Understanding OCD

Obsessive compulsive disorder is more nuanced than the “dirtphobic” characterisation it has been given by the media, and interventions by occupational therapists can be incredibly helpful in allowing clients or patients to managing day-to-day activities

Obsessive compulsive disorder (OCD) is a mental health condition that is much misunderstood by the general public. People are not all “just a little OCD”; nor is the disorder solely about compulsively washing hands or cleaning, although that can indeed represent part of some people who live with OCD’s experiences. At its most basic level, a person who lives with OCD will experience obsessive thoughts and compulsive behaviours. Per the NHS, OCD can affect anyone, but symptoms will usually appear in early adulthood - but it can start affecting people during puberty or even childhood. Obsessive compulsive disorder is distressing, and it can prevent people from living full, independent lives at its worst. Obsessive thinking is the first aspect of OCD: it is not simply being obsessed - in the way we use the word casually to mean we really like something. Rather, obsessive thoughts, images, or impulses will intrude constantly within their minds, and can be challenging or disturbing to the person experiencing them. These can manifest in any number of ways: obsessive thoughts may indeed relate to germs, and be obsessively concerned with contaminating things with dirt or germs. People may even struggle with obsessive thoughts about their loved ones, or more violent or sex-related obsessive thoughts.

Comparatively, compulsions are repetitive behaviours which people may engage in as a way to stop, lessen or “fix” the obsession. If someone is having obsessive thoughts about their kitchen being contaminated after cooking, they will clean it doggedly. Someone who experiences obsessive thoughts about their house burning down from leaving the oven switched on at the wall while they’re out may repeatedly switch the oven on and off to “prove” to themselves that it is, indeed, off and therefore safe. The nature of OCD is that the obsession demands the compulsion to settle it, which can interfere dramatically with a person’s day-to-day functions. People living with OCD will also regularly be aware that both the obsession and the compulsion they are experiencing is irrational, but this does not mitigate either. It’s apparent that, for some people, their OCD acts as a barrier between themselves and completing their ADLs. In that instance, the intervention of an occupational therapist may prove to be incredibly useful and beneficial. With that in mind, what interventions or methods may prove useful in helping patients or clients learn to live effectively with OCD? Exposure response prevention (ERP), also known as exposure therapy or graded exposure, may be useful as a way to explore triggers in an environment which the patient or client feels is safe. It allows the individual to slowly and safely address situations in which they feel discomfort, anxiety or fear, dependent on how their OCD manifests, by gradually exposing a person to the scenario which triggers their anxiety in a measured and controlled way. Cognitive behavioural therapy is also helpful to give clients a feeling of being “in control” when faced with invasive thoughts; in the same token, behavioural activation can help people living with OCD by setting goals that will allow them to engage in more meaningful behaviour. Occupational therapists can also give clients or patients practical tools and techniques to help establish control over feelings of anxiety that may arise from dealing with obsessive and compulsive thoughts. These can include relaxation and mindfulness; yoga, breathing exercises, and meditation may be useful tools for people who find their OCD causes anxiety or stress. There are other aspects through which occupational therapy may greatly improve quality of life - for example, people who live with OCD may find they have poor timekeeping due to compulsions preventing them from leaving their home on time - if they have to return to check switches or plugs, as an example. To help with this, occupational therapists may find it useful to outline goals and objectives that will help the client to get back on track, and feel in control of both their OCD and their timekeeping. While obsessive compulsive disorder can affect an individual’s ability to complete daily tasks or activities, occupational therapists have the tools and understanding to offer interventions that can lead to a marked improvement in their quality of life, alongside appropriate care from other health professionals. The involvement of an occupational therapist in the care of a person whose life is in flux due to the symptoms of their OCD could be helpful in returning a sense of balance and, importantly, control.

Wiltshire Farm Foods registered dietitian Maia Fergus-O’Grady discusses the obstacles that service users with dysphagia can encounter at mealtimes

For many of us, mealtimes are best enjoyed with others. For those living with swallowing difficulties, however, the prospect of eating with friends and family can be one filled with anxiety and dread. Despite a general lack of research, there have been some key studies looking at the social impact of swallowing difficulties, also known as dysphagia. A study by Ekberg showed most patients initially seeing

mealtimes as a great way to come together and connect with others, but since their dysphagia diagnoses, only 45% of individuals still enjoyed mealtimes; 41% of participants experienced panic and anxiety during meals, and 36% were consciously avoiding eating with other people altogether. A further study showed those living with dysphagia reported feeling embarrassed about their condition, a general disinterest in food since their diagnosis, and needing assistance during mealtimes as factors impacting their food intake. Texture-modified (TM) foods are often one of the firstline treatments for those living with dysphagia; when texture is missing as a cue, the appearance and taste of a meal become even more important. With those living with dysphagia often eating less, it’s also important to maximise the nutrition available within each bite of food. Moulded TM foods with distinct, identifiable protein, carbohydrate and vegetable portions often have a better visual appeal, which in turn has been found to increase consumption. These meals are also more likely to promote dignified dining, as the meals bear a closer resemblance to a regular plate of food. Home delivery services enable those travelling to visit loved ones an opportunity to eat appropriately textured meals in a social setting. A service such as this has potential to reduce levels of anxiety or embarrassment for hosts preparing and serving food. This means that those with dysphagia are then able to enjoy a meal that they feel comfortable bringing to the table and any kind of social awkwardness is avoided. It’s worth being aware of the impact that eating in social settings can have on those living with dysphagia. If you have any patients or service users living with the condition, it may be worth checking in and seeing how they are doing; although a small gesture, it has potential to make a real difference.

Wiltshire Farm Foods has launched a new range of Level 4 Puréed Toasties so each of them now appears beautifully browned; enhancing their visual appeal and making them more appetising than ever. Choose from three delicious flavours: Bacon, Cheese and Tuna. All your service user needs to do is call the local branch to arrange for free delivery. To view the meals and for more information, visit: wff.link/HCPrequest