OCD (Obsessive Compulsive Disorder)

George is a bright, sensitive 28 year old man. As a child of about 8 or 10, he used to carry out various 'rituals'. These started with things like lining his toys up in a certain way before going to bed, or blinking a fixed number of times when kissing his mother goodnight so that nothing bad would happen to her. His childhood was marked by great anxiety; his father had been paralysed from the waist down in an accident at work and was often angry, frustrated and abusive. He remembers his mother being very distressed and anxious; George felt that it was his job to take care of her.

As he grew older, he developed more elaborate rituals, some of which took up a great deal of time. For instance, he would not be able to leave the house he shared with several friends without checking every window was closed, every electrical appliance switched off, every tap prevented from dripping. On leaving the house he would often close the front door and then have to go inside again to make sure he had done it all properly. He felt deeply ashamed and did his best to prevent other people from realising what he was doing. Sometimes, he avoided going out altogether in order to avoid the stress and anxiety of not feeling sure he could trust his own memory about what he'd locked or turned off. He criticised himself for being weak and pathetic, as he could not seem to stop what he was doing.

He was 26 years old when he saw a TV programme about OCD. At first, he was relieved to know that he wasn't alone. Then he started to look online and read up about OCD. Finally, a couple of years later, he decided to seek professional help and found a CBT practitioner.

The first session with his therapist was spent gathering information about his particular experience of OCD: what he did, what the triggers were, a general history of his condition, and also talking a little bit about what OCD is. His therapist explained some of the elements that keep OCD going, ranging from seeking reassurance, to avoidance of situations which cause anxiety, neutralisation (thinking or doing something to 'neutralise' the perceived threat of a bad thought or action) and thought-action-fusion (a state in which someone believes that thinking something is the same as doing it). George and his therapist agreed that they would work together for 6 sessions and then review his progress.

Early on, they drew up a formulation (see previous case study), in which they captured as many of George's thoughts, feelings, physical sensations and aspects of his behaviour as they possibly could. George started to understand that he saw danger where others would not. He felt hugely responsible for everything and everyone and worried that if he failed to complete his 'safety checks', there might be a fire or a break-in and, in his mind, it would be all his fault. He also realised that he could not stand the idea of being uncertain about anything, hence his need for constant checking.

In conversation with his therapist, George gradually began to understand that all his safety-seeking, reassurance-seeking behaviours and avoidance were designed to help reduce his anxiety, some of which may well have arisen from his early life experiences, which had left him feeling that he was somehow responsible for warding off harm or catastrophe. He also started to see that, in fact, all these behaviours ultimately perpetuated his anxiety. Over the weeks, he undertook to keep a diary monitoring how his anxiety levels rose and fell as he slowly gave up his rituals. It became clearer to him, once he understood that his anxiety was the enemy rather than any external state of affairs, that it was impossible to have total control or cast-iron guarantees in life about anything, and that his anxiety was exacerbated by focusing constantly on possible risks. His therapist also encouraged him to see the benefits of change, ways in which he could reclaim his enjoyment of life.

In the event, George and his therapist opted for a further 6 sessions as he wanted to be confident that, if he had lapses in the future, he knew how to reframe his need for compulsive checking and remind himself how the OCD cycle is maintained, and how it can be broken.

From time to time, George came back for one or two 'top-up' sessions, but overall he managed to overcome the worst of his OCD and live a life which was not ruled by worry and anxiety.