Updated: Apr 7, 2022
All mental health disorders and conditions have a multitude of negative aspects. All of them are tough, with no quick fix, despite what pharmaceutical companies would have us believe. OCD is difficult to treat and has distinctive characteristics, idiosyncrasies and challenges which is why we recommend treatment with an OCD specialist and not a general therapist. Some of these are:
1. It doesn’t always help to talk: talking about mental health is encouraged for sufferers, carers and practitioners but for those with OCD, the difference between seeking support and seeking reassurance is blurred. People with OCD can’t easily distinguish between asking for support and getting reassurance that they ‘aren’t a bad person’ or ‘it will never happen’, etc. Similarly, the boundaries between talking their worries through and confessing, which is a compulsion, are not always clear to the person with OCD or the other party. Not only are the boundaries unclear, but the person with OCD can’t help themselves even if they realise they are confessing or seeking reassurance – the urge is so great. Doing either can greatly exacerbate OCD.
2. OCD is a matrix: OCD isn’t linear but is a complex matrix of obsessions and compulsions. Although OCD can be divided into sub-types (often on the basis of the obsession) this doesn’t always make categorisation a uniform process. The same sub-type or obsession can manifest in a different set of compulsions or rituals. The same set of compulsions or rituals don’t necessarily result from the same obsession, hence contamination OCD can represent a core obsession regarding responsibility or personal discomfort.
3. A condition within a condition: OCD has 10 or more sub-types and each of these has their own presenting attributes and obstacles. Consequently, the treatment between sub-types can vary and it takes expertise to be able to accurately identify and effectively treat the various sub-types. Experienced therapists may specialise according to sub-type, as do we.
OCD can change – sometimes dramatically: sub-types of OCD can change, quickly, and without warning. Although the underlying issues may not have shifted dramatically, the symptoms and obsessions can seem very different and new to the person with OCD. This is a particular characteristic of OCD and throughout a person’s lifetime, they can experience a number of OCD sub-types.
4. OCD mimics other disorders: the chance of misdiagnosis is high since OCD can be seen as a number of other disorders. The bizarre nature of the obsessions means that it is sometimes mistakenly seen as schizophrenia. Some obsessions around body image or food contamination can be misinterpreted as an eating disorder. Postpartum OCD is often mistaken for postpartum depression and highly ruminative ‘pure O’ is likely to be treated as depression.
5. OCD mimics other issues: the nature of relationship OCD and the current media obsession with all things relationship, particularly those of celebrities, means that clients with relationship OCD present late for therapy after they have spent hours and resources getting help analysing/fixing their relationships when this is actually counterproductive for relationship OCD. Similarly, many clients with HOCD, where sufferers worry about their sexuality, may well have spent considerable time analysing whether they are or aren’t gay.
6. Family & carers can be integral to recovery: unlike other disorders, where treatment is directed predominantly towards the sufferer, OCD may involve other people, and to a large extent. As the sufferer withdraws from daily functioning and starts to avoid, so the family/partner/carer may take those functions on for them, resulting in a complicated and unhelpful system of collusion and enabling. As this develops, so the severity of OCD becomes environmental and dependent upon the continued help of others. For example, treating acute contamination OCD without setting guidelines for involved carers can slow any progress. Unlike addictions, where enabling or providing access to substance abuse is widely regarded as negative, enabling OCD by ‘helping’/rescuing/reassuring can seem a natural and even helpful course of action for people around them. Moreover, others may not realise they are doing so, or know where the boundaries lie.