OCD, Stuck In A Loop Of Wrongness.

OCD

Stuck In A Loop Of ‘Wrongness’

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OCD

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No one knows exactly what drives people with obsessive-compulsive disorder to do what they do, even when they’re fully aware that they shouldn’t do it, and when it interferes with their ability to live a normal life they struggle to stop it.

We explore how OCD takes over someones life.

We want to end the stigma surrounding this mental illness, and educate you on what its like being trapped in a loop of ‘wrongness’. OCD shouldn’t be something a sufferer has to hide, but with stigma towards the mental illness at an all time high you wonder why people go to extreme lengths to hide it.

End the stigma, Educate yourself.

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OCD: IT’S NOT JUST ABOUT WASHING YOUR HANDS

CONTENTS 1. INTRO 2. PERSONAL 3. VISUAL 4. SCIENCE

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OCD is a mental health condition in which a person experiences intrusive obsessive thoughts.

Those thoughts provoke anxiety.

Sufferers may act them out or try to avoid acting them out through compulsive behaviours to control their anxiety. Both the cognitive and the behavioural aspects can be debilitating for the sufferers and may also impact on their loved ones. It affects men, women and children, and can develop at any age. People’s conditions sometimes develop around puberty, but typically develop during early adulthood.

End the stigma, Educate yourself.

Throughout this book it aims to explore how a person with OCD copes with normal day to day life.

Exploring their repettitive behaviours that make simple tasks exaughsting.

It also looks into personal experience demonstrating the mental battles people with OCD face. Finally, it takes a dive into the science behind what we know about this mental illness.

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End the stigma, Educate yourself.

PERSONAL

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End the stigma, Educate yourself.

Emmas Story

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Emmas Story

few paragraphs.”

I didn’t know I had this illness. It’s been with me for 26 years, and I didn’t see it until I was 25. That’s the thing, many mental disorders are hidden illnesses, hidden even from ourselves. It all seems obvious in hindsight, and what a relief to understand now.

I grew up with obsessive thoughts, or more aptly, intrusive thoughts. I believed they were a reflection of who I am, but recently I have learned the very opposite. They are exactly who I am not. There is a dark honesty about the next few paragraphs, but I feel it needs to be told.

I, like many others I’m sure, used to associate OCD with not being able to leave a room unless the light had been switched on and off a certain amount of times. Or repeatedly counting, an aversion to odd numbers, or consistently cleaning your home. While these presentations are true in some cases, they reveal only the latter half of the illness: the compulsions.

“I was completely unaware that I have obsessive thoughts.”

My intrusive thoughts (intrusions) have always been violent. From as young as 4, I remember thinking about death. A little older, about killing, rape, murder.

Under the age of 10, I would constantly be haunted by thoughts of torturing people around me. Inappropriate acts of violence.

And even though I didn’t understand it, acts of sexual violence. These thoughts came in fast and in succession. They become constant, repulsive, extremely distressing and real.

I was completely unaware that I have obsessive thoughts. These thoughts are clever, because the voice they are spoken in sounds like your own; they are convincing, realistic (to you) and almost always very distressing. These thoughts, or my OCD rather, lives somewhere in my brain. Research suggests that both the structure of the brain and communication from neurotransmitters are markedly different in OCD sufferers, however it is not yet fully understood.

“There is a dark honesty about the next

'I mostly hiD my compulsions too. out of fear that I would be unveiled’

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End the stigma, Educate yourself.

Emmas Story

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Emmas Story

When I was little, I recognised intrusions as bad thoughts. I knew I shouldn’t be having them but I didn’t know how to communicate them to others. They could be so frightening, it almost felt like my own mind was blackmailing me. To make matters worse, obsessive thoughts ugly brother, consequence stepped in. Consequence took my compulsions and mixed them up with my obsessions. It reared its head in the voice that speaks, “If you don’t match all of the spoons up together, your mum will die today”. “If don’t you cross your toes when your legs are crossed, you will crash your car into those school children.” “If you don’t wash your hands 3 times in the 12 step process, your house will be robbed while you are at work”.

began to accept them. I believed that I was an awful person, capable of violence, rape and murder, and that I was living a double life. That no one knew who I really was. That I was the only person who must think like this. I felt so incredibly lonely.

My compulsions may seem strange at times. I have a real issue with the cutlery drawer. I later came to understand this as perfectionism. There were few times where my perfectionism correcting compulsions were apparent to others, and to one person in particular they were very obvious. For me and my best friend in school, they became a game.

'I didn't know at the time, but I was having a panic attack'

Consequence is a master of blackmail.

So clever, that I let consequence seep in to my conscious mind and let it tell me that I couldn’t speak to anyone about my thoughts, because if I did, I would act upon them. It convinced me that by hiding them, I was protecting everyone else. It linked my obsessions and compulsions seamlessly, and meant that I mostly hid my compulsions too out of fear that I would be unveiled.

On reflection this was an incredibly helpful coping mechanism; by means of distraction, reframing a negative thought as a positive and of course my favourite therapy, laughter.

So believing my intrusions and consequence, I had these thoughts for over 20 years. However, I grew tired of the distress they caused me in my mid-teens, and I 17

Emmas Story

End the stigma, Educate yourself.

Libby and I sat next to each other in most core lessons, and we knew exactly how to cause trouble for each other. We would come in, sit down and get our books out. I would then line up my pencil case, pen and book with a centimeter between them and the table edge, all equally spaced from each other, ready to do work. The intrusions that led to this, were that I was a failure and that I wouldn’t do well or pass my exams, mild in comparison to a lot, but equally devastating for my self-esteem.

A few times, Lib would accidentally knock something out of place and I would carefully put it back and smile. Libby quickly learned that this provoked a reaction and would do it more frequently with more mischief.

On multiple occasions, we would laugh as it seemed so ridiculous, but I needed everything to be lined up.

Libby’s prime was when she muddled everything up, drew an erratic dot pattern on my work (If you have a friend with OCD, please do not do this!) and I had to leave the class to be sick. I didn’t know at the time, but I was having a panic attack.

I have very physical presentations of panic attacks (another time I fainted in Wilkinsons while looking for a planner because none of them had white pages and all had too much writing in them…). They make me feel so horrendous that I used this experience as a catalyst to understand why they were happening and how I could stop them.

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Emmas Story

and I didn’t fail. I had my first piece of hard evidence that the thoughts had lied- and I don’t tolerate liars well.

‘My brain tortures me with every possible bad outcome'

All of a sudden, my daily thoughts were manageable. I could shoo away many perfectionism induced intrusions and for a year and a half, my happiness was almost pure.

So I resumed the game. Aware of the trigger, and solely focused on preventing the awful outcome. I would concentrate on the laughter, Libby’s disappointment when there was no dramatic outcome, and how, physically, it didn’t actually make a difference where the items were placed on the table. I told the voices for the first time to be quiet, and they did. And we laughed. And my work was covered in dots, and lines, unevenly aligned prose and inappropriate doodles, “They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts until we give them meaning.”

“They are only thoughts

My other OCD trait however, is a little more complex. It transpires that I have an excessive need to please others, and in neglecting this, my brain tortures me with every possible bad outcome - and worse- so that I can’t cause any harm. In a less than endearing way, it is protecting me and making me a better person. Although I would much rather learn this lesson in a different way.

It turns out, that OCD sufferers are the least likely people to actually cause harm to others, as they are so repulsed by their intrusions, that they would never act upon them. This was the line from OCD UK that started my recovery. As it happens, I am not

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Emmas Story

a violent, murderous rapist. They were just intrusive thoughts. I’m also not going to get burgled if I close my blinds. I don’t have to check the conservatory door is locked multiple times. There doesn’t need to be three pieces of cutlery in each section of the dishwasher. My boyfriend isn’t going to leave me if the traffic light turns red. My parents won’t die if I don’t mention them in my thoughts before bed. I won’t jump in front of that bus. I’m not going to stab my brother in his sleep. And I especially don’t want to kick your dog into the river.

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REMEMBER THAT THEY ARE ONLY THOUGHTS UNTIL WE GIVE THEM MEANING, DON'T GIVE THEM THE PLEASURE OF MEANING, LET THEM PASS

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Emmas Story

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d the stigma, Educate yourself.

Bryonys Story

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Bryonys Story

"I WENT TO BED HAPPY AND WOKE UP EIGHT AND A BIT HOURS LATER IN A STATE OF TURMOIL, AS IF I HAD BEEN ABDUCTED BY ALIENS BEFORE BEING RETURNED TO MY BED WITH A CHIP IN MY HEAD” I think I might be dying, It came to me in a dream. I know that sounds absolutely ridiculous, but it did, I promise you. One moment I was a regular twelve-year-old, working out which one of Take That I would marry, [Preferred order: Robbie, Mark, Howard, Jason, Gary. I know this is controversial and that the list would eventually reverse itself, but bear with me, I was young] praying that I would make it on to the netball A team because the B team would mean another year in social Siberia with my monobrow and the tartan socks my mother insisted I wore to school; the next, I was convinced I was dying of AIDS. You know. All that normal pre-pubescent girl stuff. I had gone to bed that Sunday night in December 1992 with only a passing knowledge of Acquired Immune Deficiency Syndrome, gleaned almost entirely from an ‘advert’ warning of the dangers of

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Bryonys Story

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'i think i might be dying’

unprotected sex and needle-sharing and umpteen other things that really shouldn’t have bothered a twelve-year-old girl living in a terraced house with an Aga on the outer reaches of west London. I could go entire months without speaking to a boy and it would be years before I was even kissed by one. Recreational drugs were still at least a decade away and even then they never got intravenous. Indeed, on paper, I had absolutely nothing to worry about other than accidentally-on-purpose waking up my baby brother by stomping up the stairs in a huff. I had an annoying little sister who told everyone I farted into glasses, but, goodness, didn’t everyone? Life was good – by any standard, life was great – and there was little to keep me awake at night as I snoozed in my bedroom, decorated with Designers Guild wallpaper that I had plastered over with posters of Take That, much to the horror of my mother. (This was a long time before the phrase ‘first-world problems’ existed, which is a shame, because I would have loved to throw it back at her every time she complained about a border being buggered up by Blu-Tack.)

To give you an idea of just how privileged I was, I should tell you that that afternoon I had actually attended the Smash Hits Poll Winners Party, which felt to me like the Oscars, if the Oscars were hosted by Simon Mayo and the goodie bags included flashing

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Bryonys Story

deely-boppers and bright pink whistles. It was the kind of thing most young girls would have given their right eye to go to at the time – most except the ones at my posh, all-girls school (you see? Such privilege) who saw pop music as totally lame and shallow and thought it was way cooler to be into Nirvana, because this showed you existed on a higher plane of consciousness or loftiness or whatever. (I should say that when Take That re-formed in the twenty-first century, and adult- hood made it acceptable to admit to liking them, many of these girls – now grown women who should really have known better – claimed that they had always loved Take That, which I would have found deeply unjust if I hadn’t had better things to do with my time, like shovelling cocaine up my nostrils or drinking my body weight in strong continental lager.)

“I went to bed happy and woke up eight and a bit hours later in a state of turmoil, as if I had been abducted by aliens before being returned to my bed with a chip in my head.”

Anyway, I had gone with my primary-school friend Emily, whose father happened to be in the music industry (yet more privilege), and we must have been the picture of innocence.

I imagine us in floral dresses and T-bar shoes, because I am nostalgic like that, although in reality it was probably hideous Global Hypercolor T-shirts that blushed pink at the armpits, teamed with leggings and LA Lights

trainers – the kind of thing that Hoxton hipsters wear now because they mistakenly believe that wearing things ironically will make them interesting (in much the same way my school friends thought liking Nirvana did). The Smash Hits Poll Winners Party had been a spectacular event for Emily and me, less so for her dad, who spent the whole event with his hands over his ears, looking like a light had gone out behind his eyes. Take That cleaned up, walking away with such accolades as Best Group in the Whole Wide World, Most Fanciable Male, and Best Haircut (Mark, not Robbie, sadly, but still a win all the same). I now see that this must have been deeply demeaning to Mark, his vast musical talents reduced to the follicles on his pretty head, but at the time it made me feel joyous. It was vindication for choosing Take That. Was Kurt Cobain ever going to win best haircut? No! Was Dave Grohl ever going to saunter off with the most fanciable male title? I somehow doubted it.

We skipped out of Kensington Olympia on a high even though it was pouring with rain, and in

Evidence suggests that OCD runs in some families and may be genetically inherited.

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End the stigma, Educate yourself.

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Bryonys Story

the car back home we sang ‘Could It Be Magic’ over and over, telling Emily’s dad to be quiet every time a new song came on the radio in case it was a Take That one. This was despite

DOES THIS PAGE IRRITATE THE FUCK OUT OF YOUR OBSESSIVE COMPULSIVE DISORDER?

the fact that Emily’s dad hadn’t said anything for nearly two hours, and may have actually been in a catatonic state. I remember getting home and feeling a strange mixture of excitement

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and embarrassment as I described to my mum how totally amazing Take That were. I remember getting into bed with the sound of my own screams of delight ringing in my ears.

I remember drifting off knowing that I had seen the man I was going to marry (Robbie) and that everything was going to be OK, netball A team or no netball A team. And this is the last time I remember life without darkness in my brain.

When I look back on my life and the mental illness that has defined so much of it, there is pre-dream Bryony, in her imaginary T-bars and Laura Ashley skirts, and there is post-dream Bryony, in Doc Martens and a perpetual frown. People often talk suspiciously of overnight transformations, but this really was one – I went to bed happy and woke up eight and a bit hours later in a state of turmoil, 28

ITS FUC ME YES

Bryonys Story

as if I had been abducted by aliens before being returned to my bed with a chip in my head. And who’s to say this didn’t happen?

I mean, isn’t it far more plausible than being sent nutso by a series of involuntary images and ideas that flash into your mind while you are unconscious? No. Don’t answer that.

Already I am worried that you think I am bonkers.

S CKED OFF S

Anyway, I know that listening to other people’s dreams is only marginally less tedious than transcribing minutes from a meeting about treatment for fungal infections, so I will keep this brief.

This may seem like selflessness, but in actual fact my linguistic parsimony is because the dream was as dull as dishwater. It wasn’t particularly vivid or detailed. I remember very little of it, other than that it was the start of a long civil war in my head, the effects of

which would every now and then be felt in other parts of my body, as if refugees had

fled my brain and sought solace elsewhere – in a gaunt cheekbone, for example, or a pronounced clavicle. Basically, I dreamt that I had an incurable disease. I didn’t look ill, or feel ill. I was up and doing all the things I usually did, including going to school, playing Nintendo and watching The Simpsons. But in my dream a doctor told me I was dying and that was that. No respite. I would be dead in months. Days, maybe.

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Bryonys Story

I remember a friend at a sleepover telling us all, in a terribly serious tone, that if you die in a dream, you die in real life. Perhaps that was why I woke up in a cliché of cold sweat, convinced that it was all over, my nightmare not a fevered dream caused by watching an advert but a terrible premonition of things to come. I had read in a newspaper that people with HIV didn’t know they had it until it was too late and the virus had developed into AIDS. Perhaps this explained why in my dream I had been given a death sentence while outwardly appearing well. Yes, that was it – it made perfect sense. I was dying of AIDS, and I wasn’t even a teenager yet.

I honestly thought I would never become a teenager. Although I don’t remember too much detail of the dream, the weeks afterwards have all the nightmarish detail of a Salvador Dali painting. At school that day everyone chatted excitedly about their weekends and I remember feeling a great weight above my heart because I thought that I would never again be able to do the same. All the joy I had felt after the Smash Hits Poll Winners Party had evaporated. I could scarcely believe that the girl tunelessly singing ‘Could It Be Magic’

they were still red, then perhaps everything was fine. I wore gloves as much as I could but this in itself was not without danger, because who knew who had handled them while they were still on sale in the shop? Clothes with pockets posed a similar problem, but in a rare moment of lucidity I reasoned that they were better than nothing.

I would have worn bandages round my hands if I could have.

Christmas was coming and joy was everywhere but I couldn’t share in it. I helped to decorate the tree in the solemn belief that it was probably the last time I would ever do so. The smiling carol singers and the laughing Father Christmasses on the television seemed to make my misery more acute. Everyone’s happiness seemed obscene given what was going on in my head. I simply could not comprehend how normal life could continue when I felt so

in blood spots. I was Lady Macbeth, without the murderous impulses (I hoped). At night I lay in bed staring hard at the scabs on my red raw hands, checking to see if they had turned green. Green, I had decided in my not very logical way, was a sign of infection. If 30

Bryonys Story

'EVERYONE'S HAPPINESS SEEMED OBSCENE GIVEN WHAT WAS GOING ON IN MY HEAD. I SIMPLY COULD NOT COMPREHEND HOW NORMAL LIFE COULD CONTINUE WHEN I FELT SO ABNORMAL. JUST ONE OF THOSE FUNNY THINGS.' - Bryonys story

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This is why it’s difficult have OCD. One estimate of the global populatio UK alone; but it could b as many people with th realise they have it. Wh was suddenly seized by re shagging his sister with, an avocado, would he au had a neurotic disorder know that messages wer and preventing him fr of what-the-fuck thoug off without worry? He he had a deep-roote The problem with statistics

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to say how many people e puts the figure at 1% on, or 630,000 in the be significantly higher, he condition don’t even hy would they? If a boy epetitive thoughts about say, the narrow end of utomatically assume he r? How could he possibly re misfiring in his brain rom dismissing the kind ghts most people shrug e wouldn’t. He’d assume ed personal problem.

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Alex’s Story

I don’t remember a time when I wasn’t anxious. As a kid, I worried about small things, big things, even existential things, for as long as I can remember. Two early examples, from when I was probably about 5-6 years old, that come to mind are: 1- When I realized that one day, the 1990s were going to end. I sobbed to my mom, wondering what was going to happen when we weren’t living in the 90s anymore.

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2- I had a terrible thought that I didn’t love my dad as much as I loved my mom, and in my head, this was very, very wrong. I, again, sobbed about this to my poor mom, who did her best to comfort me as I then began to list off every person I didn’t think I loved enough in my life.

Growing up, my parents loved watching Law and Order, and other TV shows revolving around murder and other terrible crimes. I began to worry that something like what happened on these shows would happen to me, or worse, that I would somehow become the bad guy and be responsible for one of the awful things that always happened on those shows. Horror movies and books gave me similar

worries. I saw The Omen at around 11 or 12, and worried that maybe I was a child of the devil.

My Christian faith was always important to me, and this played into these thought patterns. I obsessed over questions like: Am I making sure I’m good enough? Did I do something that would be the one thing that would keep me from being able to be loved by God? Am I going to turn into one of those crazy people who thought God was telling them to do something awful? What if God did tell me to do something terrible to prove my faith? Am I actually evil?

This thought cycle reached its most distressing level when at about age 14-15, I went to get something from the kitchen while my mom was in our den watching TV. As I walked by the knife drawer, I thought about the possibility that I could take a knife from the drawer, walk down the stairs, and use the knife to kill my mom. Immediately, my thoughts began to spiral. I loved my mom more than anybody- how could this even enter my mind? I couldn’t get the images of myself hurting my mom out of my head.

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Alex’s Story

'THERE IS HOPE FOR ME AND FOR YOU’

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Alex’s Story

End the stigma, Educate yourself.

My life from then on became about fighting these thoughts and images. I tried to avoid being alone with my thoughts, because any time my mind was not occupied, these terrible images would flood in. I sometimes prayed continuously, trying to use the right words to rid myself of this idea, thinking that maybe God could somehow assure me that I would never harm my mother. I read books chapters and chapters of books at night, trying to fill my mind with something besides tortured thoughts. I even played games with myself to try to get an outcome that would prove I would never act on this thought of killing my mom.

My life became miserable. I had always been close to my family but I couldn’t enjoy being around them because I was afraid I had this horrible secret that had the potential to destroy everything. I became confused about God (did God put this idea in my head? What does that mean? Is God telling me to kill my mom? If so, would that mean I would have to put my mom above God in order to not do it?)

‘My life became miserable. I had always been close to my family but I couldn't enjoy being around them because I was afraid I had this horrible secret that had the potential to destroy everything.'

Then one day, on a car trip, I read 36

Alex’s Story

an article in Seventeen magazine about obsessive-compulsive disorder. It was a full feature article describing one girl’s struggle, then listing symptoms of OCD. As I read it, I had this frightening, sinking feeling that it was describing me.

Did this make me crazy? Crazy people are the ones who do commit murder! And also, maybe I was making up an excuse for these scary thoughts when really it was God or something, right?

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End the stigma, Educate yourself.

Alex’s Story

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Alex’s Story

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A Poem

OCD it is not cleanliness, It is thoughts that feel like dirt, OCD it is not tidiness, It is causing yourself hurt, OCD it does not mean, That this place must look white pure, OCD unfortunately, There is no known cure.

OCD is not me having a routine, It is counting to ten every time, I see something I shouldn’t have seen, In my thoughts or in the world, That doesn’t feel right to me, That makes my mind want to bleed.

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OCD is constantly a battle, An argument over what will happen, Will I die or will they die?

If I leave the toaster plugged in?

Will my whole family burn alive?

If they are a bad person, Then surely that means so am I? OCD is my lifelong struggle, I cannot drink from that water bottle, Because what if it is contaminated, What if someone else has touched it?

What if I have to spend the night in a hospital bed? Or someone else wakes to find me dead.

OCD please I haven’t done anything wrong, what are you accusing me of?

Every day is a prison sentence, So much I sit alone in silence, 42

A Poem

And hit out, angry, lonely, desperate, Why are my thoughts doing this to me?

OCD is a pit of mess, a place of isolation, Where everywhere you hit a wall, And where you hurt yourself, OCD has me at breaking point, As every time I wake the thoughts begin, And I think do I want to end this?

Can I carry on pretending?

OCD does not mean cleanliness, It means I feel horrendous.

OCD however guides me, As I try to let it go, And I break it everyday, And piece by piece I smash up my routine, And become the world’s messiest person they’ve ever seen, But how can I make it look organised?

So no one knows what I am going through? Tough, just let them know this is what you are going through.

OCD is a constant battle of going the opposite way to the current, But I will not drown in it any longer, And I will keep on swimming, Until I reach the shallow end, The beach waiting for me, And the sun rising, OCD doesn’t mean that I cannot turn around and face the horizon.

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Alex’s Story

'MY LIFE FELT LIKE IT WAS FALLING APART, BUT I COULDNT GET OUT. I WAS COUNTING THE DAYS BETWEEN ONE OF MY THEORTICAL WORRIES TO THE NEXT, THERE WAS NEVER A GOOD TIME.

wanted her to know, but didn’t want to say out loud. Looking back now, I think this was really helpful in me being able to get all of my fears and worries out and for my therapist to understand what I was going through.

AND THEN I REALISED MY THEORETICAL WORRIES WERE ACTUALLY INTRUSIVE THOUGHTS’

My therapist diagnosed me with OCD. We did cognitive behavioral therapy and what I now know is exposure and response prevention: she had me speak what I was most afraid of aloud into a tape recorder, and I had to listen to it over and over again. I specifically remember this part because I was terrified to do this at first, but it was extremely helpful. She also helped me to recognize thoughts as intrusive and not holding meaning.

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I told my mom some of the thoughts I had been having and showed her the article. I am so thankful for her gentle and nonjudgmental listening, and her seeing my real need for help beyond what she could give on her own. She set up an appointment for me with a child psychologist.

I had protested against this, mostly because I did not want to tell my worries to anyone, for fear of what they might think of me. But, I knew I needed help. One thing that made a big difference for me in getting started, and I would recommend to others, was that I wrote my psychologist a letter before we really had our first meeting. I laid out in detail everything about what I had been mentally going through, all the gory details, as much as I

Eventually, when I was probably about 16, I “graduated” from weekly therapy when I had learned how to manage these thoughts. For the most part, even though I had a random intrusive thought from time to time, I thought I had conquered my OCD. As an adult, if I ever told anyone about this time of my life, I would say I had OCD when I was a teenager- past tense, not present. For my own life, I had put OCD in this one box of my specific thoughts about harming my mom.

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I didn’t realize it could show up in new ways.

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One way I believe OCD began to show up was in my relationships.

Or rather, my lack of relationships.

I’ve always been a romantic, and have somewhat idolized the idea of true love. I have also always had a fear of ending up in the wrong relationship, stuck with someone out of habit or ease rather than real love. To me, that would be worse than being alone. I think this made it hard for me to date at all, because as soon as it seemed like something might happen romantically with someone, I started to let my anxiety take over.

I would get to the point where it seemed like a relationship was about to start with a friend or someone I had a crush on, but then, I would freak out, feeling like something wasn’t right anymore.

For a long time, the only “real” relationship I had was a threemonth relationship with a guy in college. He was very cute, we got along great, we had great chemistry and similar values and sense of humor. Before we started dating, conversation was so easy and fun. But as soon as things got official, I began to obsess. Was he only using me for a physical relationship? Again, God came into it- would God want me to be with him? Was I just giving in to my own desires instead of listening to God? I worried that anything we did together physically was wrong and must be stopped, and meant he was the wrong person for me. I worried about it constantly, to the point where I even had hives on and off. It began to be awkward

around him because my fears made

Alex’s meStory insecure about everything he

said or did. Finally, he got frustrated with the different person I had seemed to turn into, and we broke up.

I never connected this to my OCD. I also never found a relationship that stuck, and had a hard time even committing to a first date with anyone I didn’t think would be perfect.

Then, I met the guy who is now my boyfriend. From the get-go, I was anxious about our relationship. Was he the one? Should I stop dating him if I already have a feeling that he’s not? Having these thoughts made it hard to completely enjoy even our first dates, when I couldn’t have possibly known whether he was the right person or not. He let me know early on that he is not a Christian, which again gave me faith-related worries- am I prioritizing a man over God? We have now been together for over two years, and have talked about marriage and moving in together- but I still worry about whether he is “right” for me. I worry about whether I truly love him or am just kidding myself because I want to be in a relationship. I worry that we don’t have enough in common, that I don’t find him attractive enough, that I am just faking it because it is easier than breaking up. I am generally a conflict-averse person who tried to keep everybody happy- is this the only reason why I don’t break up with him?

46Story Alex’s

Alex’s Story

He is steady, kind, funny, thoughtful, smart, adventurous, and so many other things that I love. But part of me wonders still if there is someone else out there who would match me better, who would bring out better parts of me, who would help me live my life more fully than my boyfriend can.

Did it feel right when we said “I love you” to each other? One morning, I woke up with the thought “I don’t love him, I just want to love him.” That thought is sitll one I struggle with.

During one particularly distressing episode of these thoughts, I realized that it felt similar to the way I had felt when dealing with OCD as a teenager. I was having the same overwhelming “woosh”ing feeling associated with the dreaded thoughts, the need to overanalyze, the mental compulsion to try to get the thoughts out of my brain, and the ultimate inability to get away from the thoughts. Then, I looked back on the other romantic moments and relationships in my life and noticed this thread of anxiety running through them all.

sign to me that maybe OCD had attached itself to my relationships and feelings about love. I did a Google search to see if there was such a thing as relationship-related OCD. I had never heard this was a possibility for OCD sufferers. But sure enough, an article popped up about OCD. I cried with a sense of relief and as I read through the list of signs of OCD, seeing myself in so many of them.

I finally talked to my boyfriend about the thoughts I had been having, and explained to him that I thought they might be connected to my OCD. He was incredibly understanding and has been so patient and loving through all of this, but still struggles with hearing my doubts, worrying that he needs to perform a certain way for me, or that he is going to lose me.

I found a therapist a few months ago, and described to her that I thought I was experiencing OCD attached to my relationship. While she was a wonderful person, I don’t think she had the training

When I looked back and saw this pattern in my life, it was another 47Story Alex’s

Alex’s Story

Hearing the stories of others through this podcast has been very helpful to me in understanding my own experience. I have also found a couple of books to be helpful: the Mindfulness Workbook for OCD, as well as Overcoming Unwanted Intrusive Thoughts.

I KNOW THERE IS HOPE FOR ME AND FOR YOU. we've just got to trust ourselves.

End the stigma, Educate yourself.

to approach OCD specifically, and we instead talked about my childhood stresses that could have led me to be unable to trust myself, and what I need in relationships- things that I’m sure may be helpful to me at some point, but for now only really added to the things I worried about within my OCD cycles. Through this experience, I have discovered that finding someone who really truly understands OCD is a must for recovery.

Hope comes from working to be present in the moment so I can experience life without worrying about it. In the moments I can manage to live in the present, I can really enjoy my boyfriend and our relationship, and get outside of myself.

Hope also comes from intentionally looking for the good qualities in me that are actually related to an over-analytical mind. These have been hard to identify, but I think they are there. For example, I believe OCD gives me a deeper sense of empathy for those struggling with any kind of mental illness. I also have the ability to analyze and see necessary details in a situation that others may miss.

My favorite aspect of this type of mind is probably the ability to remember little things about people- which helps me to be a great gift-giver!

Last week, I went to my first appointment with an OCD specialist. It was so comforting to be able to talk with someone who understood what my mind had been doing. She gave me a questionnaire specifically about relationship OCD, which showed that this is in fact, most likely what is going on with me. This in itself was incredibly affirming to me. I’m looking forward to continuing my work with this therapist.

I am hoping to learn how to trust myself, and to trust God, even with and through this OCD. I believe- I know- there is hope for me, and for you.

For me, there is much to hope for, even when OCD feels overwhelming and I worry that it will ruin the big moments in my life.

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Alex’s Story

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SCIENCE

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Within this section, science becomes the main topic exploring how and why OCD occures, and what logic there is behind this extremely unlogical mental illness. This chapter looks into theories and explores what we know and what it means to have OCD. A range of studies are included in this section hoping to not only end the stigma, but also educate people on the potential reasons this illness has such a large impact on ones everyday life.

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AN INNER LOOK INTO THE MINDS AND BRAINS OF PEOPLE WITH OCD

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Complex computer modeling demonstrates that obsessive-compulsive disorder patients learn about their environments but don’t use that information to guide their actions.

“I turned to walk away, and had to do it all again, and again and again, he say’s You get stuck in this horrific cycle, where all the evidence you use to form judgments in everyday life tells you there’s no blood, And if anyone asked youd say no Yet when you ask yourself, you say maybe.’”

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About 10 years ago David Adam scratched his finger on a barbed wire fence. The cut was shallow, but drew blood. As a science journalist and author of The Man Who Couldn’t Stop: OCD and the True Story of a Life Lost in Thought, a book about his own struggles with obsessive-compulsive disorder, Adam had a good idea of what was in store. His OCD involved an obsessive fear of contracting HIV and produced a set of compulsive behaviors revolving around blood.

person’s life. Adam’s story illustrates a curious feature of the condition.

Sufferers are usually well aware their behavior is irrational but cannot stop themselves from doing whatever it is they feel compelled to do.

In this instance he hurried home to get some tissue and returned to check there was not already any blood on the barbed-wire.

“I looked and saw there was no blood on the tissue, looked underneath the fence, saw there was no blood, turned to walk away, and had to do it all again, and again and again,” he says. “You get stuck in this horrific cycle, where all the evidence you use to form judgments in everyday life tells you there’s no blood. And if anyone asked, you’d say ‘no.’ Yet, when you ask yourself, you say ‘maybe.’”

A new study published September 28 in Neuron uses mathematical modeling of decision-making during a simple game to provide insight into what might be going on. The game looked at a critical aspect of the way we perceive the world. Normally, a person’s confidence about their knowledge of the surrounding environment guides their actions. “If I think it’s going to rain, I’m going to take an umbrella,” says lead author Matilde Vaghi. The study shows this link between belief and action is broken to some extent in people with OCD. As a consequence, what they do conflicts with what they know.

This insight suggests compulsive behaviors are a core feature rather than merely a consequence of obsessions or a result of inaccurate beliefs.

Such compulsive behaviors, and the obsessions to which they are typically linked, are what define OCD. Far from merely excessive tidiness, the mental disorder can have a devastating impact on a

The research of Vaghi and colleagues demonstrates the type of research being performed by the relatively new field of computational psychiatry. The work could ultimately lead to tools 55

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for early detection of people at risk. The field also may help pave the way for improved diagnosis based on understanding the biological or cognitive mechanisms of mental disorders rather than merely observing symptoms, as psychiatrists currently do. A more mechanistic analysis might also reveal that a tendency to repeat inappropriate actions (a compulsivity “trait”) is shared among multiple disorders such as OCD, substance abuse and eating disorders. And this type of analysis might distinguish among different types of OCDs and give psychiatrists a better idea about who might respond best to particular treatments.

In principle, the fact that beliefs and actions in OCD patients are often at odds could have several explanations. It is possible their ability to learn about the environment might be impaired in some way or they might lack confidence in things learned, despite their being accurate.

Inspired by these questions, Vaghi and colleagues decided to investigate the relationship between belief and action during learning in people with and without OCD with the goal of discerning that connection—and what may go away in OCD. The team—led by graduate students Vaghi and Fabrice Luyckx at the University of Cambridge, and neuroeconomist and senior author Benedetto De Martino at University College London—used an established task to study how beliefs and actions evolve over time during learning.

They recruited 24 volunteers with OCD and 25 people without the disorder and had them play a video game in which they had to move a target (the “bucket”) around a circle to catch colored dots (“coins”) emitted from the center of the circle. The participants had to move the bucket to a position they thought most likely to catch the next coin, and give a rating as a percentage of how confident they were of the choice they had made. Most of the time the average destination of the coins was more or less the same, varying only slightly, but there was a one-in-eight chance each time that this position would dramatically shift.

The groups did not differ as far as how many coins were caught, but people with OCD tended to move the bucket toward exactly where the last coin landed more than healthy volunteers did. The actions of healthy participants closely mirrored the predictions of a mathematical model of learning whereas the actions of people with OCD deviated substantially from these predictions. Instead, the OCD group overreacted to what neuroscientists call “prediction error,” which in this case is the difference between where they placed the middle of the bucket and where the coin actually made contact with the circle. The healthy volunteers paid less attention to these errors unless a big shift took place in the average direction of the coin. The control group, instead, made a mental calculation concerning the average direction of the coin over the preceding trials.

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Dual Systems.

‘They are also consistent with a “dual-systems” view of behavioral control that distinguishes between explicit, conscious reasoning and more implicit, automatic behaviors’

Conscious Reasoning

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Automatic Behaviours

The middle area created by the overlapping circles symbolises Obsessive Compulsive Disorder at its purest. Both Conscious reasoning and automatic behaviours combined produce OCD. 58

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As a consequence, they tended to move the bucket less.

(washing to relieve anxiety about contamination, for instance). “The orthodox story is it’s all grounded in the obsessions; these drive anxiety and people take compulsive actions to alleviate that,” says computational neuroscientist Nathaniel Daw of Princeton University, who was not involved in the study. “This study supports the alternative idea that the compulsions themselves are a core deficit, not secondary to obsessions.”

Crucially, though, confidence ratings (which dropped sharply after a shift, then rose as evidence of the new average direction accumulated) were indistinguishable between the two groups, suggesting the patients developed as accurate a sense of what was going on as the healthy volunteers.

But their actual bucket placements showed they were not using this knowledge to guide their actions.

“This study shows that actions are dissociated from thoughts, in a sense,” Vaghi says. “It’s very much related to the clinical manifestation, when [sufferers] say: “I know it’s unlikely I’m going to get contaminated by touching the door handle, but even so, I will wash my hands.’”

The results suggest the brain calculates confidence independently of action but healthy functioning depends on linking them tightly together. They are also consistent with a “dualsystems” view of behavioral control that distinguishes between explicit, conscious reasoning and more implicit, automatic behaviors, Daw says. “A number of issues in psychiatry related to compulsion have to do with a disconnect, or imbalance, between these two types of process.”

The team also found that the extent to which confidence and action were uncoupled tended to be greater in individuals with more severe symptoms. “The new, exciting thing is the finding of a dissociation between action and belief in OCD that seems critical in this disorder,” De Martino says. “We found a clear correlation between the degree of this dissociation and the severity of symptoms.” These results suggest compulsive behaviors are a core feature of OCD rather than just a response to specific obsessions

The study illustrates the potential of computational psychiatry, Vaghi says.

“It’s an example of how integrating computational and clinical aspects is a really powerful approach,” she adds.

“Without computational modeling we wouldn’t have been able to pin down exactly what this behavior relates to—we were able to understand which component of the model explains the behavior.”

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The Science

everyone experiences intrusive, random and strange thoughts? WHY YOU SO SPECIAL? 60

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Everyone experiences intrusive, random and strange thoughts.

Most people are able to dismiss them from consciousness and move on. But these random thoughts get “stuck” in the brains of individuals with OCD; they’re like the brain’s junk mail. Most people have a spam filter and can simply ignore incoming junk mail. But having OCD is like having a spam filter that has stopped working – the junk mail just keeps coming, and it won’t stop. Soon, the amount of junk mail exceeds the important mail, and the person with OCD becomes overwhelmed. So why does the brain of individuals with OCD work this way?

In other words, what causes OCD?

people with OCD compared with those who don’t. Research findings suggest that OCD symptoms may involve communication errors among different parts of the brain, including the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus.

Abnormalities in neurotransmitter systems – chemicals such serotonin, dopamine, glutamate (and possibly others) that send messages between brain cells – are also involved in the disorder.

Although it has been established that OCD has a neurobiological basis, research has been unable

Using neuroimaging technologies in which pictures of the brain and its functioning are taken, researchers have been able to demonstrate that certain areas of the brain function differently in

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1. NEUROBIOLOGICAL 2. GENETIC 3. BEHAVIORAL 4. COGNITIVE 5. ENVIRONMENTAL FACTORS IT IS BELIEVED THAT OCD LIKELY IS THE RESULT OF A COMBINATION OF NEUROBIOLOGICAL, GENETIC, BEHAVIORAL, COGNITIVE, AND ENVIRONMENTAL FACTORS THAT TRIGGER THE DISORDER 62

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to point to any definitive cause or causes of OCD. It is believed that OCD likely is the result of a combination of neurobiological, genetic, behavioral, cognitive, and environmental factors that trigger the disorder in a specific individual at a particular point in time.

Following is a discussion of how those factors may play a role in the onset of OCD.

immediate family member with the disorder. In addition, twin studies have indicated that if one twin has OCD, the other is more likely to have OCD when the twins are identical, rather than fraternal.

Overall, studies of twins with OCD estimate that genetics contributes approximately 4565% of the risk for developing the disorder.

A study funded by the National Institutes of Health examined DNA, and the results suggest that OCD and certain related psychiatric disorders may be associated with an uncommon mutation of the human serotonin transporter gene (hSERT). People with severe OCD symptoms may have a second variation in the same gene. Other research points to a possible genetic component, as well. About 25% of OCD sufferers have an

A number of other factors may play a role in the onset of OCD, including behavioral, cognitive, and environmental factors. Learning theorists, for example, suggest that behavioral conditioning may contribute to the development and maintenance of obsessions and compulsions.

More specifically, they believe that compulsions are actually learned responses that help an individual reduce or prevent anxiety or discomfort associated with obsessions or urges. An individual who experiences an intrusive obsession regarding germs, for example, may engage in hand washing to reduce the anxiety triggered by the obsession.

Because this washing ritual temporarily reduces the anxiety, the probability that the individual will engage in hand washing 63

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End the stigma, Educate yourself.

when a contamination fear occurs in the future is increased. As a result, compulsive behavior not only persists but actually becomes excessive.

Many cognitive theorists believe that individuals with OCD have faulty or dysfunctional beliefs, and that it is their misinterpretation of intrusive thoughts that leads to the creation of obsessions and compulsions. According to the cognitive model of OCD, everyone experiences intrusive thoughts.

People with OCD, however, misinterpret these thoughts as being very important, personally significant, revealing about one’s character, or having catastrophic consequences. The repeated misinterpretation of intrusive thoughts leads to the development of obsessions. Because the obsessions are so distressing, the individual engages in compulsive behavior to try to resist, block, or neutralize them.

The Obsessive-Compulsive Cognitions Working Group, an international group of researchers who have proposed that the onset and maintenance of OCD are associated with maladaptive interpretations of cognitive intrusions, has identified six types

of dysfunctional beliefs associated with OCD: 1. Inflated responsibility: a belief that one has the ability to cause and/or is responsible for preventing negative outcomes; 2. Overimportance of thoughts (also known as thought-action fusion): the belief that having a bad thought can influence the probability of the occurrence of a negative event or that having a bad thought (e.g., about doing something) is morally equivalent to actually doing it; 3. Control of thoughts: A belief that it is both essential and possible to have total control over one’s own thoughts; 4. Overestimation of threat: a belief that negative events are very probable and that they will be particularly bad; 5. Perfectionism: a belief that one cannot make mistakes and that imperfection is unacceptable; and 6. Intolerance for uncertainty: a belief that it is essential and possible to know, without a doubt, that negative events won’t happen.

Environmental factors may also contribute to the onset of OCD. For example, traumatic brain injuries

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have been associated with the onset of OCD, which provides further evidence of a connection between brain function impairment and OCD. And some children begin to exhibit sudden-onset OCD symptoms after a severe bacterial or viral infection such as strep throat or the flu. Studies suggest the infection doesn’t actually cause OCD, but triggers symptoms in children who are genetically predisposed to the disorder.

that stress or the way a person interacted with his or her parents during childhood causes OCD. Stress can, however, be a factor in triggering OCD in someone who is predisposed to it, and OCD symptoms can worsen in times of severe stress.

Stress and parenting styles are environmental factors that have been blamed for causing OCD. But no research has ever shown

IN SUM, ALTHOUGH THE DEFINITIVE CAUSE OR CAUSES OF OCD HAVE NOT YET BEEN IDENTIFIED, RESEARCH CONTINUALLY PRODUCES NEW EVIDENCE THAT HOPEFULLY WILL LEAD TO MORE ANSWERS. IT IS LIKELY, HOWEVER, THAT A DELICATE INTERPLAY BETWEEN VARIOUS RISK FACTORS OVER TIME IS RESPONSIBLE FOR THE ONSET AND MAINTENANCE OF OCD. 65

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The Science

'ocd sufferers are portrayed in the media as simply being intense neat freeks’ 66

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END THE STIGMA EDUCATE YOURSELF 67

End the stigma, Educate yourself.

The Science

WE SPOKE WITH EXPERT CLINICAL PSYCHOLOGIST DR. STEVEN PHILLIPSON, WHO STUDIES INTRUSIVE THOUGHTS AND BRAIN SIGNALS. IN PARTICULAR, DR. PHILLIPSON STUDIES THE AMYGDALA. THIS PART OF THE BRAIN CONSTANTLY SENDS MESSAGES TO ANOTHER PART OF OUR BRAIN THAT DOES THE COGNITIVE THINKING. Signals. We See, Hear And Send Signals As Often As THIS PART OF THE BRAIN We Have Thoughts. Right MAKES AUTONOMOUS Signals. Wrong Signals. Mixed Signals. They’re A Major Part DECISIONS. Of The Ways In Which We

Communicate With One Another.

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For someone with intrusive thoughts, the place where these thoughts are created is not from a part of the brain that reflects character development or autonomous decision making. In actuality, the space where they enter the mind is a part of the brain where you define yourself. This process is what makes intrusive thoughts seem so contrary to who you are as person.

According to dr. Phillipson, intrusive thoughts are a mental disorder, not a mental illness. When an intrusive thought hits, dr. Phillipson calls it a spike. The mental rituals that result are called the rumination. Through this distinction, dr. Phillipson has defined the brain’s signals in a way that’s more meaningful for someone who experiences intrusive thoughts.

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End the stigma, Educate yourself.

AARON HARVEY : SO HOW IS IT THAT HIGHLY INTELLIGENT, SWITCHED-ON PEOPLE ARE EXPERIENCING SUCH A LEVEL OF TRAUMA AND FEAR? WHAT IS SORT OF THE SCIENCE BEHIND OCD?

Dr. Steven Phillipson (SP): It’s not completely clear. There are systems in our brain that are designed to prepare us for an emergency. So the system that I focus most on is called the Amygdala. That portion of the brain isn’t responsible for a lot of thinking. That portion of the brain is responsible for a lot of very basic functioning: hunger, sleep cycles and also emergency systems if we’re in danger. My belief is that this portion of the brain has a malfunctioning misfiring mechanism going on. This basic portion of the brain is sending a signal that the thinking portion of the brain becomes aware of. And I think that the brain doesn’t like to feel like we’re about to die without having an association as to where from. And so the brain spontaneously pairs this emergency signal with these thoughts and it infuses a completely authentic experience of danger. So, you know, if there was a poisonous snake running around the floor, you and I would have a very natural physiological reaction of terror and we think “get rid of the snake” and we’ll calm down. So with OCD, 70

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sufferers then react in the most basic and instinctual way, which is get rid of the danger. So that might involve for the classic subset of OCD, if I touch a doorknob that might have AIDs on it and washing and for the pure o to prove that I’m not capable of harming somene. To try to maybe ask other people whether or not they see me as dangerous, to look up online, you know, what are the qualities of a murderer and after time it’s not really clear whether the anxiety comes first and then the thought follows or whether the thought comes first and then that precedes by triggering the anxiety response. I think over time it really becomes a chicken and the egg question.

AARON HARVEY : AH: SO IS OCD A MENTAL ILLNESS? SP: Many of my patients speak about themselves as if they have a mental illness, and I often correct them to say and OCD is an anxiety disorder. Most humans experience anxiety at some point in their life.

And if you look at all the forms of anxiety disorders, OCD is just sort of the top of the pyramid of the complexities of the different types of anxiety disorders. Patients with OCD often find it difficult 71

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End the stigma, Educate yourself.

to disclose their condition to loved ones or friends because it’s often misunderstood. So to say that I often have thoughts about molesting children or harming you, people can misconstrue that.

I reserve the term mental illness for things that are more severe like psychosis, schizophrenia, hallucinations, bipolar disorder. I see those as being much more of a severe form of mental illness or disruption.

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SIGNALS. WE SEE, HEAR AND SEND SIGNALS AS OFTEN AS WE HAVE THOUGHTS. RIGHT SIGNALS. WRONG SIGNALS. MIXED SIGNALS. THEY’RE A MAJOR PART OF THE WAYS IN WHICH WE COMMUNICATE WITH ONE ANOTHER.

- PSYCHOLOGIST DR. STEVEN PHILLIPSON

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The Science

UNDERSTANDING AND IMPROVING THE LIVES OF PEOPLE WITH OCD. OBSESSIVE COMPULSIVE DISORDER IS A CHRONIC ANXIETY-RELATED CONDITION THAT IS ESTIMATED TO AFFECT OVER 740,000 PEOPLE IN THE UK ALONE. OCD IS CHARACTERISED BY TWO MAJOR SYMPTOMS. OBSESSIONS AND COMPULSIONS.

OCD develops when a person becomes trapped in a cycle of obsessions and compulsions and this can have devastating effects on overall quality of life. The World Health Organisation ranks OCD in the ten most disabling conditions of all kinds.

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The complex origins of OCD With such a complex range of types of OCD, it is perhaps unsurprising that the underlying causes of the condition remain a subject of hot debate. Some believe that compulsive behaviours occur in response to negative thought patterns or faulty beliefs about the world and the way that it works. For example, a person may think they will contract an illness if they don’t wash their hands multiple times before a meal. This explanation is often referred to as the ‘cognitive model’.

may underpin his specific area of research, Relationship OCD. “In Relationship OCD, individuals feel their own worth is dependent on their relationship functioning or the perceived value of their partner.

They hold extreme beliefs regarding relationships, for example – ‘if I’m in the right relationship, I must feel euphoric all the time’, or ‘if I get intorelationship I’m not happy in, I won’t be able to get out of it”. In this instance, these unwelcome thoughts are likely to contribute towards the onset of obsessions and compulsions in affected individuals.

“The onset of OCD symptoms is multi-faceted and involves a combination of factors”, describes Guy. “Some factors may be common to most OCD presentations, including general biological predispositions and maladaptive beliefs, whilst other factors may be more specific to particular presentations”.

Whilst the cognitive model has its supporters, recent research suggests that it may not always be the best way to view the origins of OCD.

Guy believes that faulty beliefs

MQ fellow Dr Claire Gillan is the driving force behind a number of studies investigating the role of habit formation in compulsive behaviour.

“Our research focuses on the automatic behaviours that we call habits,” explains Claire.

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“We’ve done a range of experiments that suggest people with OCD are predisposed to form habits, meaning their behaviour tends to become automatic more readily than it does in those without OCD. We all need to form habits to get through life, but in OCD we see that this process of habit formation gets kicked into overdrive.” Claire and her team believe that this excessive habit formation could actually be the main cause of many cases of OCD.

End the stigma, Educate yourself.

Ocd sufferers have a faulty belief systems.

“Often, when talking to someone with ocd, they can tell you just how irrational they think their behaviour is,” explains claire. “That is often what makes ocd so frustrating, because people can reflect on their behaviour and say ‘i know that i don’t need to do this ten times’, yet they are unable to override the need to perform these repetitive habbits.’

Claire draws on her personal experiences in the clinic to argue against the idea that people with OCD have a faulty belief system.

“Often, when talking to someone with OCD, they can tell you just how irrational they think their behaviour is,” explains Claire. “That is often what makes OCD so frustrating, because people can reflect on their behaviour and say ‘I know that I don’t need to do this ten times’, yet they are unable to override the need to perform 76

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these repetitive habits.”

Shining light on the brain circuits involved in OCD Once repetitive cycles of obsessions and compulsions have been established, how do they get hardwired in the brain?

This question forms the basis of Dr Susanne Ahmari’s MQ-funded project on OCD. Specifically, Susanne investigates whether problems in the brain’s circuits - the networks in the brain responsible for transmitting information - could explain the symptoms of OCD. “OCD patients show increased activity in several regions of the brain,” says Susanne.

“However, in people, we have no way of directly testing cause and effect”. Instead, Susanne and her team turned to mouse models and an exciting new technology known as optogenetics, which enables activation of specific circuits in the brain by using short pulses of blue light.

“We targeted a circuit in the mouse brain that is hyperactive in OCD patients,” describes Susanne.

“To our surprise, hyperactivation did not directly lead to repetitive behaviours in the mice. However, if we repeatedly stimulated these 77

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circuits for multiple days in a row, we saw a progressive development of repetitive grooming behaviours, similar to the compulsive behaviours associated with OCD.” This study suggests that repetitive inputs could be required for the formation of certain symptoms and sheds light on the circuitry of the brain during the earliest stages of OCD.

End the stigma, Educate yourself.

Using research findings to develop new and improved treatments Both Claire and Susanne are hopeful that their research can improve the lives of those living with OCD. “If you can understand the mechanisms that cause the symptoms of a disorder, you can intervene more effectively,” explains Claire. “If you know exactly what it is that’s going wrong, you can target that specific factor more accurately using behavioural interventions or medications.”

in facing and wrestling with their symptoms is incredibly moving, and I want to do all I can to give them the tools that they need for this battle, be it new medications or new approaches to psychotherapy.”

As we continue to learn about the underlying causes of conditions like OCD, we are able to fine tune strategies of prevention and treatment.

Susanne is also driven by a desire to improve the lives of those living with OCD. “As a researcher who is supported by public funds, I believe that I have an obligation to constantly be striving towards the goal of the improvement of public mental health,” says Susanne.“The people I really want to help are the patients that I treat. These men and women really bring home the suffering and unrealised potential that can result from psychiatric illness. Their bravery 78

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‘LOOKING FORWARD TO THE FUTURE, THERE IS REAL HOPE THAT WE WILL BE ABLE TO DEVELOP NEW THERAPIES AND ALLEVIATE THE IMPACT OF OCD ON THE THOUSANDS OF PEOPLE LIVING WITH THE CONDITION TODAY.’ 79

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Within this visual element of the publication. It aims to visually demonstrate how OCD suffers live day to day lives through their eyes. Showing the rituals they follow, and behaviours which they generally attempt to hide through shame.

“It’s not about being tidy, it’s about having no control over your negative thoughts. It’s about being afraid not doing things a certain way will cause harm.”

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I believed that I was an awful person

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I am fucking great

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I believed that I was an awful person I am fucking great

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Scan me for support and more information on OCD.

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AS IT HAPPENS, I AM NOT A VIOLENT, MURDEROUS RAPIST. THEY WERE JUST INTRUSIVE THOUGHTS. I’M ALSO NOT GOING TO GET BURGLED IF I CLOSE MY BLINDS. I DON’T HAVE TO CHECK THE CONSERVATORY DOOR IS LOCKED MULTIPLE TIMES. THERE DOESN’T NEED TO BE THREE PIECES OF CUTLERY IN EACH SECTION OF THE DISHWASHER. MY BOYFRIEND ISN’T GOING TO LEAVE ME IF THE TRAFFIC LIGHT TURNS RED. MY PARENTS WON’T DIE IF I DON’T MENTION THEM IN MY THOUGHTS BEFORE BED. I WON’T JUMP IN FRONT OF THAT BUS. I’M NOT GOING TO STAB MY BROTHER IN HIS SLEEP. AND I ESPECIALLY DON’T WANT TO KICK YOUR DOG INTO THE RIVER. END THE STIGMA. 101

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OCD, Stuck In A Loop Of Wrongness.

Produced By Charlie Sedgwick, Second Year Graphic Design University Of The West Of England 2020 Typefaces Avenir, With My Woes, Paralucent.

Pantone 100 U Content References Https://Hellopoetry.com/Words/Ocd/ Https://Www.ocduk.org/Ocd/WhatCauses-Ocd/ Https://Www.mqmentalhealth.org/Posts/ Improving-Lives-Ocd Https://Theocdstories.com/ Https://Www.mind.org.uk/InformationSupport/Your-Stories/My-Ocd-Story/ All Images Copyright Free, And Digitally Manipulated By Myself.

All Visual Imagery Created My Myself.

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GET OUT MY HEAD AS IT HAPPENS, I AM NOT A VIOLENT, MURDEROUS RAPIST. THEY WERE JUST INTRUSIVE THOUGHTS. I’M ALSO NOT GOING TO GET BURGLED IF I CLOSE MY BLINDS. I DON’T HAVE TO CHECK THE CONSERVATORY DOOR IS LOCKED MULTIPLE TIMES. THERE DOESN’T NEED TO BE THREE PIECES OF CUTLERY IN EACH SECTION OF THE DISHWASHER. MY BOYFRIEND ISN’T GOING TO LEAVE ME IF THE TRAFFIC LIGHT TURNS RED. MY PARENTS WON’T DIE IF I DON’T MENTION THEM IN MY THOUGHTS BEFORE BED. I WON’T JUMP IN FRONT OF THAT BUS. I’M NOT GOING TO STAB MY BROTHER IN HIS SLEEP. AND I ESPECIALLY DON’T WANT TO KICK YOUR DOG INTO THE RIVER. A University Of The West Of England Publication.

Author, Charlie Sedgwick.

Copyright 2020/2021

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