Angst

Procedural memory is when you do things without consciously thinking about what you have to do. It involves motor skills with things like tying knots such as shoelaces or riding a bike which requires coordination and balance skills. When we start to do things like tying shoelaces we are very conscious of our actions but with practise it becomes automatic. When, for example, domestic tasks are done automatically this is part of procedural memory. Many craft skills involve procedural memory. Our hands and limbs do things automatically It could be that your procedural memories have become much more elaborate then they need to be over a period of time with the development of OCD rituals. And with additional stress the automated response to do things weakens.

I wonder if your Dad considered that the shelf was contaminated? It could be that he perceived things differently. Is your notion of ‘powerlessness’ to do with people not perceiving things the same way as you do and thus doing things not acceptable to you? I understand that the infringement of OCD rules will cause discomfort. Are your parents seeking to punish you? Or do they have different ways of perceiving the world?

The idea of karma for over 50 or more years has become part of our cultural repertoire. It is reflected in John Lennon’s 1970 song Instant Karma where the consequences of one’s actions are immediate rather than over a lifetime and experienced in the nature of rebirth. I don’t believe it. I believe in luck which is purely random and we can have periods of good and bad luck. A lot of people seem to do quite bad things with no consequences and bad things happen to good people. As said, don’t let it become a territory for OCD.

It’s a leading open question. It assumes that you have made positive changes. Rather like the question - When did you stop beating your wife? It assumes that you did beat your wife. I think I would write not applicable as I consider that I have made no progress. I haven’t seen the entire questionnaire but it sounds from this one question badly designed and biased. Designed to record positive results. Therefore the cumulative results from such a questionnaire are not really ‘evidence based’. On an individual level, it is an attempt to bed in any positive changes that a client has made. But the questionnaire should ask if you perceive that positive changes have been made.

The urge to keep on thinking about it is rumination. What do you want to sort out? You have already done an investigation about the age of the actor. This could be labelled as a compulsion. I think any ‘sorting out’ would be a compulsion. Let the whole think drop

I doubt whether a therapist will be able to tell you why the sale fell through. A large number of sales fall through. The longer the chain, the greater the risk that the chain will collapse. It’s a pain because you have probably spent money on a survey and solicitor’s fees.

Hi Sarah J Recurrent images can certainly be a sign of OCD. It is good that you see that they are part of OCD. I certainly get them. You’re half way there in this recognition that they are a feature of OCD and I think the secret is not to linger on the images. You recognise again your compulsions when eating such as deep breathing and slow eating. Do you think that you will be able to minimise these compulsions? A lot of us have interacting conditions and a history of anorexia can certainly have an impact on OCD. I have diabetes and OCD and monitor the effect of types of food and drink on my blood sugar. Getting the balance right between obsessing about eating and checking bloods sugar and being cavalier about the effects of food and drink on my body can be tricky. There is a happy medium. It is good that you are seeing a specialist. I think it is important that people with interacting conditions see a specialist, especially if there are very significant conditions such as anorexia. While you wait for the specialist treatment are you still seeing a GP and the primary team to support you? The waiting time for specialist treatment seems to take longer and longer. Any indications about when the treatment will start?

OCD with a contamination theme does seem to be quite a diverse thing. The theme might be associated with toxic chemicals or germs but also in racialised societies with pollution from outsider groups for example water wells polluted by ethnic out groups or separate water fountains, toilets and other facilities for different groups. Or in caste societies areas polluted by lower castes. Or in certain religions, there are certain contaminated foods. The list is quite long. There was no germ contamination OCD before the rise of germ theory spreading in the late 19th century which promoted the provision of safe drinking water and sewage systems in the UK. I think the pattern of OCD is in part generated by time and geography. In the latter part of the 19th century the age of consent was raised from 13 to 16. This was after a huge campaign. Puberty in the 19th century on average was a lot later. I agree with the ages being 16 and in certain cases 18 these days. HOCD can mean homosexual or harm OCD. In the case of homosexuality you would see different approaches in different parts of the world. Prior to the1970s homosexuality was seen as a mental illness. The pace of science and technology is much faster now. For example microplastics and the chemicals in processed foods. I use plant based tea bags. But I am using ready meals because of an arm problem. As somebody said on another thread perhaps we should limit our exposure to the science?

Lack of sleep can make things worse. I am having problems with my left arm and hand and waiting for x rays and blood tests after seeing a GP twice about the pain. I am on strong pain relief at the moment. It restricts my dexterity so simple things like washing hands are painful. Pain and disrupted sleep are making me irritable. I going to spend the afternoon in the sun. Though part of me wants to remain indoors. You sound as if things and people in your environment are getting to you. Money would give you choice and an escape route for rest and relaxation. But your environment will change soon. Can your GP give you something to ease your discomfort? It took me weeks to see a GP on both occasions. At times you need to see them rather than speak to them over the phone or send pictures.

I think it is good practice to ask a client to do a questionnaire about their emotional well-being being before therapy and after therapy to see whether there has been any improvement. If the therapist is an employee or has a contract with an organisation then their efficacy needs to be monitored. If a significant proportion of clients achieve an improvement then the therapist’s work can be deemed satisfactory or good. It is in the therapist’s interest to report improvements in patients’ well being. I have experienced good practice in evaluating therapeutic efficacy when the questionnaires are collected by administrative staff and not the therapist to retain quality. In the same way academic staff are rated on their work by student surveys and by their university peers on their research quality. The staff who train and educate therapists are judged by trainee medical staff and trainee therapists. Yet at times the clients do not have access to judge the therapists.

Hi robinstar I see checking and washing as compulsions. Whilst obsessing over how one is perceived I see as an obsession. I refer to your first paragraph. My major compulsion is or was checking. Checking that I have locked doors, turned switches off, filled up forms properly and such like. The fears relate to stopping uninvited intruders entering my property, to stop fires and floods that could affect my safety and those of others, and filling up forms correctly so that I do not commit fraud. In my case my OCD fears do not contradict my morality. I do not want to be a victim of burglary, I check physical things to stop harm to me and others and I do not want to commit an illegal act by fraudulent activity. What is defined as OCD depends on the DSM or WHO classification system. We are on DSM 5 at the moment. DSM 4 included as a ‘subtype’ of OCD hoarding. DSM stands for Diagnostic Statistical Manual for mental disorders. We will soon have DSM 6 and it is suggested that there will be profound changes. Hoarding CBT is different to CBT OCDin crucial respects. OCD is a complex thing and the diagnostic categories allow for some variation.

I agree that values are expressed by what we feel. For example the feeling of patriotism towards a nation state can motivate us to defend a nation. The Roman Empire was able to create pan Roman sentiments among many members of its Empire. Belief systems affect values so the values of the Aztecs might be different values of Buddhists. And yes emotions are divided in OCD. I felt resentment that I felt that I had to do compulsions and that it stopped from having a normal life. I felt envious of people who did not need to repeatedly check. But this emotional conflict provided the seeds of insight that I needed to acknowledge I was the author of my mental pain and things could change. OCD is self torment. Husserl and phenomenologists have had a great influence on mental health. The term ‘lived experience’ comes from them. We need to understand the experiences of others in order to help them and help ourselves. Our lived experiences of having lived OCD lives helps us understand others and proffer advice to those who have similar experiences.

Hi W I think the combination of medications is quite common in some instances of OCD. Do you find yourself less troubled after taking them? I find that sometimes I have the same phrase coming to mind. I trace it to a past experience. I don’t think that I have ever seen myself in the past or future doing things. I obviously see aspects of my body in the here and now as I type this reply on my iPad. But seeing yourself as a spectator would must be pure imagination. Pretty standard advice. Do not linger on the phrases and images. Conjure up positive images. Have a pleasant day dream on your awakening.

A philosophy underpins the treatment of OCD and all physical and mental ills in the UK and it is called utilitarianism. It is the philosophy which underpins the work of NICE. The greatest good to the greatest number. In public policy the philosophy is measured in monetary value. That is why certain drugs are not approved as the cost per additional life year are too expensive. The money is better spent in other areas to prolong life. The extension of free talking therapies in England mainly involving CBT for those with anxiety and depression was made on utilitarian grounds. Overall it was reckoned that there would be a greater good and patients could return to work after treatment or maintain working habits. It is the philosophy of John Stuart Mills and Jeremy Bentham and underpins a lot of decision making.

Yes it’s a problem - is it an event real or distorted. Theory A and Theory B is an approach rooted in the here and now. I found it very useful. A past event is more ambiguous and perhaps tenuous. PSTD is about a memory or memories haunting and influencing us. The aim is to assimilate or process the memory or memories. It is based on the later Freud’s writings in and after the 1st World War - the unprocessed memory that needs integrating into the psyche. The memory is experienced in therapy and therapeutic work done on it to assimilate it. PSTD was a mental health concept generated by the US Vietnam veterans and spread its therapeutic reach to more and more areas. The earliest naming of it was shell shock in the 1st World War. Can you try it and see?

It might worth searching on the forum for EDMR. I have been thinking of exploring EDMR for PTSD for real life events from childhood. One poster I found to be very informative explaining EDMR. He had undergone the therapy. There is distinct therapy session for each event. In the UK it is a recognised therapy for PTSD. Unless it has changed recently, not for any other condition. There was controversy on this site as one poster said it was not recommended. He was from a different country. There are different policies in different countries. Don’t know about the effect of neurodiversity on OCD. I think the idea of therapy is that we can re wire the brain. But early conditioning, at least in my case, makes me think about this. The experiences, especially early experiences of us and other mammals, can be profound.

Hi Sean Magical thinking is where there is no causal link between two things, but you think there is. We do things to stop bad things happening but there is no possibility that these things will stop bad things happening. And the idea that bad things will happen is also false. For example, I once thought that I had to walk down the other side of the road or something bad would happen. I ignored the thought and carried on walking down the same side - there was no observable obstacle or hindrance to my path on either side of the road. Counting and other forms of repetitive behaviour can be a feature of OCD. I have used counting procedures in the past - for example pushing against the front door in sequences of five to assure myself that the door is locked. Again these counting sequences have no causal significance. The numbers are arbitrary and have no effect in securing my home to make it safe from intruders. They are just ideas of things that I had to do that popped into my mind. Over time these things we feel we ought to do - compulsions - can get more and more elaborate and take up more and more time. I learnt that there are no terrible consequences from not doing counting or not doing repetitions. If you stop doing them there will be no bad consequences. I stopped doing these things in a gradual way. Step by step. It will take time. You have been doing these things for a long time. That is why help is needed. Have you seen a clinical psychologist in addition to your psychiatrist?

You appear to be self tormenting yourself on what you might see in your mind’s eye and what you might hear in your mind’s ear. You are worried that your perceptions might become false. As with all anxiety you are worried by might/may be’s. Images of demons and such like occur in all cultures. In medieval times the books that the monks produced had images of them and churches had as features gargoyles depicting demons and such like. There are paintings that depict Hell. Horror films started in the 1920s to frighten the filmgoers. As Hitchcock, the director said, people like being frightened in a controlled and safe way. He gave as examples some fairground rides and some films. We can conjure up in our mind’s eye all sorts of images. Does the exposure your therapist recommends involve conjuring up in your mind’s eye demons? if so, do you think it will work? Even if a temporary image appears in your mind it will not harm you. It will be a transient episode. Also, more importantly, such things have not happened - you are worried by may be’s.

Aaron Beck indicated that he owed a lot to the Stoics. I think that I would be more self confident in Ancient Rome and Greece if I were a citizen rather than a slave. Sometimes our choices are governed by the context. Some people have more choice than others. I think money helps to provide choice, for example. I think it is about how we think about things as well as our circumstances. Herbert Simon, a Nobel Prize Winner in Economics, suggests that we ‘satisfice’ when making decisions - a good enough decision - the endless search for an optimal decision takes too long and is counterproductive. He advises businesses and individuals to satisfice not optimise.

There is a rise in all or most diagnoses. I believe stress can cause or at least contribute to mental ill health. One feature that causes stress is the intensification of work we find in education and the prison service or health service many workers reporting stress and is reflected in high turnover of staff. Environmental conditions cause stress with bad housing, insecure work and lack of money. Insecurity can be generated if you job becomes more insecure due to trade policies. The rise in mental ill health is deemed to cause a fiscal crisis in the state with for example the PIP criteria being changed. There are also a number of books that have been recently published saying that there is an over diagnosis of mental heath conditions as well as neurodivergent conditions. Is this a coincidence? It is not just people bothered by ‘micro aggressions’ there are broader material conditions as well.

That was lucky!

From experience I know when depression interacts with OCD then this magnifies problems. Depression can make us inactive and want us to stay in bed. But this feeds the depression you need to energise yourself. The range of techniques to energise yourself is called Behavioural Activation for Depression. It is in the range of CBT therapies and focuses on your behaviour and doing things. You manage your depressed mood by doing things - do not wait until your mood recovers but take control by doing things to raise your mood. There is a lot about it online. The University of York has an online course on it. This is reassurance - there is no risk regarding your clothes. I have depression at the moment caused by a physical problem. My left arm and hand are painful due to tendon and cartridge problems. Even things like washing hands cause pain. So I am using soothing and pain relieving creams and I also have gone back on anti depressants. These chemicals can lift mood but take time to be effective. Your instinct to protect yourself and stay in bed is a false gut feeling. It is generated by redundant evolutionary behaviours that have protected us in the past. Our bodies and minds have not really changed in thousands of years. But we have more knowledge about how our brains and bodies work now. Despite an internal resistance get out of bed - make a drink, prepare a meal, phone a friend, tidy up and perhaps on Monday see a doctor to get some anti depressants. These work for OCD as well.

There hasn’t been topless female models in the tabloids for quite a few years. But in Germany there are still full frontal nude pictures of men and women in family magazines the equivalent of Take a Break. In Germany there are nudist zones in parks such as the English Gardens in Munich. I am personally very open minded about human nudity. Only a minority of people experience road rage. I am open minded about swear words they can emphasis a point. At work in professions behind the scenes they can act as a form of release and comradeship. The brain to me is more complex than a lump of fatty tissue. It is a marvellous interconnection of neuro cells that makes us human. Mental illness and disorders are abnormal ways of experiencing the world. The science is called abnormal psychology. Many things have a normal distribution like intelligence, height, and so forth. There are other probability distributions as well. If our experiences were not abnormal or unusual how could you justify diagnoses, welfare payments such as PIP, psychiatrists, counsellors, clinical psychologists, counsellors and such like?

Sorry to hear about your and your partner’s problems. There is a wait for therapy, but it seems odd that your medication has been withdrawal in the interim. Has your GP suggested alternative medication? As a former carer, I strongly believe that carers need care. Being a carer intensified my OCD to a considerable degree. How do you mean the medicine can make things worse?

Hi G You mention that you have difficulty in letting past slights go. And you feel anger about them. In social interactions people sometimes ‘wind people up’ - you deliberately say things to annoy them. This is a deliberate interactional strategy to elicit a particular emotion in another. It is similar to a ‘put down’ an interactional strategy where one person acts or speaks in a manner that elevates the speaker in comparison to the other person. Both are used in ‘banter’. If put downs are used amongst friend or people of equal status and power than you can reciprocate the put down. But if there are asymmetries of power then a reciprocal put down can be a silly thing to do because a boss or president can hold a grudge. On social media a troll seeks to provoke written emotional displays from readers or some readers. In this case a non response is best. In interactional situations good strategy is to read the situation and act appropriately. That is why people like cabin crew, social workers, sales staff and teachers are taught to deal with clients. To read the situation. Often say when a teacher loses their temper or a social worker loses their temper then there is not a good outcome. My advice is to read the situation and don’t carry the emotion of anger beyond the situation. Speak to a confidante on how you feel. Do some physical exercises. But also learn from the situation on how best to respond in the future.