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If you wake up already braced for the day, heart going before your feet even hit the floor, you are not imagining it and you are not alone. An OCD hangover is that specific flavour of morning dread: acute anxiety, a wave of intrusive thoughts, and a heavy, foggy feeling that can make the first hour of the day feel like the hardest one. There is a real, checkable, biological reason it happens, and there is a lot you can do about it once you understand what is actually going on. Quick answer: an OCD hangover is driven partly by the Cortisol Awakening Response, a natural spike in cortisol in the first 30 to 45 minutes after waking, which can be stronger and longer-lasting in people with OCD and other long-term anxiety conditions. It is not a sign that something has gone wrong. Getting up quickly, eating something, using a short breathing technique, and having a written morning plan ready the night before are the fastest ways to take the edge off, and specialist OCD treatment can reduce how often it happens at all. What an OCD hangover actually is, and why mornings hit hardest The term is not an official diagnosis. It is the name a lot of our own clients reached for, unprompted, to describe waking up already fighting intrusive thoughts and a wall of dread before the day has properly started. When we informally asked our own client population which was worse, mornings or evenings, the split came back close to 50/50, which tells you this is not a rare experience among people with OCD. It is closer to a coin flip. What makes the OCD hangover distinct from ordinary morning grogginess is the combination: physical heaviness, a spike of anxiety that arrives before you have even had a coffee, and obsessions that feel louder than usual for the first hour or so. Knowing that this pattern is common and explainable tends to take some of the sting out of it, because the fear that something is uniquely wrong with you is often worse than the sensation itself. The real cause: a cortisol spike you cannot just think your way out of There is a genuine endocrinological reason mornings can feel this hard. In the first 30 to 45 minutes after you wake, your body releases a spike of cortisol, a stress hormone produced by your adrenal glands. This is known as the Cortisol Awakening Response, and it exists to help kickstart your body and get you moving for the day ahead. The problem is that cortisol also drives your fight-or-flight response, and in people with long-term anxiety conditions, OCD included, it can run higher and for longer than it does in people without one. Researchers have documented this pattern in detail; you can read more about the mechanism on Wikipedia’s page on the Cortisol Awakening Response. In practical terms, that means your body is doing exactly what it is designed to do, just at a higher intensity, at the worst possible moment, before you have had any chance to use a coping strategy. That distinction matters clinically. An OCD hangover is not evidence that your OCD is getting worse, and it is not a signal to panic. It is a hormonal pattern layered on top of an existing anxiety condition, and hormonal patterns respond to structure and routine far better than they respond to willpower alone. OCD hangover or hangxiety: is it the same thing Some clients use the word hangxiety instead of OCD hangover, and the two overlap more than they conflict. Hangxiety is usually used to describe next-morning anxiety after alcohol, but plenty of people with OCD borrow the word because the physical sensation, a jittery, dread-soaked start to the day, feels similar even without a drink the night before. The distinction worth keeping in mind is the cause. Alcohol-driven hangxiety is tied to withdrawal and dehydration and tends to fade within a day. An OCD hangover is tied to the Cortisol Awakening Response interacting with an existing anxiety condition, so it can show up most mornings, alcohol or not, and it responds best to consistent morning strategies rather than a one-off fix. Why compulsions and reassurance-seeking can quietly make mornings worse It is worth naming a pattern we see often: the urge to lie in bed replaying the intrusive thoughts, trying to reason your way to certainty before you get up, or reaching straight for reassurance, whether that is checking something, asking a partner if you are okay, or scrolling for answers. All of these feel like they should help. In practice they tend to feed the exact anxiety loop they are trying to calm. Reassurance-seeking in particular is a compulsion, not a neutral coping step, even though it rarely feels that way in the moment. The short-term relief it gives is real, but it teaches your brain that the only way to feel safe is to seek reassurance again next time, which is part of why the OCD hangover can start to feel like a fixed part of the morning rather than something that can actually change. The same applies to mental compulsions that never leave the bedroom: silently reviewing the day ahead for danger, mentally checking a memory from yesterday, or trying to reach a feeling of certainty before you are willing to get up. These are easy to miss because nobody else can see them happening, but they keep the nervous system on alert during exactly the window when cortisol is already at its highest, which tends to stretch the OCD hangover out rather than let it settle. Does what you do the night before change the next morning Bedtime habits will not switch off a hormonal response, but they do influence how much reserve you have to meet it. Going to sleep at a wildly different time each night disrupts the body's normal cortisol rhythm, which can make the morning spike feel more chaotic rather than predictable. A consistent wind-down and wake time, even an imperfect one, gives your body a more stable pattern to work with. Screens late at night are worth a mention too, not because of a strict rule about blue light, but because scrolling, checking, or googling in bed is often where reassurance-seeking compulsions live at their most active. Ending the evening with a calmer, screen-light routine tends to mean fewer unresolved obsessions are waiting to greet you the moment you wake. None of this is about achieving a perfect bedtime. It is about noticing that the OCD hangover does not start the second your eyes open. It is shaped, at least partly, by the hours before it too, which is genuinely useful to know because it means you have more than one point in the day where you can intervene. Nine ways to ease an OCD hangover, starting the moment you wake up None of these need to be done perfectly, and you do not need all nine on a hard morning. Most clients find that three or four, used consistently, make a real difference over a few weeks, and it is worth picking the ones that feel realistic on your worst mornings rather than the ones that sound best on paper, since a strategy you actually use beats a longer list you abandon by day three. Get up as soon as you reasonably can. Lying still and replaying the thoughts tends to intensify them rather than settle them. Use short, practical self-talk: "this is expected," "this is a hormone, not a warning," "this will pass." Accepting the wave works better than fighting it. Try box breathing: in for a count of four, hold for four, out for four, hold for four, repeated for a minute or two. Eat something within the first half hour, even something small. A stable blood sugar level genuinely helps take the edge off the cortisol spike. Write tomorrow's morning plan tonight. Deciding what to do while calm removes the need to make decisions while anxious. Get outside or near a bright window as early as you can. Natural light supports a healthier daily cortisol rhythm. Put on music you actually like. A familiar, steady sound gives your attention somewhere to land that is not the intrusive thoughts. Move your body, even for ten minutes. A short walk or stretch helps process the adrenaline the cortisol spike brings with it. Reach out to a friend for support, not for reassurance. There is a real difference between "I'm having a rough morning" and asking someone to confirm an intrusive thought is not true. If you try a natural supplement aimed at lowering cortisol, speak to your GP or a nutritionist first rather than self-prescribing. This is general information, not medical advice, and what is safe varies from person to person. When it is more than an OCD hangover: signs worth mentioning to your therapist A difficult morning is not automatically a relapse, and it is worth resisting the urge to read every hard start to the day as a sign your OCD is spiralling. That said, a few patterns are worth flagging honestly at your next session rather than pushing through alone: The dread lasting well past the first hour rather than easing off once you are up and moving. Compulsions creeping back into your morning routine that you had previously stopped doing. A growing urge to avoid mornings altogether, for example by oversleeping or dreading the alarm days in advance. None of these mean treatment has failed. They usually mean it is a good time to check in with your therapist and adjust your plan before the pattern sets further. It helps to keep a rough, honest record rather than relying on memory alone, since a genuinely bad week can make every morning feel identical in hindsight even when some were milder than others. Even a short note of how intense the dread felt, out of ten, and roughly how long it lasted, gives you and your therapist something concrete to compare week to week instead of relying on a general impression of things getting worse. If morning distress ever tips into thoughts of harming yourself, or simply feels unsafe, that is not something to manage with the tips above. Contact your GP urgently, call 111, or in the UK reach the Samaritans free, any time, on 116 123. That support exists exactly for moments like this. How specialist OCD treatment breaks the cycle, rather than just managing mornings Coping strategies help you get through a hard morning. They are not the same as treating the OCD driving it. That distinction is exactly why OCD-specific treatment, built around Exposure and Response Prevention (ERP) rather than general anxiety management, tends to reduce how often the OCD hangover shows up in the first place, not just how you survive it once it does. We have worked in OCD specifically since 2003, and every therapist on the team has either their own lived experience of OCD or has cared for someone close to them who has it. That matters here because morning dread is one of the hardest symptoms to describe to someone who has not felt it, and a therapist who recognises it immediately can start targeting the actual compulsions feeding it, including reassurance-seeking, far faster than a generalist approach can. An assessment looks at your specific subtype, screens for what is actually driving your mornings, and builds a treatment plan around it, whether that is regular weekly sessions or a more intensive format. You can book an assessment to find out which approach fits your situation, with a realistic timeline and cost discussed upfront. For some clients, a more intensive block of treatment, run across five to fifteen days rather than spread out weekly, makes the biggest difference precisely because compulsions like morning reassurance-seeking get addressed directly and repeatedly in a short window, rather than once a week with six days in between for the pattern to re-establish itself. It will not suit everyone, and a proper assessment is what determines whether it fits your situation rather than a general rule. Common questions about the OCD hangover Is an OCD hangover the same as a panic attack? Not usually. A panic attack tends to peak sharply and pass within minutes. An OCD hangover is more of a sustained low, heavy dread combined with a wave of intrusive thoughts that can linger for the first hour or more after waking, tracking the shape of the cortisol spike rather than spiking and dropping as fast as a panic attack does. How long does an OCD hangover usually last? For most people it eases within the first 30 to 60 minutes after waking, which lines up with the window in which the Cortisol Awakening Response is at its strongest. If the dread is regularly lasting for several hours, that is worth raising with a specialist rather than assuming it will settle on its own. Can medication help with the OCD hangover feeling? Some people find medication helps with OCD symptoms generally, including morning anxiety, but this needs a proper conversation with your GP or psychiatrist rather than general advice here. Medication for OCD is not a precise, one-size-fits-all science, and what helps one person may not suit another, so it is genuinely worth discussing your specific situation with a prescriber rather than starting or changing anything based on an article. Does everyone with OCD experience a morning hangover feeling? No. In our own informal client survey the split was close to even between people who find mornings harder and people who find evenings harder. If your OCD is worse later in the day, that is just as real and just as worth addressing, even though it gets talked about less often than the morning version. When should I speak to a specialist about morning OCD symptoms? If the dread is not easing with consistent morning strategies after a few weeks, if compulsions are creeping back into your routine, or if mornings are starting to affect your ability to get to work or care for yourself, those are all reasonable points to book an assessment rather than keep managing it alone. Does caffeine make an OCD hangover worse? It can, for some people. Caffeine stimulates the same fight-or-flight system that the morning cortisol spike is already activating, so a strong coffee on an empty stomach can sharpen the jittery, on-edge feeling rather than settle it. It affects everyone differently, so this is worth noticing for yourself rather than assuming it applies to you. Eating something first and waiting even twenty minutes before caffeine is a simple, low-effort thing to try if mornings feel especially sharp. Ready to stop just surviving your mornings and actually treat what is driving them? Book a specialist assessment, read more about how our OCD treatment options work, or learn more about OCD from the International OCD Foundation, an independent source with no connection to our practice.

Supporting someone with mental health issues isn’t easy. Let’s start there. Secondly, If you are supporting someone with OCD, you will already know that your role involves a unique set of challenges. Challenges that are specific to OCD and seem counter intuitive to anyone’s idea of the supportive, caring role. For any partner who has been followed around the house until they give in to the escalating demands for reassurance, you will know what I mean. For any parent who has been banned from stepping foot into numerous rooms in their own house, this will resonate. For any friend who has received 47 texts asking the same question, this will sound familiar. For those of you who haven’t experienced this, I can tell you that OCD is very lifestyle invasive with symptoms often extending to the immediate environment. At best, OCD can be entirely covert and the person with OCD seems distracted and inwardly suffering. At worst, the OCD symptoms are overt and the whole family is unable to function, disabled by the OCD. I’ve worked with grandparents dealing with the nightly humiliation of witnessing a teenage grandchild showering at 4am, to ensure each body part is adequately cleansed. Or a partner out at 6am to check that no one was harmed overnight on the train tracks. Carers, families, partners, children caring for someone with OCD can themselves suffer significant mental health issues as a result. However bad the situation, it is never too late for them to set boundaries. Setting boundaries can often be the very first step in the person with OCD realising they need to take action. In my experience, here are the most impactful boundaries to start with: Try to remember that OCD distress manifests as anxiety. Whilst it is distressing to witness in a loved one, it is harmless & furthermore, efforts to avoid or escape it only make the situation worse. The solution lies in the person learning to tolerate & accept it. Seeing OCD as a disease or illness might not be conducive to the person recovering. Disease or illness can imply the situation is outside the control of the person with OCD. Seeing it as a condition is more accurate. It reflects the episodic nature of OCD which needs to be managed and leads to… The severity of OCD isn’t a biological phenomenon. There aren’t more aggressive forms of OCD (except for childhood cases of PANDAS) and the severity is determined by a person’s ability to adapt their environment and the people within it around the OCD. OCD is the one condition where it doesn’t always help to talk. A person with OCD will want to talk, to describe their thoughts, their feelings, ask questions, check or seek reassurance. They are unlikely to be able to stop. Learning how to communicate, what to say and what not to say, will make a huge difference to their recovery… Beware of questions. They will often be reassurance based and reassurance is highly addictive for the person with OCD. Try to respond with closed-ended answers & never imply that certainty is possible. You can either kindly decline to respond or don’t be afraid to say, ‘I don’t know.’ or ‘Who knows?’. Be especially careful of their assurance which will sound like, ‘This isn’t OCD, but….’ Try to learn the difference between empathetic and sympathetic support. Empathy would be ‘I can see how tough this is for you but I know you can do it’. Whereas sympathy would be ‘You are right. Your life is terrible and I don’t know how you will cope.’ Try not to change your own behaviour even if the person with OCD becomes very demanding. For example, they may insist that you shower at particular times or that you stop using knives or going to specific shops or venues. Be aware that once you agree to change your behaviour, it will be tougher to reset this boundary later on. Furthermore, the more you adapt your life around the OCD, the greater the danger that you will normalise dysfunction. If you agree to carry out daily tasks for the person with OCD, the situation is likely to deteriorate. This includes cleaning, checking, avoiding or other organisational tasks. As they become more discomfort intolerant, your responsibility for their tasks will increase, having a detrimental impact upon their ability to cope. Similarly, if you take long-term financial responsibility for them, so that they no longer have to work or attend school, this will ultimately be unhelpful for their recovery. Understand your limitations. Manage your expectations. You can’t change another human being and you can’t make them want to recover or seek help. You can inform yourself and encourage them to seek help but they may decide not to follow your advice. In this case, you will need to make decisions about how you will cope in the future and what steps you might need to take to protect your own mental health, even if you are a parent. Finally, do not ignore or neglect your own well-being. You are as entitled to support and help as the person with OCD. You cannot support others if your own mental health is deteriorating. Try to seek local or online support in the guise of help groups or therapy for yourself. They can help you set appropriate boundaries and support you implementing those in difficult circumstances. Try to set aside you time where you see friends or carry out pursuits and interests that provide relief and enjoyment. Most of our enquiries are from carers, families and friends so please be kind to yourself and thank you for supporting someone with OCD. #ocd #ocdawareness #ocdrecovery #ocdmemes #ocdproblems #obsessivecompulsivedisorder #obsession #intrusivethoughts #pocd #harmocd #anxiety #pureo #anxietysupport #anxietyawareness #anxietydisorders #mentalhealth #anxietyattack #anxietytips #ocdtips #mentalhealthadvocate #mentalhealthawareness #mentalillness #mentalwellbeing #therapy #therapist

As therapists with OCD we really do understand why our clients believe that their OCD fear is the most terrible thing that can happen. We believed it too – once. But the truth is, by the time many clients present for therapy, their lives are often worse than their OCD fear. By ‘worse’ I mean, they are often more distressed and disabled by OCD then they would be if their OCD fear actually happened. The 'cure' that OCD is offering them is the problem. An example would be relationship OCD (ROCD) where the worst fear might be, not being in love with their current partner, or their partner not being ‘the one’. Should either of these concerns materialise, it would be upsetting for sure, but relationship issues and break-ups are an unfortunate part of the process of life. In contrast, obsessing for 99% of waking hours, suffering acute anxiety (often panic), coupled with life disabling mental or physical checking, comparing, seeking reassurance and problem solving aren’t a necessary part of the process of life. I’ve worked with clients where the majority of their waking hours are spent ruminating about their relationship to the point where their relationship is strained and their social life, family and work are suffering. Relationship break-ups are hopefully finite and there is a natural recovery and healing process, however, there is no end or limit to the distress of untreated relationship OCD. Moreover, if the person with OCD takes the ill-advised step of ending their relationship due to the OCD, they may well face the same traumatic experience in their next meaningful intimate relationship. When it comes to responsibility OCD, where a person’s greatest fear is harming their family, their symptoms are usually sufficiently severe that their family is very concerned, worried and confused. In essence they are already suffering as they watch their family member with OCD deteriorate inexplicably before their eyes, regardless of the harm detailed in the OCD thought. Whether the OCD fear is contaminating their family or harming them in some other way, the negative impact of the OCD upon the family is often worse than the original fear. A family member is likely to handle accidental harm more easily than coping with the long term impact of constant reassurance, involvement in rituals, helpless concern and overwhelming confusion. Ironically, the OCD fear of harming their family can result in the family members suffering mental health issues, leading to medication or therapeutic support of their own. We care for our clients so we’d like to offer them a ‘VIP: it will never happen’ gold card but we know the relief won’t last. What we can do, as part of a larger programme, is help them see that OCD is making their current life worse than the thoughts they are being threatened with. To help them see that the 'cure' offered by OCD is the problem. We can never guarantee that their worst fear won’t happen (as is true for everyone) but we can 100% guarantee that, without managing OCD, their life will be worse.

HOCD, ROCD, POCD......I thought I’d discuss the issue of OCD sub-types since for most people, it is absorbing and somewhat addictive. It’s absorbing for clients since they are driven to define their OCD (for some it is one of their obsessions) and it’s absorbing for professionals since they equate a more detailed conceptualisation with greater understanding and skill. For some clients, a large part of their day is spent online, gathering reassurance that they have OCD by scrutinising the various sub-types. The driver behind this compulsion is the need for confirmation that their worst fear isn’t true, i.e., they won’t actually kill someone, they just have OCD (phew!) or their partner isn’t entirely wrong for them, it is just OCD (phew, again!). This offers some relief but it is short-lived and so I steer such clients back to focusing on the solution rather than the problem. Therapists/professionals might do as well not to concentrate on the significance of sub-type. OCD subtypes are interesting and useful at the beginning of therapy but as work progresses, it becomes clear that commonalities rather than the differences between subtypes are more significant. As a practice, we specialise according to sub-type, e.g., responsibility, pure-O, relationship, religious, etc. and this is helpful early on in the therapeutic process. It reassures our clients that they are understood. It also tackles those miserable thoughts of isolation that no other single human being can identify with what they are going through. Additionally it helps us as therapists set highly specific behaviour work that we know targets that particular sub-type, however, as the client works through this and makes improvements, they realise that their core obsessions are based firmly in self-worth and discomfort. One of the overriding concerns of the clients attending our group intensive courses is that they might ‘catch’ someone else’s OCD but of course, their core issues are ultimately the same, and you can’t ‘catch’ what you already have! At the outset of the group courses of mixed subtypes, clients are heard to say, ‘I wish I had your OCD, since I would know that wouldn’t happen!’…………..at the end of the group course they are more likely to be nodding in complete empathy and agreement.

It is sadly the case that the UK mental health sector is paradoxical. On the one hand, we’ve blazed a trail in evidence-based health & social care since 1999. The National Institute for Clinical Excellence (NICE)* is an international role model for the development of evidence-based clinical guidelines so that mental & physical health care is at the very least, empirically sound. Hurray! Clinical Excellence 1, Unprofessional Standards 0. On the other hand, these guidelines haven’t actually translated into higher standards or more uniformity of care within the unregulated, inconsistent, multifarious sector that is the UK mental health care system. Clinical Excellence 0, Unprofessional Standards 1. The reasons why this is the case are essentially simple: the users of the mental health care system don’t read the NICE guidelines and many of the professionals delivering the treatment don’t adhere to them. The first issue is understandable. Why would distressed people with mental health issues trawl through tedious clinical protocols when they are at their most vulnerable? They are unlikely to know that such guidelines exist. The second issue is much more complicated. In many ways, mental health care isn’t as evolved as physical health care and consequently, specialism is a rarer occurrence in mental health. Whereas NICE guidelines for clinical excellence are condition or disease specific, mental healthcare tends to be approach specific. In other words, the clinical guideline for the treatment of obsessive-compulsive disorder and body dysmorphic disorder, or Guidance CG31, is condition specific. However, most mental health professionals are delineated according to their approach, e.g., cognitive behaviour therapy (CBT), psychodynamics, systemic, etc. suggesting that the condition must fit the approach. This seems incongruent with clinical excellence where the imperative is to standardise a protocol for a condition. Ultimately, even though NICE is an Executive Non-Departmental Public Body, and Government directed, there isn’t widespread adherence, certainly not in the case of mental health and particularly OCD (I suspect that there is more adherence in the NHS but insufficient resources for it to be meaningful). Odd, because the guidance isn’t ambiguous. It is explicit; Cognitive Behaviour Therapy (CBT) and Exposure Response Prevention (ERP) with or without medication support, is the only evidence-based treatment for OCD. Furthermore section 1.5.2.8 states: When adults with OCD request forms of psychological therapy other than cognitive and/or behavioural therapies as a specific treatment for OCD (such as psychoanalysis, transactional analysis, hypnosis, marital/couple therapy) they should be informed that there is as yet no convincing evidence for a clinically important effect of these treatments.** Nevertheless you don’t have to look far to see general counsellors, hypnotherapists, psychoanalysts or psychodynamic therapists professing to treat OCD. In fact, the vast majority of our clients have seen one of the aforementioned on their journey to us. In the 16 years since this guidance was published, not one of these clients has been informed of the above and we’ve asked them! How has this situation been able to continue? It is largely because the UK private mental health care sector is largely unregulated. The regulatory bodies that do exist are voluntary and currently anyone can call themselves a therapist in an environment where marketing and online presence isn’t determined by qualifications, reputation or professional ethics. It is determined by Google position and social media followers. Hence you can have OCD therapists with no cognitive behavioural qualifications in Somerset earning tens of thousands per month due to Google position and an Instagram 'recovery' group with no qualifications but thousands of OCD followers earning even more than that. This situation relies heavily upon vulnerable people in need, for whom there is no central, clear source of information. For OCD, as with other mental health disorders, the solution won’t be simple but it should include the following: Clear, user friendly, accessible Government information on mental health treatment protocols based upon NICE (aimed at the general public not professionals) Distribution and marketing of the above information on and offline (think COVID guidance – we know it can be done!) Compulsory regulation and accreditation of mental health practitioners according to training, qualifications and experience Increased cooperation between NICE and mental health professional regulators Increased mental health specialism based upon training, qualifications and experience Increased focus upon condition rather than approach specific training Stricter controls for those offering mental health advice/treatment via social media Criminalisation of practices that include payment for unregulated & unqualified mental health advice/treatment It is inspiring that the message ‘It’s good to talk’ is being widely promoted but the professionals, regulators and policy makers aren’t talking to each other nearly enough. For as long as this is the case, clinical excellence, professional standards and those in need are very much the loser. * https://www.nice.org.uk/ ** https://www.nice.org.uk/guidance/cg31/chapter/1-Guidance

Everything is going to be OK. It may be tough at times but it will be OK! You are not crazy or sick. You have a condition which can be managed No one is normal and you are as good as everyone else OCD is a long term condition but, with coping skills, it need not stop you doing anything you want in life You will need to learn coping skills and keep practicing these Many successful people have OCD including business leaders, actors, musicians, singers, artists, etc. You are in good company OCD means that you may feel emotions more strongly than others - this is OK! In order to manage your OCD you will need to learn how to tolerate discomfort (mainly emotional) and not try to get rid of it In order to manage your OCD you will need to make sure you work hard on doing tasks for yourself Working on your OCD will be really beneficial for your life in general As parents we are here to support you (but not to do OCD things for you!) We are going to get the right, specialist help for you from people who understand We are going to get through this as a family Never give up on your OCD! You can do it! Please do seek specialist OCD treatment so that you get sound, reliable advice as a family. The most effective treatment for children with OCD should be based upon the FIT model, in other words, Family Integrated Therapy. OCD is a lifestyle invasive condition and when it comes to treating children, should be family-focused. What you say to your child now will make all the difference in how they relate to themselves and their OCD in the future.

Have you been embarrassed about having OCD? Attitudes and awareness regarding OCD are certainly better than 10 years ago. OCD is featured more frequently in the press, films and TV and the portrayal seems to be more accurate, empathetic and insightful than previously. There is a wealth of info and commentary on social media (some helpful and some not so...). Nevertheless, OCD stigma still exists and we see clients struggle with the concept of informing friends, employers, family and partners. However, if you didn’t know already, here are a few reasons never to be ashamed of having OCD: 1. You are in good company! Many successful people have OCD. From David Beckham to Camilla Cabello and Lele Pons. I would be prepared to bet that a large proportion of the world’s most successful people have strong OCD traits, just like you. Their obsessiveness drives them to be successful. If it is channeled correctly, your need for perfection, attention to detail, foresight and intuition can set you ahead of the rest. 2. You are in big company! It is estimated that approx. 1.5% of the world’s population have OCD, making it the most common mental disorder after depression. Not only that but a recent study found that 25-30% of people in a GP’s waiting room are presenting with mental health issues (some unknowingly so). Therefore if you factor in addictions, depression, anxiety, panic, etc. and wherever you are, you are not far from someone else who is also struggling. 3. It’s good to talk! For every one of us who ‘comes out’ about OCD and generally, mental health issues, the more people will feel able to follow suit. Even if one person feels able to open up as a result of your actions, it’s progress. When I made an appearance on TV, the show’s driver, producer and researcher admitted that they have OCD. Opening up is contagious. People with OCD are good people! Believe me, I’ve worked in this area for 15 years and the OCD mindset tends to be sensitive, honest, kind, communicative, responsible/accountable (sometimes overly), empathetic, creative, detailed (again, often overly) and intuitive. Correctly managed, these are positive and admirable traits in any human being and ones that contribute to society. 4. People with OCD do good things! On the subject of contribution, if you are able, you are likely to be giving back in some form or another. Whether you are taking care of people in your family or community, involved in charity or non-profit work, social work or counselling. Being at the emotional end of the spectrum you are naturally drawn to these fields and have an abhorrence of violence or abuse towards humans and animals. You are the ideal person to make a difference to the world. 5. Everyone needs people with OCD! With a few exceptions, many people would prefer to employ a perfectionist. Although they may seem a bit glib, there are people out there saying, ‘I would prefer my architect/accountant/child minder/cleaner/driver/editor/assistant, etc. had OCD’. We know that the actuality of OCD is more serious than this but there is some truth in the fact that you are likely to be more thorough, precise, conscientious and diligent than anyone else 6. OCD is a condition! OCD isn’t insanity, a disease or an illness. It is a biological condition which can be managed and there is no scientific evidence that the severity is biological. It is is more likely to be based upon your environment so that means you can change how you respond. You have a condition which results in an emotional over-response and this is nothing to be ashamed of.

At OCD Excellence, I talk a great deal about behaviour work, also known as exposure work, ERP, de-sensitisation and habituation. As a practice, we stress the importance of this component as part of a successful OCD treatment programme. We also have to ‘walk the talk’ since, as therapists with OCD, we've backed up our theory with practice over time to maintain our own ‘OCD wellness’. With regard to our clients, we have compiled a 500 + list of behaviour tasks, compiled over 17 years and delineated by sub-type or trigger. However, there still seems to be some confusion around behaviour work and I would like to try and offer some clarity as follows: Behaviour work is the ‘B’ component of CBT (Cognitive Behaviour Therapy) or our OCD Excellence-preferred REBT (Rational Emotive Behaviour Therapy) The ‘B’ (Behaviour) and ‘C’ (Cognitive) work are designed to be done concurrently and mutually reinforce the other The premise behind behavioural therapy is that dysfunctional behaviour can be both learned and unlearned An effective OCD behavioural plan will involve the concepts of both classical conditioning, e.g., flooding and desensitisation, and operant conditioning, e.g., a therapist-led system to reinforce positive and helpful behaviours Targeted behaviour work is always required for treating OCD, even for clients with no physical compulsions As yet, there is no alternative to behaviour work although clients understandably try to circumvent or avoid it. No amount of cognitive work alone will produce optimum results Even with ‘Pure O’ OCD, where there are no physical compulsions, behaviour work is still recommended since there will be mental compulsions Since behaviour work is uncomfortable, clients can opt to start gently and step up over time but there is no scientific evidence that this step-up approach is more effective. It’s a little like tentatively wading into cold water – it’s ultimately less painful and quicker to jump right in If therapists set the correct tasks and clients are mentally prepared, behaviour work is highly effective with a steep recovery curve… ….however, unless the behaviour work is supported with an equal amount of robust and skilled cognitive work, the results will be short-lived due to the adaptation of OCD (OCD is treatment resistant) into enhanced or entirely new triggers If a client has a history of family, friend or partner collusion (others becoming involved with OCD) and this level of collusion remains unchanged throughout therapy, then the success of behaviour work will be limited or entirely undermined. This is why we work with carers to set specific guidelines and skills The legacy of the behaviourists has resulted in an assumption that behaviour work or ERP alone will be sufficient for clients with OCD to make a full recovery. In the case of OCD, this is simply not the case! When I worked in the US, the term ‘behaviour modification’ described the entire approach of some therapeutic practices. Behaviour work is a vital and unavoidable treatment component but it is part of a solution which must include extensive cognitive work and a ready focus on environmental & clinical factors, such as collusion and medication.

OCD is very lifestyle invasive and in the case of younger clients, family and carers can be very involved in the daily maintenance of OCD. As a therapist, treating children and teenagers with OCD is rewarding but I have observed particular challenges: Children and teenagers have yet to develop an effective ‘penalty-reward system’ based upon their experience so lack the ability to project forward. Adults tend to have a greater understanding of the penalties of not taking action and the rewards of doing so. Hence younger clients will be less motivated to embark upon tough work to manage their OCD. Similarly, children and teenagers often consider that they don’t ‘have to change’. They are unlikely to become homeless, destitute or abandoned. Thankfully they won’t default on their mortgage or child payments or face redundancy but it can affect their engagement in the process and commitment to see therapy through People with OCD are intelligent and so children and teens can be surprisingly resourceful and focused in their efforts to manipulate the people in their environment. Even if their parents set helpful boundaries, it is not unusual for younger clients to redirect their efforts towards grandparents or the wider family. This isn't malicious, it is the OCD. Mental health awareness is improving but has still some way to go, therefore younger clients are loathe to accept their OCD. Mental health issues can be a frightening and alienating concept and may be seen as failure Parents will default to over empathising. As a parent there is a natural and biological urge to rescue your child from emotional and physical discomfort. Adapting their overtly collusive behaviours may not mean they have dealt with the more covert ones, .e.g., reassurance, debating, negotiation and problem-solving It is tough for families to draw the line between unhelpful collusive behaviours and the behaviours of a caring parent. There may also be some inter-family issues between Mum and Dad or parents and grandparents. Parents tend to agonise about ‘what is OCD and what is normal parenting’ The family unit may be dispersed, e.g., parents separated or working away from home so a coordinated family approach and shared message may be more tricky to implement OCD rarely exists in isolation from other conditions, e.g., depression, but ‘teenagerness’ the etiology of which isn’t a clinical discipline (!), can have a profound impact upon OCD and therapy Finally, a tough one! The origin of OCD is thought to be genetic hence one or more parents will also have obsessive tendencies. They may be similarly indecisive and anxious. They may overthink regarding their child’s condition, the options for treatment, the treatment itself and their role. Helping parents manage their discomfort may be key to long term change.

…or surprising ways lockdown is impacting those with OCD: Permanent High Readiness: people with OCD live with a sense of foreboding. Bad things happening, often on a large scale, is an ever-present threat. Disaster, catastrophe, disease and suffering are part and parcel of the mental existence of the OCD. Many clients of ours are experiencing acceptance rather than shock and surprise. Bark is worse than the bite: for someone with OCD, living with a threat can seem worse than a bad event actually happening. The ‘what if’s?’ are such a painful and debilitating part of their lives that they respond well in an actual crisis. This may be because they have had time to think of many scenarios and have developed skills in lateral thinking. Or it could be that external events are easier to deal with than the internal ones. In any case, for someone with OCD, lockdown isn’t the worst thing they can imagine Off the streets: sadly, responsibility OCD symptoms might be eased by isolation. For those who fear harming others, social distancing represents a reduced risk of their worst fears happening. For some with this sub-type, enforced isolation means less chance of harming others Hitting the Ground Running: in common with depression, addiction and other disorders, the tendency to withdraw socially is a big factor. Spending time alone, withdrawing from family & friends, resigning from work or limiting public activities be 'business as normal' for OCD. The Pressure’s Off: more than a few clients have expressed some relief as a result of lockdown. Feeling as if OCD has robbed them of valuable years and opportunities, they have said that it seems as if everyone is in he same boat. The sense of everyone busily living their lives, moving forwards and making progress is no longer dominating their day, impacting upon their self-worth Walk a Day in my Shoes: our current situation, i.e., isolation, hyper-vigilance/responsibility, anxiety, neurosis, hypochondria, cleaning rituals, depression and uncertainty is a daily occurrence for some with OCD. Suddenly, we are all equal, vulnerable and apprehensive “The key to overcome crisis is patience, courage, self-discipline, adaptation and alertness.” - Amit Ray

I am the founder of OCD Excellence and I have OCD. My OCD began as I entered my teens. I had no idea that there was a name for the strange stuff in my head, let alone treatment. Doing everything 4 times (or multiples thereof), associating bar codes with death, avoiding the colour red, amongst 100’s of other weird symptoms. After struggling along for 10 years I found CBT in my early 20’s and adapted it to my own OCD, courtesy of a kindly therapist who freely admitted she knew little about the condition. The lack of knowledge, help and support for people and families of people with OCD was all-pervasive. OCD treatment was a rare and elusive thing. After working in finance and PR, I gave up my career for lack of interest and a growing sense of something more meaningful. I volunteered for an anxiety charity whilst studying and establishing my own OCD treatment protocol. I found myself inundated with OCD enquiries on the helpline. The gold standard for treatment at the time was Seroxat. Being medication averse (common in OCD) my interest was peaked and I was determined to find a medication-free solution. So after some applied learning via the charity, I started my journey with a Masters in CBT. Over the last 15 years I split my time between New York and London, observing the cultural and professional differences in mental health care and OCD treatment. From the barely disguised psychoanalytical options in New York, to the barely functioning NHS CBT-based offering in the UK, there still exists an international need for highly specialist treatment for OCD. One that is based upon efficacy rather than medication, ineffectual protocols or a bureaucratic squeeze following another budget-serving whitepaper. My goal was to establish a gold standard for OCD treatment: the optimum combination of education, anxiety management and psycho-therapeutically robust techniques. It has been a lonely road. In the US they admire entrepreneurship & private practice but medication is king. In the UK, medication is met with open suspicion and the more socially-minded are known to spit on private practice. Any association between mental health and entrepreneurship is considered at best, unethical, at worst, illegal. Thank you NHS. The cumulative result of which is often life-threatening procrastination, low levels of self-responsibility and an unhelpful sense of entitlement against a continuing background of poor NHS provision. It’s a lose/lose. Sadly that hasn’t changed. But many other things have! The world is a dramatically different place relative to 2003 when I first practiced and ordinarily, in the case of other conditions, technological and medical innovations would be the only independent variables, but this isn’t necessarily the case with OCD — and for reasons you might least suspect. Who would have thought that one of the variables would be cultural or social? I have always conceptualised OCD as emotional hypersensitivity so that (thanks to Dr Jeffery Schwartz) I realised that people with OCD over-respond to emotional triggers across the board, and not just those with anxiety-provoking implications. People with OCD feel the full gamut of the emotional spectrum more acutely — anger, disappointment, rejection, you name it! I believe that the outcome of this biological anomaly is that people with OCD are highly sensitised to their environment. This can be witnessed in response to ‘new’ OCD obsessions fuelled by the media, e.g., the media’s concentration on paedophilia cases and the current media fascination with all things celebrity and most significantly, their relationships. These trends have coincided with an increased presentation of clients with responsibility paedophile concerns and also relationship neuroses. Hence, OCD evolves according to social and cultural emphases. The other aspect of our modern existence that has affected OCD is the dominance of the ‘self’, i.e., ‘selfies’, ‘self-awareness’, ‘self-marketing’, ‘self-absorption’, ‘self-analysis’, ‘self-diagnosis’….need I go on? It isn’t all bad. Who wouldn’t welcome the opportunity for people to take advantage of access to information so that they can make more informed decisions regarding their mental and physical healthcare? Obviously this is a huge step forward from the days of relying on the lucky dip of a single medical opinion from one’s local GP, who is often under pressure to meet timelines and patient quotas. Nevertheless, the OCD hours spent researching online, reading forums and just ‘thinking’ (I have clients that set aside days from work to ‘think’) are not conducive to recovery. Researching online is now in our ‘Top 10’ of compulsions across all sub-types. Which brings me to what else lurks online and this is the proliferation of treatments and interventions for OCD. Some of course, are helpful, but many aren’t and so online marketing rather than therapeutic skills, credentials and experience is king. Anyone with online marketing skills can present themselves as a viable therapeutic option, especially to those who are vulnerable and desperate for help. It is possible that options such as Chinese medicine, herbal remedies or hypnotherapy may have complementary benefits but it still remains that the only evidence-based intervention for OCD is cognitive behavioural therapy (CBT) and even then, we firmly believe that a sub-set of CBT, namely Rational Emotive Behaviour Therapy (REBT), is a much more robust intervention for OCD. We adjunct this with other approaches but REBT is an integral component of our protocol. In my own early search for help with OCD I fell foul of a lack of information and now, as a practitioner on the ‘other side’, I believe people are deluged with a confusing excess which detracts from finding effective therapy. All therapists run the gauntlet of others thinking this an easy commercial opportunity and so access to information can be risky!! Therapy can seem nebulous at the best of times but therapy for OCD requires a particular type of acuity. People with OCD are, by default, articulate and perspicacious so countering their complex, highly developed yet irrational obsessions requires sharp wits and proficiency. Hopefully in time, the quality and composition of OCD therapy will become standardised. Finally, our collective preoccupation with all things ‘comfortable’ including the categories of convenience, quick-fix and control. This is the big variable and it’s gathering speed and size. As a society we have moved further away from our grandparent’s notion that ‘life is difficult’ and closer towards the idea that ‘life needn’t be difficult for me if I can just find a way to get round it…….’, supported by the media and advertising industries who naturally know we are seduced by comfort and are in the business of selling us ideas, services and goods we want but are not necessarily good for us. I often think that Scott M Peck’s ‘The Road Less Travelled’ was a last ditch attempt in the 80’s to halt the downslide! And everyone bought it….but gave up anyway because life was just too hard! It isn’t rocket science that my single parent clients relapse less often than my teenage clients who have loving and very obliging parents. The single parent has to get better and the teenager doesn’t — well, not yet anyway. It’s a sad reflection that something we stand to lose is far more motivating. Concerned parents should always know that their child will only get better if they see the benefits of changing, or the penalties of not changing or both. If they see neither, then they aren’t ready to change. In summary, the world in many ways is working against people with OCD so that we therapists are often playing catch up. We, and society, like to believe we are proactive but instead we are reactive — to environmental stressors and influences outside our control. The idea of control, certainty, comfort — so integral to the core issues of OCD. I am aware that I deal with a condition that runs, nay sprints, towards these three ideals in a constantly changing, uncertain, chaotic world that lies to my clients. It tells them that the impossible is possible, their irrationality is rational and what’s more, loads of others would agree. I’m a therapist but really, I’m a dealer in answers and sometimes I have to limit these to no more than 5 per session…………. The big answer of course, is acceptance and the road less travelled, which is the cornerstone of what we do. Encouraging and supporting our clients to do the stuff of their nightmares. The basic premise isn’t rocket science — but shaping their detailed and complicated non-acceptance into acceptance requires conviction and guts! As I said, it’s a lonely road. Then, when they recover, there they are, ‘newly rational’, realising that the rest of the world is nuts. Ha! Join me on that road, I say.

What’s the problem with reassurance and OCD? Any experienced OCD therapist will stress the importance of not reassuring as a priority, but why? One of the first-occurring and easiest means of dealing with anxiety is reassurance. This can be done instantly online or obtained quickly from our nearest and dearest. We have learnt since childhood that our parents offer immediate, soothing reassurance as is their practice. Not only was this one of our first coping mechanisms but it was freely given and parents are conditioned to emotionally rescue their children, believing that it was the one thing they could do well. It’s quick, cheap and seems like good parenting. However, in the case of OCD reassurance seeking, this is most certainly a compulsion and very quickly exacerbates the OCD and establishes poor coping skills. Access to various types of reassurance is easy these days and the predominant ones are: 1. Online reassurance: this can come in many forms. It tends to start with OCD forums. Clients with responsibility OCD will use the forums to see if they have OCD or are actually a bad person. HOCD sufferers will research for criteria to confirm they are or aren’t gay. ROCD means hours spent reading articles such as ‘How do I know I’m in love’ or ‘Are they the right person for me’ etc. Hypochondria/health OCD can find thousands of self-diagnostics online. The internet is a great resource but not when it is used compulsively Medical testing reassurance: for those who can brave being tested for their worst fears, getting tested is addictive. It seems at first as if it is a genuine health issue, followed by the idea that a test is definitive and can stop the worry. The sad truth is that the test will provide only short term relief before the urge to have another, and another accompanied by ‘It may not have been accurate’ or ‘it’s safer to be tested again’. Included in this category are visits to your doctor or specialist. 2. Verbal reassurance: this can come from all sources – family, partners, friends, colleagues. Not only is this unhelpful but it is very addictive, to the point where the sufferer needs the reassurance constantly. If others realise that they are doing the wrong thing then the sufferer can use creative ways in which to get it – asking cryptic questions, changing the theme and mostly, saying ‘this isn’t OCD, but……………’ 3. Self reassurance: in many ways, the most dangerous of all as this is entirely covert and can be continuous. A sufferer will reassure themselves, even during therapy and exposure work which can undermine the effectiveness. They can say to themselves, ‘I would never do that.’ Or ‘I’m not that type of person.’ They may have ritualistic chants or soothing messages. For a person with OCD, reassurance is discomfort avoidance whether obvious or concealed. It is a direct route to avoid anxiety and will work, at first. However, reassurance works like a whiskey to an alcoholic. At first, one or two a night is enough to feel good……….