I should do. I allow the thoughts to come and try not to react because that makes it worse. You have to focus on what is good in your life.
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