My client Y hadn’t been able to get the bus to see me for our weekly session one time because she was consumed with a fear of contamination. This was one of her very many and varied fears, and it didn’t last too long, nor latch on too tightly. If her thoughts of this fear had become intrusive and repetitive (‘obsessive’), and if they meant she felt she had to act out rituals or think other thoughts (ie ‘compulsions’), Y might have a devastating and debilitating mental illness. As tempting as it is for us to describe being organised or liking books to be lined up neatly as being a ‘little bit OCD’, we shouldn’t be flippant about this illness. Nor is it possible to suffer from it ‘a little bit’, in the same way that, in my fertile days, I could never have been a ‘little bit pregnant’.
Although OCD is categorised as its own disorder in the latest DSM, and is distinct from anxiety disorders, it shares many similarities with them, and many people suffer with both. Anxiety is a core experience of OCD, as the obsessions involved cause such distress and anxiety. The charity OCD-UK estimate that about three quarter of a million people in the UK live with it, and ‘contamination’ fears are only one type of many more: OCD can spin from thoughts on any subject, on any person, on any fear, although it frequently fixates on what’s important in a person’s life. So, a primary school teacher I worked with had obsessional fears of her harming children, while another client battled with thoughts of blasphemy despite being a committed Christian.
While we can’t suffer from OCD ‘a little bit’, it is possible to suffer it mildly, that allows for day-to-day functioning, albeit with great effort and distress. My client P struggled with fears of causing a fire by leaving plugs left in or not switching appliances off properly. Often the last one in the office at the end of the day, he would check, double-check and then triple-check that he had unplugged his computer and turned off all the lights (it didn’t seem to bother him that other lights in the building couldn’t be turned off, as is often the way with the irrational logic of anxiety). At home, P performed safety rituals around his house before going to bed, unplugging devices that his mind told him were the most dangerous. For years he, and his family, had lived his relatively stable level of checking without it really getting in the way of things. Other than this ‘quirk’ of his, he was relatively happy.
P came to see me for help when the triple-checks began to triple and then triple again. By the time we met he was getting home from a long day at work later and later, and going to bed later and later. He was, unsurprisingly, extremely anxious, fed up with his mind, and exhausted and it took many weeks for us to loosen the grip of his obsessional mind.
The level of distress for P was bad enough, but OCD can ramp up to another dimension of illness with a very long road to recovery: it can keep people in bed because of a fear of meeting airborne insects (to the extent of bed sores developing), it can hospitalise people with kidney problems from dehydration when they fear drinking poisoned water, or involve 24-hour nursing care because the hell of bearing the symptoms makes them at risk of suicide. So all of this is to say is to say ‘OCD’ without knowing what it can involve risks minimising a way of being that needs compassionate treatment.