Monday 23 October 2017

Living with Obsessive Compulsive Disorder: 'I began to fear my own mind'

Dean Van Nguyen was diagnosed with Obsessive Compulsive Disorder four years ago, and believes he has been suffering from the condition from the age of seven. His life has vastly improved since the diagnosis.

Dean Van Nguyen
Dean Van Nguyen

Obsessive Compulsive Disorder is one of the most misunderstood conditions in Ireland right now. I know that because, before I was diagnosed with OCD four years ago, I probably had many of the same misconceptions about it that you have.

Today, I attribute those false impressions to the lack of good understanding of the disorder among the public, driven by fictitious portrayals in the media, in which the condition is used as a comedy punch-line.

For those living with OCD, it's no joke. I have very clear memories of the first time I struggled with a symptom. I was around seven years old and a distressing thought became wedged in my head, like a record stuck on repeat. It caused me a significant amount of discomfort and I remember questioning whether I would ever be able to remove it from my head permanently. Over two decades later, I still suffer from the same upsetting thought on occasion and have accepted that I will for the rest of my life.

I struggled on through my teenage years, feeling isolated and alone with my symptoms. Some I found too distressing to speak about. Unaware that I had a condition, I felt something was uniquely wrong with me. I began to fear my own mind, constantly nervous that today might be a day that the obsessions and compulsions would be particularly prominent. That fear, of course, just fuelled the symptoms.

A few years ago, I developed a fear of contamination and would repeat complex hand-washing rituals. The logical part of my brain knew that the fear was irrational, yet if I failed to complete the rituals, my anxiety would spike viciously, or I wouldn't be able to focus on anything else for a day, maybe a few days. My behaviour became driven by the fear of not being able to function, as well as the contamination itself. Why risk the day-long unease when you can just wash your hands and get it over with? The rituals, as well as destroying or throwing out anything I deemed to be tainted, became normal.

It's an incredibly difficult and exhausting way to live.

Two types of OCD

You probably have some vision of what OCD is - that people with OCD like their houses neat, that they can never wear socks that don't match, or other things of this nature. Contrary to popular belief, people who are neat and have a keen attention to detail do not necessarily have OCD (I am not tidy or organised at all).

According to non-profit support organisation OCD Ireland, OCD is "the name given to a condition in which people experience repetitive and upsetting thoughts and/or behaviours". These thoughts can fit into two categories: obsessions and compulsions.

Obsessions are the involuntary thoughts, images and impulses that become wedged in the mind. Often they are disturbing and cause high levels of anxiety. Compulsions, meanwhile, are the behaviours or rituals that some people with OCD are compelled to act out, like lock-checking and hand-washing. Usually, compulsions are performed in an attempt to make obsessions go away. But the relief never lasts: the more you perform the rituals or compulsions, the more you reinforce the intrusiveness of the thought and the urges usually come back stronger.

Read more: Living with OCD: “I have a rare minute when I’m not thinking about OCD but other than that my brain is always turned on”

OCD-related obsessions can be just as debilitating as the compulsions, though are often harder to understand because a tangible symptom (like hand-washing) is not always present, with the trauma playing out almost entirely in the mind of the sufferer. Common obsessions include constant thoughts of doubt ('Did I leave the stove on?', 'What if I got pricked by a needle infected with HIV?'), and unwanted thoughts or images that the sufferer finds repulsive, disturbing or the opposite of their value system. These thoughts can include imagery of a violent nature.

"For whatever reason, people seem to associate the outward rituals - the classic ones like hand-washing or checking the lights or checking the stove or checking locks - as being OCD," says Leslie Shoemaker, a counselling psychologist and OCD expert. "But there's other types of [OCD] which are more inwards. It can be counting, it can be thinking the same thought over and over again, it can be questioning the thought over and over again. It can be even saying prayers."

Misconceptions

Despite the debilitating nature of OCD, many still associate the disorder with people who are simply neat, organised and finicky. For example, an article published on news and viral content website Buzzfeed titled '5 Types of OCD Friends You Know and Love' listed 'The Organiser', 'The Always Prepared' and 'The Picky Eater' as the kind of people with OCD readers likely know. These are major misconceptions. Simply put, the difference between people with OCD and those who are considered 'picky' is that the OCD sufferer's behaviour is driven by crippling anxiety.

"The biggest thing that people miss out on is the anxiety that it causes," says Margaret Curran, a Meath-based cognitive behavioural therapist. "I think you can have moments of wanting to straighten things, like if somebody's coming into the house and you like your house tidy. The difference is the wanting and the having to.

Read more: 'I can only imagine how awkward those meals were for everyone else involved, sitting and eating dinner with a ghost'"

Somebody with OCD, they have to do it and they have to do it all of the time, regardless of whether somebody is coming in, necessarily, or not."

One of the most upsetting things I hear is the term 'OCD moment', which is often said when a person feels a once-off urge to, for example, arrange objects in a symmetrical way. It's an expression that also aggravates Shoemaker. "That's really condescending and inappropriate, and also shows a lack of understanding of how serious the disorder can be for some people," she asserts. "I've encountered people in my experience, who are so crippled with their anxiety from the OCD that they can barely leave their home. It impacts family relationships, friendships, work, social life… it's all encompassing. So it's patronising to say, 'Oh yeah, I'm having an OCD moment'."

The cause

Unfortunately there's no definitive cause of OCD, and experts are split between that eternal debate of nature versus nurture. Some believe OCD is completely psychological, while others believe that it's a disorder of the brain.

"I'm kind of in the middle," admits Shoemaker. "I think how things impact one person depends on a whole combination of factors."

According to Curran, experiences in childhood can play a role. "I find, with the children that I have that have OCD, there's a very anxious parent or two parents in the house. So the child has a hyper-awareness around anxiety. So you can get a trigger, like somebody getting a talk in school about germs, just to give you an example. If you've a child who is quite an anxious child, or you have a parent who is constantly saying, 'Don't do that, that wouldn't be good,' or 'Don't eat that', or 'Don't put your hand there', you've got a child who is heightened in relation to what this could mean. Then somebody comes into the school, gives a talk around germs, and bang, that's triggered them."

OCD doesn't have a cure, but there are treatments for the condition through psychotherapy and medication. A currently popular treatment is Cognitive Behavioural Therapy (CBT), a form of therapy that helps people understand the thoughts and feelings that influence behaviours.

For OCD patients, CBT is not about trying to stop the obsessive thoughts or compulsive urges, but rather changing the patterns of thought that cause high anxiety. For example, people who fear contamination may be asked by a CBT therapist to handle something they consider 'dirty' and go about completing normal tasks without washing their hands. These exercises cause huge anxiety among patients, but repeated over time, their anxieties ease.

I found CBT a few years ago when, during a particularly bad period of struggle. After reading about OCD online, I instantly recognised it to be what I'd experienced in my childhood. CBT helped massively, but, I will never not have OCD. I force myself to walk away from the urge to complete rituals every day and, when the compulsion is too much and I slip into old habits, I can only start the process all over again.

Things are better now. Upon initial diagnosis, I was prescribed with Prozac and, although I found the drug to be helpful (effectiveness treating OCD is a difficult thing to gauge), I disliked the side effects. Now, my strategy for good mental health is exercise, regular counselling and keeping busy with work. But nothing was as effective as being told I wasn't alone.

Writing about my OCD is deeply uncomfortable for me, but I do so in the hope that someone reading this article, who may feel alone, might be encouraged to find the help that's out there.

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