OCD - what is it and what is in common among people suffering from it

OCD is one of the most painful human conditions. It is a complex psychological, physical, behavioural and cognitive set of experiences that involve all aspects of a person and has far reaching consequences on the quality of life of who suffers from it, and on the people around them.

What is OCD?

The most common definition of OCD includes two elements

1- Obsession: a set of intrusive, repeated and powerful thoughts and beliefs that take hold of the mind. In addition to the thoughts, the person feels strong anxiety and dread. This anxiety is felt in the body as great discomfort, to the point that something needs to be done to make it go away; this leads to the second leg of OCD…

2- Compulsion: a set of actions, that usually follow a specific and rigid sequence, that the sufferer feels compelled to do to lower the level of anxiety. Compulsion can be one, or a combination of, the following

a) actions on an external object (walking in a certain way, opening and closing something a specific number of times),

b) actions on the body (scratching, pulling hair, etc.),

c) internal actions not visible externally (having to remember something or having to erase or change certain inner sensations).

In addition to what I have described above, all people suffering from OCD have

3) Doubts : the obsession is usually linked to a specific doubt that the person has got. Usually the doubt is about something bad about the person. The most common OCD doubts are about sexual topics, or having done something wrong. 

Usually this doubt is very specific and the person cannot find the truth about it.

A hole in their inner world

The doubt that the person suffering from OCD has got can only be resolved by connecting to some inner experience that will clarify it. 

Let’s say, for example, that the OCD sufferer doubts whether they like apples. In their mind, though, liking apples is something totally wrong that they cannot possibly accept to be true. If that was to be true, they’d be devastated.

The sufferer typically goes through the following

1) they see an apple, or someone talks about apples, or they simply remember or think of an apple (trigger)

2) as soon as the apple is at horizon of their thoughts, they start checking and monitoring their bodily reactions… they fear that they will find out that their body might, indeed, like apples

3) the checking, though, fails, because the fear of them liking apples is so strong that the experience of potentially liking apples is repressed

4) the OCD sufferer, at this point, has got no way to shade any light on their doubts… because they cannot feel their own reaction to the apple. As a consequence, another level of checking starts. The OCD sufferer starts drilling their own memories in search for clues about whether they like, or ever liked, apples. This brings no result though, and the sufferer starts analysing anything they had said, thought or done that might prove that they like apples. It is, truly, as if they have entered a court of justice in which they have to prove to not be guilty.

Notice that, when this checking starts, the sufferer is not going to be able to find any valid answer. The answer to the doubt lies in the felt experience of liking apples, and not in the memory of some other fact that shows a liking of apples. 

It is at this point that the suffering is only destined to grow. The more the person looks for clues in their memories, the more the fear of them liking apples grows. Nothing is ever enough to come to a conclusion, and the fear keeps on piling up.

Once this has reached a peak of discomfort, the person is compelled to do something to release it.

The best point of therapeutic intervention is to act on the first set of fears, the ones that block the experience that might lead to clarity over the doubt. This is, obviously, very scary to a client who is doing their best to not feel that experience. There are extreme parts of the clients that do not allow the embodied experience of “liking apples” to be felt. It is necessary to acknowledge, respect and work on these fears for as long as it is needed until the client can find the truth and clarify their doubts themselves.

The history of doubts

Before starting the therapeutic work on the fear of feeling that sensation that might prove whether the client likes apples or not, it is important to understand the history of such doubts. 

As I wrote earlier, these doubts are usually fixated around sexual aspects (but they do not have to be sexual; they can be about anything). These doubts usually have a history and they stabilise around puberty or after major changes in life. Usually clients can identify easily that, before they doubted about liking apples, they might have doubted whether they liked ice cream, etc.

Generally the first memories of OCD-like obsessions and compulsions appeared in the first 4 years of life. This means that the roots to these behaviours are in something that was happening in the family from early infancy. 

The fear of causing death of a parent

It is in the early memories of infancy that, in almost all cases, clients have told me that they had deep fear that their actions would, in some way, harm one or both of their parents to the point that they would die.

You can see here what we generally call “magical thinking”, which is the way in which children think. Children feel extremely responsible for their parents’ actions and reactions, and they are extremely skilled at picking up what is good and wrong behaviour. In other words, the more the parents respond to the child’s behaviour in extreme ways (anger, rage, disgust, full-on telling off, etc.) the more the child will think that their actions have enormous effects.

We tend to forget that, for children, mum and dad ARE the whole world. If anything happens to their parents, the child is deeply affected without barriers and without defence. The child trusts the world and absorbs all that is around them.

Guilt and shame combined

Having such childhood experiences leads to experience a combination of shame and guilt. People suffering from OCD feel extreme guilty for something about them, which they doubt might be true, and are also ashamed of it. 

Going back to the apples example, the OCD sufferer not only dwells with the doubt of whether or not they are guilty of liking apples, but also keeps the whole thing secret because “liking apples” is shameful. 

Shame and guilt are the emotions that are most at the surface of OCD clients. To ease some of the pain, it is important to deal with these two first, and slowly go to the original fears. This work requires trust and hope, and the willingness to face distressing emotions. At times, the use of medications might be needed to stop acute crisis when compulsive behaviour stops normal functioning.