Kevin Flynn and Laura Philpott from TCD’s OCD support group give advice on dealing with obsessive-compulsive disorder.
Picture this… your mind is a record player stuck on track A. Now imagine that track A is a specific image or thought that keeps replaying in your mind. You want to fast-forward and skip this track but no matter what you do or how hard you try, the image or thought keeps replaying in your mind over and over again. With this thought or image comes anxiety. Anxiety is your body’s warning system; it tells your body to expect fear and to prepare for danger. You might realise these feelings are irrational and make no sense but these intense emotions still feel very real.
This is only a snapshot of what it feels like to have OCD (obsessive-compulsive Disorder) – a stark contrast to the phrases ‘being a little bit OCD’ and ‘being OCD about something’. These phrases are thrown around in everyday language but OCD needs to be taken seriously. It is a debilitating and disabling psychological disorder, so much so that the WHO (World Health Organisation) ranked it in the top 10 most disabling illnesses. Based on current estimates of the student population, there are approximately 200 TCD students currently experiencing OCD. This is enough people to fill the Beckett Theatre.
OCD has been referred to as the ‘imp of the mind.’ For most people, the imp is a fleeting annoyance, but for those with OCD it can lead to disabling degrees of anxiety and distress. Have you ever wondered whether you have left the oven on, door unlocked or immersion on and had to check it? What would it be like if each time you checked you still doubted yourself? Have you ever had an odd thought like crashing your car? Typically, a person might notice that this is an unusual thought and move on. However, what if you took this thought seriously, and then believed that you might actually do this? Think of the guilt and shame you might feel if you believed yourself to be capable of this act. What if the only way you could neutralise these distressing thoughts is through elaborate rituals that interfered with your day-to-day life? This is the experience of those with OCD.
Signs and symptoms
OCD is characterised by the presence of both obsessions and compulsions. Obsessions present themselves in the form of persistent and intrusive thoughts, worries and/or fears. Obsessions come in many guises including:
– Worries about germs/disease;
– Fear of acting on impulse of harming others;
– Fear of being responsible for something terrible happening;
– Unwanted sexual thoughts, such perverse sexual thoughts or images;
– Religious obsessions.
Compulsions are repetitive behaviours or thoughts that people use in response to their obsession. Common compulsions associated with OCD include:
– Constant checking;
– Repetitive behaviour, sometimes in multiples;
– Excessive washing and cleaning;
– Mental compulsions, such as counting while performing a task to end on a “safe” number;
In the same way we all experience occasional recurring thoughts, though, not all repetitive behaviours are compulsions.
Does it affect students?
OCD can have a significant impact on the lives of students with OCD. The stresses of assignments and exams can be triggers for obsessions. Perfectionism, excessive checking or paying too much attention to detail, can also be a significant issue, impacting on students’ productivity and making it difficult for them to let go of assignments. Constantly doubting and ruminating about getting things right and needing everything to be in order before feeling you can get into a study routine is also common. This obsessiveness can lead to procrastination, avoidance and excessively high standards that can fuel anxiety.
OCD is generally considered to be a disorder of the brain and often begins in childhood or adolescence, although it can develop in adulthood. We are unsure what exactly causes OCD but genetic factors, environmental factors and neurological factors are being investigated. It has been found that family members of people with OCD are more likely to have an OCD spectrum condition. However, identical twins do not necessarily develop OCD, so it appears that genes are not the sole determinant of whether someone may develop OCD. OCD sufferers’ brains have been found to function differently than non-sufferers under the scrutiny of advanced brain scanning technology, but the precise mechanism of these differences are unclear.
The neurotransmitter serotonin, which is related to anxiety, sleep and memory, has been implicated in OCD. Stress has found to be a trigger for individuals with OCD. Stressful events such as relationship difficulties, exam pressures or problems at work can exacerbate issues with OCD, and contribute to the frequency and severity of a person’s OCD. People engage in compulsions as they feel it will ease the anxiety their obsession triggers. However, this is only a temporary solution and short-term escape. OCD sufferers might engage in avoidance of situations that trigger their obsessions. Again, avoidance is only a short-term solution and adds to the maintenance of OCD. OCD is maintained by the vicious cycle of obsessions, anxiety and engaging compulsions in response to the anxiety. Avoiding a situation where a trigger might arise leads to short-term relief as you have avoided the distress you think might have happened, but this only reinforces the presence of OCD.
The NICE (National Institute of Clinical Excellence) provides guidance on the treatment of OCD. Using current research findings, NICE guidelines outline evidence-based recommendations for treating OCD depending on levels of functional impairment. These levels might vary from moderate to severe impairment on one’s day-to-day functioning. NICE Guidelines recommend the use of cognitive behavioural therapy (CBT) based low intensity psychological treatments for the initial treatment of OCD. CBT is a structured programme which involves exposure and response prevention. This involves facing situations you find distressing (exposure) and not engaging in a compulsion following the exposure to the feared situation (response prevention).
This programme uses a hierarchical approach in the levels of exposure, gradually building from easier situations to more difficult situations NICE Guidelines suggest the use of brief individual CBT through structured self-help materials, brief individual CBT by telephone and group CBT. It is advised that ERP (exposure and response prevention) are included in these CBT interventions. For those not responding to CBT or those experiencing severe functional impairment, NICE guidelines suggest drug treatments such as SSRI (selective serotonin reuptake inhibitors). Support groups are an additional help, providing a safe environments where sufferers of OCD can share their experiences and provide support for each other in a non-judgmental atmosphere.
Does this all sound familiar?
If these symptoms and experiences sound familiar, you can speak to your GP. TCD students can access support through the Student Counselling Service on: (01) 896 1407. OCD Ireland also runs a support group in TCD on the second Monday of every month. More information is available at www.ocdireland.ie.
Illustration: Natalie Duda