Have I got OCD?
Helen* came to see me because worries about everyday items of food being contaminated were interfering with her ability to enjoy life and she wanted help for what she thought might be OCD. She explained that her difficulties started 6 years earlier whilst she was pregnant with her first child.
She became increasingly preoccupied with concerns that something in her diet might affect her unborn child throughout the course of the pregnancy. She added that she has always been quite an anxious person and over the course of each of her two pregnancies and for the six months or so following the births her anxiety was always significantly worse.
Whilst her anxieties about food did improve following the birth of her first child they have waxed and waned ever since and have been particularly bad whilst she was pregnant again and in the months following the births of her children. Currently she rated her anxiety at 5 out of 10, a level that she finds it relatively easy to tolerate but was seeking help because she and her partner were planning to have another child.
Understanding how OCD develops
Helen explained that her primary concern is that food might be contaminated in some way and as a consequence she takes what she recognises as disproportionate measures to ensure that this is not the case. For example when buying supermarket food she looks for the longest dated food and disposes of it 3 or 4 days before the best by or use by date.
She also reported being very concerned that her hands might contaminate food and reported washing her hands up to 50 times a day. I could see that her hands looked quite ‘raw’ from this washing. We spent a little time talking about the consequences of eating contaminated food and it emerged that she was very fearful about becoming sick and offered that she can still remember a time that she was very sick when on a family holiday and wonders whether her fears stem back to this time. Despite her difficulties her mood has remained fairly positive throughout and she denied experiencing any prolonged periods of low mood or depression in the past.
Helen reported a happy childhood, although she felt that her mother has always been a “nervous person” and she believes that she may have inherited some of her anxiety from her mother. She enjoyed her schooling, though described herself as quite a shy child with a relatively small group of friends. She attended London University and subsequently trained as a biochemist.
She has not worked since the birth of her second child two years earlier but is planning to return to work at some point in the future. She had read several self-help books on OCD and demonstrated a good insight into what keeps this unhelpful habit going, but recognised that she needed professional help in changing her behaviours.
In Therapy for OCD – CBT
- a brief description of the situation involved, e.g. I attended GP surgery with my youngest child who had an earache;
- the worrying thoughts, e.g. “all these sick people, everything I touch must be contaminated;
- the difficult emotions she experienced, e.g. fear; and the way that she coped, e.g. washed my hands at the GP and immediately on returning home had a shower and changed clothes.
It also emerged early in therapy that Helen avoided some situations, such as attending restaurants, that she’d previously enjoyed due to her fear that such activities might elicit more worries.
Over the first few weeks of therapy a clear pattern of emerged between the situations likely to elicit worries, the nature of the worries and the behaviours that Helen felt compelled to engage in in order to neutralise the worries and provide some short-term relief from the difficult emotions she experienced. We also developed a list of situations/places that she routinely avoided and placed them in order, with her ‘most feared’ situation, which was bar-b-ques in public places, being at the top of the list.
Progressing through Therapy
Each week Helen would bring a record of the situation that had provoked difficult feelings in the prior week and we rationally evaluated the risk involved in each situation, i.e. what the real risk of contamination/poisoning was, and examined Helen’s response to the difficult emotions she experienced. Over time she learned to ‘stick with’ her emotional discomfort and in the first instance delay her (unnecessary) neutralising behaviours and eventually eliminate them. We also began to deliberately schedule the situations she was avoiding, starting with the least feared situation and encouraging her once again to stick with the situations until her fear passed without engaging in any cleansing rituals.
By the end of three months of weekly sessions, Helen’s worries and anxiety was very much improved. She felt far more able to tolerate any anxiety that she experienced without immediately having to engage in neutralising behaviours, she was enjoying activities that she had mostly avoided in recent years and had reduced her hand washing significantly.
We arranged one further ‘follow up’ session 6 weeks after the end of therapy, to endure that everything was still ‘on track’ (which it was) and when I last saw her Helen told me that she was still undecided but on balance was thinking of returning to work rather than having another baby at that time.
* This Client Story is not based upon a single client but is rather composed from details from several clients and all identifying information has been changed to protect anonymity. Nevertheless, the difficulties described and the course of therapy is typical.