Tag Archives: ocd

Obsessive-Compulsive Disorder and Secrecy

Great article by:

Albert Rothenberg, M.D.

Creative Explorations

https://www.psychologytoday.com/ca/blog/creative-explorations/201910/obsessive-compulsive-disorder-and-secrecy

A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients’ secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.

More than with many other psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one’s clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.

The feelings of shame and desire for secrecy strongly influence patients’ open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.

Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.

Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.

How much is “excessive”? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?

At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.

For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations.

Obsessive-compulsive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.

Mental IMAGES

OCD is defined as: Obsessions are unwanted and repetitive thoughts, urges, or images that don’t go away. They cause a lot of anxiety. These obsessive thoughts can be uncomfortable. Obsessions aren’t thoughts that a person would normally focus on, and they are not about a person’s character. They are symptoms of an illness.

I wanted to shed light on mental images in OCD, a lot of times people who do know about OCD know about the intrusive thoughts or the compulsions. But what about the mental images? Many people who suffer with OCD are plagued by mental images that are often disturbing & distressing in nature. This makes the fears amplified to the point of the individual now picturing in detail their worst nightmares. Aaron Harvey describes it in an interview with Cosmopolitan.

“One of the things I have to deal with the most is harm OCD, and it’s really challenging. When I step into the shower and see the razor blade, it will automatically trigger [an image of] me, like, mutilating my genitalia. If I react to those images, they just get worse. It’s kind of like living in a nightmare. …I’ve struggled with sexual identity as a result of repeated, intrusive sexual thoughts about men, despite being straight. During sex, I may have dozens of intrusive thoughts spanning incest, violence, and other unwanted imagery that steals the beauty of the moment. I have graphic flashes of friends and strangers engaging in bizarre sexual acts” – Aaron Harvey (creator of instrusivethoughts.org)

The images are extremely debilitating, and getting to a point where you are okay with just allowing them to pop in and out is extremely painful and difficult. The images cause a lot of distress, so suffers gut reaction is to try their hardest to get rid of the thoughts. But as we know trying to push away and resist the thoughts fuels OCD and makes it worse.

ERP is a great tool against the images, exposing yourself to the images and not allowing yourself to engage in compulsions will allow the reaction subside. To really challenge yourself purposely try and think of the images and confront the discomfort.

Exposure Response Prevention, commonly referred to as ERP, is a therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions.

Exposure therapy starts with confronting items and situations that cause anxiety, but anxiety that you feel able to tolerate. After the first few times, you will find your anxiety does not climb as high and does not last as long. You will then move on to more difficult exposure exercises.

Being asked to face your fears is perhaps one of the bravest aspects of treatment, and is where the approach of the therapist is most valuable, helping a person understand the cognitive reasons behind an exercise and being there to help encourage and motivate them to face the challenges it involves.  If the therapist actually participates in the exercises too, this helps build up trust and confidence in what they are asking the person with OCD to do.

Uncertainty

OCD at its core is the inability to accept uncertainty. Life is uncertain and no one can predict the future, and for someone with OCD they will try relentlessly to try and to figure out how to reassure themselves and predict the future. OCD knows you the best out of anyone and will use that as a weapon against you. The content of the OCD does not matter it can shift to different forms and will try any angle to get your attention. If it isn’t getting a reaction it will change its approach until you fold. Remember it is not about getting rid of the thoughts, but living with them and changing your reaction. A common hurdle with dealing with OCD is the inability to accept that having these thoughts and ideas are natural and everyone experiences them. A sufferer will become so terrified that they start to resist and carryout compulsions, which just makes things worse. I met Jonathan Greyson at the conference, someone I have been admiring for years, his books, videos, and work have truly changed my life and my outlook on OCD. At the conference he told me an important message when OCD keeps attacking responding with “maybe it will happen or maybe it wont” the idea here is that we don’t know what will happen and being okay with living with MAYBE will help the brain be okay with any thoughts. I would highly recommend practicing this technique, any thought that pops up that triggers fear respond with this, I know it is easier said then done especially because OCD can be present all moments of every waking hour, but it gets easier the more you practice. Doing this while practicing ERP to purposely challenge your fears will help significantly. It is extremely important to find a therapist who is trained in ERP the IOCDF website has an approved list of therapists who know how to treat OCD:

OCD Conference 2019

I just came back from the annual OCD conference in Austin, TX and it was incredible! I encourage anyone who is suffering with OCD to attend the conference, not only are you around pioneers in the field like Doctor Johnathan Grayson and Jon Hershfield, but to meet like minded individuals is just so incredible. The conference was full of resources, talks, peer supports and so much more!

Here are a few key take aways:

  1. The doctors from Bergen Norway came to present around the 4-Day Bergen Treatment
  2. Brainsway TMS received FDA approval and will be getting approval in Canada most likely by the end of this year
  3. ERP (Exposure Therapy) is the gold standard
  4. ACT (Acceptance and Commitment Therapy) helps with pushing yourself past the thoughts and the pain by practicing mindfulness and radical acceptance
  5. Suffers with OCD are the kindest, bravest and most compassionate people I have ever met I will hold on to these incredible interactions for ever.

Next years conference is hosted in Seattle!! See below for information:

https://www.ocd2019.org/events/26th-annual-ocd-conference/custom-38-ae4b5eb661f7421da58d467be6eba399.aspx