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OCD as a symptom of other issues?


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I do not think that thinking OCD as a thing helps. The personification of a diagnostic category into a bully or genie or whatever does not help. OCD is a cluster of thinking patterns and behaviours which can be identified as having common features. 

There are versions of CBT. The concluding page of ‘Break Free From OCD’ says looking into the reasons for OCD does not assist therapy. Yet in ‘CBT for OCD’ written largely by the same authors has a new emphasis on the establishment of core beliefs. I think that this occurs because there is a new writing partner in the second book. She worked with Paul Gilbert who developed compassion based therapy. And compassion based therapy is heavily influenced by attachment theory and practice. Things move on and therapies and theories are influenced by the experiences of therapists and researchers as we are by our experiences.

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16 hours ago, Saffie said:

the more I'm beginning to realise that my OCD was more of a symptom than a disorder on its own

 

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 It is probably good for your overall mental health and long term well being to address any other co-morbid issues, but we know from lots of evidence that the way to gain control back over OCD is CBT.  So priority 1 is to focus on getting the OCD under control, priority 2 would be addressing any other issues, some of which may be flavoring your OCD, but aren't directly responsible for it.

I have come to believe that OCD is firstly a symptom of anxiety, part of the fight or flight mechanism/protection system.  It becomes a disorder if not dealt with and continued use of compulsions and avoidance become the method of trying to deal with the anxiety.  Some will have core beliefs that have helped induce the anxiety, others won't (my own experience).  I agree that the treatment for OCD itself is education and CBT.  As Dksea says, it may help to address issues that contribute to overall mental health but in essence I do believe OCD itself is a symptom rather than a disorder, the disorder is the result (or so I believe)

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Guest OCDhavenobrain

I also think that compulsions are a copingmechanism when someone is having anxiety. Good news are that anxietydisorders are very responsible when it comes to CBT.

As I see it as this point, which I think every time I am not in the grip of anxiety. We are all humans and we identify with our thoughts, people with OCD identify more closely and we get more anxiety. When one have overcome OCD that person will identify with their thoughts "to a normal degree". I don't think that you ever will get peace by arguing with your thoughts. This is how I see it all. I have come to the conclusion that it is most useful to be practical and helping sufferers is hard enough so I choice to be practical. Also want to be scientific, because I do realise that the thing above isn't grounded in science, at least not at the moment. Could turn out to be wrong too, but I personally don't think so. 

 

Polarbear said something about having a point in their life where he/she feelt that the OCD "came in". I honestly don't know, but I do remember once when I had a bad infection of some sort (earinfection and high fever) where I started to get those images of objects which were pointy and it made me disturbed, does this makes any sense? It was almost like I wanted to avoid the pointing objects. One could say that this was the anxiety not having anything to cling onto, and then it began. I don't know! But tehre is a theory that OCD starts with an infection. Btw, what if the cause doesn't matter neither? Well, I guess it matters too you because you think that you need to overcome the trauma to really get rid of it, maybe?

Edited by OCDhavenobrain
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57 minutes ago, Caramoole said:

I do believe OCD itself is a symptom rather than a disorder, the disorder is the result (or so I believe)

I’m not sure I follow, if OCD is a result, what is it a result of? 

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Good post Saffie :)

I haven't read every response but I agree with your original post. From what I've read the focus of CBT is usually to help with the immediate problems, so stuff you can't do now. This is obviously essential if someone can’t leave the house or eat etc. But I agree, often there is a lot of background stuff that remains that keeps you vulnerable to getting OCD again and I think an incredibly skilled therapist using lots of techniques from different therapy types is probably what is needed. I have found that I have had to learn a lot about myself to give up some of my compulsions. I have taken from as much psychological theory as I can to work out why and how things are this way. 

Also, it seems a lot of people say they feel they can't say certain things on the forum. I really do think there are more people here who agree with you than don't. We won't all agree all of the time, but fighting for people to have the best therapy on offer is what the charity is here for and exploring the shortcomings of CBT and particularly the often poor CBT people are given is part of that :)

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58 minutes ago, dksea said:

if OCD is a result, what is it a result of?

In very, very simplified terms, a result of repeatedly (and increasingly) carrying out compulsions designed to combat obsessions that then results in it becoming a disorder.

To use my own experience as an example.  I initially was suffering from stress and acute anxiety, it felt as though I was going to lose control.  Those sensations and feelings led to a whole string of thoughts & questions that happen so quickly, almost imperceptibly that they seem automatic......

What if this anxiety keeps on rising?  What if I can't control it? What's the worst that will happen?  What if I went mad? What does that mean? I wouldn't know what I was doing. What if I'm insane? Then what would happen? I could become dangerous.  What's dangerous, who's in danger?  The only person in the house is my Husband.  But he's stronger than me.  What if I got a carving knife (being the only dangerous/obvious thing in a house), lost control and attacked him.  That was the original, unwanted, intrusive thought that set the scene.  It happened as part of a chain of thoughts originating from acute anxiety, not because of a disorder.

Subsequent behaviour occurred because I'd had that one thought.  The very fact I'd had that thought confirmed I must be insane.  Fear of insanity, fear I'd lose control became an obsession and so the compulsions begin, hiding knives, making sure we were not alone (having parents stay) and endless rumination trying to work things out, endless putting my attention back onto that thought.  The obsessions and compulsions were a result of the anxiety process which were then maintained through fear and spilled over into other areas and generally disordered thinking.

I often think if I could have had effective explanation and intervention at that stage the long-term disorder would never have occurred or at least would have been minimised.

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Having OCD or not having OCD is not a matter of belief. It is a matter of diagnosis. The diagnosis is guided by the criteria set by DSM and the other classification of illnesses system. The criteria is applied in standardised psychometric questionnaires. Ideally the results of the questionnaire should be followed by a clinical interview conducted by a senior consultant psychiatrist with experience in OCD. Because of resource issues, this ideal diagnostic regime is rarely followed. But pragmatically GPs and others diagnose OCD. By definition OCD is one of the anxiety conditions.

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23 hours ago, Saffie said:

Also, while I'm not a fan of talking psychotherapies, I wonder why this isn't discussed more in therapy for OCD. I'd say there are many people who's ocd is a collection of coping mechanisms for feelings of guilt, shame and unworthiness. While knowing this isn't going to solve the problem, awareness of it seems very important. Should it not be a part of therapy, where you're not only challenging thoughts, exposing yourself to the fears and learning to live with uncertainty, but you're also working to amend and transform that underlying negative self image? I think if this was done together it might be much more effective. However, the CBT therapists I've had have generally not been interested in that side of things, they just want to focus on changing how you react to the thoughts. Which is essential, but not always the whole picture? When I tried to bring up other stuff before they just kind of brushed it off and were keen to get back to the 'script'.

Hi Saffie. Good topic! I agree wholeheartedly with this. It explains why OCD seems to strike again and again particularly in times of emotional crises. And when it does return, we beat ourselves up for not having banished the OCD forever.

I'm a similar age to you and only recently looked into, got diagnosed and accepted that I had aspergers. Aspergers presents very different in women than it does to men. The sense of not knowing yourself comes as standard!

OCD is a secondary response to a poor sense of self and the heightened stress (compared to non autistic people) I experience daily. It all finally makes sense to me. 

People with OCD are four times as likely to also have autism, according to a Danish study of more than 850,000 people:

https://www.spectrumnews.org/news/sweeping-study-underscores-autisms-overlap-with-obsessions/

This is a particularly good site where I found a lot of stuff that actually helps with cementing my sense of self. Even if you arent asperger, it's still very interesting and useful http://www.lifeonthespectrum.net/blog/?page_id=1906

I hope this helps. 

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Hi Orwell. I read your links. I am not sure how ‘repetitive beahaviour’ relates to your or Safire’s notion of ‘underlying negative image’. The research based article indicates that the cause of OCD or autism is genetic. Or might be.  I have the notion - could be wrong - that Saffie’s considers that her negative self image is caused by environmental issues.

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Hi angst- this is what I meant:

Not having a sure sense of self ( which might be attributed to autism, life experiences, bodily chemical imbalance etc) perpetuates a negative self image as the individual does not perceive or acknowledge evidence from daily life that would help counteract the negative perception. There is then little to no positive evidence that can be used to reinforce a sense of identity. The individual will continue to feel anxious and in fight or flight mode. The anxiety experienced might result in:

-repetitive intrusive thoughts/sensations as a symptom of an anxious stressed mind. Results in repetitive behaviours you DONT want to perform but feel you have to to feel in control. This cycle could continue into full blown OCD, a secondary problem. The individual becomes more anxious over time and their sense of self is eroded further because they may start believing the intrusive thoughts mean something bad about their character or morality. Underlying negative image becomes enhanced.

-repetitive behaviours you DO want to perform because they feel soothing. They help to emotionally regulate, become calm with yourself and get rid of the feelings of out of control ness. Autistic people do these 'stimming' behaviours which usually aren't harmful. However, the sensation of emotional overwhelm due to misinterpretation of the social environment or noises, textures etc and genetic predisposition to anxiety will always be there ( regardless of repeated exposure or no exposure to the stressor) which increases negative self image because this is the way things are and you're stuck with it.  

Having both sucks but awareness helps you make informed decisions regardless of how you're feeling.

 

Edited by Orwell1984
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Hi Orwell84

Definitely empathised with repetitive behaviours that you do not want to do but feel compelled to do so. But for me at a minimum level like pushing against a door to ensure it’s locked is OCD. It needs to be nipped in the bud before it becomes a more elaborate ritual. I believe that there are degrees of OCD or compulsive behaviour that can be measured by time it takes to perform them.

I remember as a child I did perform repetitive actions to smooth me. Such as rocking to and fro. In retrospect, I can identify the stressors that activated this behaviour. It is painful to relive them.

I do not identify with being overwhelmed by environmental stimuli. 

Not sure if I understand ‘a sure sense of self’ or ‘negative self image’. A negative self image to me smacks of depression. To me, thoughts about something bad about character are depressive thoughts. Anxiety is a future oriented emotion. For example if the door is not securely locked then I will have a break-in.

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12 hours ago, Caramoole said:

In very, very simplified terms, a result of repeatedly (and increasingly) carrying out compulsions designed to combat obsessions that then results in it becoming a disorder.

To use my own experience as an example.  I initially was suffering from stress and acute anxiety, it felt as though I was going to lose control.  Those sensations and feelings led to a whole string of thoughts & questions that happen so quickly, almost imperceptibly that they seem automatic......

I see.  But how would that account for people like myself?  Multiple times my intrusive thoughts have been the source of, not the result of anxiety.  One in particular stands out, from about, gosh maybe 10 or so years ago now.  I was relaxed, watching TV, life was good, work was not stressful when a stray thought popped in to my head and suddenly I became fixated on it and went into an OCD spiral.  It was no more significant than dozens of other stray thoughts I have, thoughts I dismiss on a daily basis as meaningless probably without even recognizing it.  If anxiety was the source of OCD, rather than the result, it should only manifest in people who are under stress/experiencing anxiety at the time right?  

I can respond rationally to basically all my OCD thoughts, I can look at it and say "look the odds of such and such worry are trivial, there's no need to worry" just like I do to other thoughts that don't get stuck,  yet the anxiety persists despite all the rational explanations in the world.  The only way that makes sense is if there is some underlying condition (OCD) that is causing my brain to malfunction in some way

Now it certainly stands to reason that a person with the underlying vulnerability is more likely to progress to full-blown OCD if they are under a lot of stress in the first place, but I think that the vulnerability would already have to be there otherwise it should happen to all people under stress and never to people who aren't stressed.

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8 hours ago, Angst said:

 

Not sure if I understand ‘a sure sense of self’ or ‘negative self image’. A negative self image to me smacks of depression. To me, thoughts about something bad about character are depressive thoughts. Anxiety is a future oriented emotion. For example if the door is not securely locked then I will have a break-in.

It is entirely possible to have a negative self-image without being depressed.  We all grow up with certain (core) beliefs about ourselves, the world, and others - and these can be positive, negative or neutral and don't necessarily result in anything untoward (but they can do). I think a negative self-image can lead to depression though - or addiction, or anxiety, or compulsive behaviours.  

I can give myself as an example.  I have always had a very negative self-image, and I wrestle with this on a daily basis. I wouldn't really say I have ever been depressed though other than maybe short bouts when OCD has been particularly bad - mostly though I have been happy in my life and found ways to defend against this feeling (not always healthy ways I might add).  It has caused me anxiety more than depression, and I am sure my OCD has arisen directly from this negative self-image (am I a psychopath? Am I evil? Are my actions indefensible? etc.) and almost all of my compulsions have arisen out of trying to resolve this issue and make things "safe", which they never are because essentially on the inside I feel like I am wrong, bad, etc.  which is something I'm working on.  

I used to think OCD was a blip in the brain, faulty wiring - but I think more and more that, at least for me, OCD does not exist in a vacuum and compulsive behaviours are a way of handling faulty core beliefs, rather than core beliefs arising from OCD. 

Edited by gingerbreadgirl
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8 hours ago, Angst said:

A negative self image to me smacks of depression. To me, thoughts about something bad about character are depressive thoughts.

Here's an example of negative self-image without depression:  Imagine a child who has a mild learning disability, say dyslexia. Because of this they struggle with their studies and unfortunately its in a time and/or place where knowledge of these disorders is limited.  So they go their whole life with they image that they just aren't that "smart" or maybe even considered "dumb".  Certainly they might not like that kind of label, but lets say they get used to it and continue on with their life.  They don't go to college (even though they could have if they had gotten the right support) but find a decent job, say as a car mechanic.  They have a family, live their life, and are generally happy.  No depression, but they still held a negative image of themselves, that they were "dumb".  All sorts of negative self images are projected on people who come to internalize them because they have nothing else to go buy in the world.  Think of how many women throughout the ages have been treated as "dumb" simply for being women whom society held to a specific standard which didn't allow for the idea that women could do certain things like become doctors or scientists or soldiers, etc.

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Guest OCDhavenobrain

It is all fint that you are trying  to find a reason or pinpoint it but remember guys that this is what OCD does. No area are free from analysis. 

I personally would go so far and say that it is what people do.  I dont believe in analyzing yourself to happiness. Won't happen.  I dont think so

Edited by OCDhavenobrain
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2 minutes ago, OCDhavenobrain said:

It is all fint that you are trying  to find a reason or pinpoint it but remember guys that this is what OCD does. No area are free from analysis. 

I think you make a good point but I don't think this thread strikes me as ocd ruminating. Ocd doesn't exist in a vacuum and we have lives and concerns outside of ocd. I think it's perfectly acceptable and in many ways essential to identify core beliefs and how these may be perpetuating issues. 

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3 minutes ago, OCDhavenobrain said:

It is all fint that you are trying  to find a reason or pinpoint it but remember guys that this is what OCD does. No area are free from analysis. 

It does come across as "overthinking" doesn't it! :)

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6 hours ago, dksea said:

But how would that account for people like myself?  Multiple times my intrusive thoughts have been the source of, not the result of anxiety

Hi Dksea :)

Firstly, I am not the Oracle, these are simply my personal feelings.  The description I gave was one of my own personal experience, what happened to me and how it arose from anxiety and subsequent reaction to a thought.  I don't think I said it  had to arise from a pre-existing anxiety condition but from anxiety (at some point)

It's difficult to say what happened in your case as I don't know what thought you had, what you were watching on the TV, what was happening with your day etc. As we know, all people have odd thoughts that flit across their minds.  It is my belief that generally they occur from some source.  It may be something they've read, heard on the news, seen in a tv programme or is spawned from a real event (standing at the edge of a railway platform thinks, what if I pushed that person onto the rails? [which  I believe is just part of the safety review our brains are constantly making about our situation])  Whatever the source, you noticed that thought and responded with anxiety.  Because of the anxiety reaction we then give it importance and enter the cycle of obsessing, using compulsions, avoidance etc.

I should point out I'm second-guessing and giving an example of the type of situation/series of events that could happen rather than describing your actual situation.  Hope that makes sense.

The bottom line is that we are not automatons and there will be many variations

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Guest OCDhavenobrain

Yep I am sorry but I really get a feeling. 

I post this again because it was edited into the post : "I personally would go so far and say that it is what people do.  I dont believe in analyzing yourself to happiness. Won't happen.  I dont think so"

What will happen is that the goalpost will be further moved into the future, "when I have overcome this or that I will become happy". And I guess that one can overcome OCD and feel bad about onself, having a very bad self-image. If one have overcome OCD I don't really see why this would be associated with OCD to such a great extent. That person would just conclude that he/she had a bad self-image, could even be sad about it but trying to connect it with OCD seems fishy to me. 

BUT I can see why some people are more invested in it all, when I am feeling fine (because this is not the case when I am down!) do I believe and accept that it could be that maybe I am not my thoughts, that maybe I am just another part of the world. And it doesn't offend me at all, actually it seems comfortable to me. I also don't think that not having free will would be a bad thing. It's the ultimate way to not getting offended not even by life itself.

I am trying really hard to be practical when it comes to OCD and I have to be suspicious, sorry for that. We doubt that's the core of it. 


EDIT: Do not ask me how I can be a doubter and at the same time have those thoughts about life and its nature, I don't know myself. I would guess, and I am only guessing now (but I am also hoping for this) that when I am feeling down do my feelings get so intense that it gets too much to even think about those things. So what I have done is to use CBT and ERP which are practical tools, and not getting to involved in why and ifs, because I don't see how OCD ever would stopped itself from taking any of our thoughts or believes as hostage.

Edited by OCDhavenobrain
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2 minutes ago, OCDhavenobrain said:

Yep I am sorry but I really get a feeling. 

I post this again because it was edited into the post : "I personally would go so far and say that it is what people do.  I dont believe in analyzing yourself to happiness. Won't happen.  I dont think so"

What will happen is that the goalpost will be further moved into the future, "when I have overcome this or that I will become happy". And I guess that one can overcome OCD and feel bad about onself, having a very bad self-image. If one have overcome OCD I don't really see why this would be associated with OCD to such a great extent. That person would just conclude that he/she had a bad self-image, could even be sad about it but trying to connect it with OCD seems fishy to me. 

BUT I can see why some people are more invested in it all, when I am feeling fine (because this is not the case when I am down!) do I believe and accept that it could be that maybe I am not my thoughts, that maybe I am just another part of the world. And it doesn't offend me at all, actually it seems comfortable to me. I also don't think that not having free will would be a bad thing. It's the ultimate way to not getting offended not even by life itself.

I am trying really hard to be practical when it comes to OCD and I have to be suspicious, sorry for that. We doubt that's the core of it. 

We will have to agree to disagree :) 

You don't seem to think core beliefs play any role in ocd and I think that's completely wrong. You may disagree but I don't think we should shut down discussion. I have overcome ocd before using behavioral methods but the core beliefs are still there and they have totally driven the relapse I have suffered this year.     I'll say it again - ocd does not exist in a vacuum and ocd sufferers do not live solely through the lens of ocd. 

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Guest OCDhavenobrain

OCD sufferers are more than their OCD. I think that people with shame and guilt in general or associated with their OCD can feel attacked when talked about having OCD. 

People do have core believes and values, but if that person don't have some functions which leads them to have OCD that person would not get OCD. He/she will just have core values and sure that person can be anxious, maybe he can be so anxious that he qualifies for a diagnosis of GAD or some other anxietydisorder - it is possible! 

I think in general that OCD-sufferers think way too much and IF that person have OCD about guilt/shame and such I also think that that person worries a lot about how she/he behaves against others and such people seem to think a lot about if they are bad or good. Let's say you are a psychopath, then you won't worry about if you are bad or good. Fact is that it seems that psychopaths live in the moment to a great extent. But they don't feel many of the feelings we feel and because of this they get bored, everything get more dull. So psychopatia is NOT the way to go, and you cant choice it either way so.. But living in the moment and not identifying with thoughts too much is the way to go, I would say.

People without OCD can worry and it can be classified as "normal worries" but it doesn't mean that it is optimal and I ultimately don't see why someone should need to worry. She/he is accepted to move along and also to do it here and now. 

 

Edited by OCDhavenobrain
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4 hours ago, OCDhavenobrain said:

 think that people with shame and guilt in general or associated with their OCD can feel attacked when talked about having OCD. 

I don't feel attacked - it's an interesting discussion :) 

4 hours ago, OCDhavenobrain said:

People do have core believes and values, but if that person don't have some functions which leads them to have OCD that person would not get OCD.

I think the causes of OCD are numerous and not fully understood but I think it is wrong to separate them out from beliefs like this.  I think if the conditions are right then a person can learn to adopt compulsive behaviours to try and maintain safety/resolve the "problem" whatever that may be.  I don't actually believe that some people "have" OCD and others don't; I think OCD develops over time as a result of carrying out compulsions.  It teaches the brain to respond like this habitually.  I think anyone can develop OCD if they learn to use compulsions as a coping mechanism.  Just as I believe anyone can develop, say, an addiction problem if the conditions are right.  That's just my opinion though - it's changed over time and may change again as I learn more. 

4 hours ago, OCDhavenobrain said:

I think in general that OCD-sufferers think way too much and IF that person have OCD about guilt/shame and such I also think that that person worries a lot about how she/he behaves against others and such people seem to think a lot about if they are bad or good.

Absolutely and I said as much earlier in this thread - it's important not to topple over the line into rumination, worrying, analysing, etc.  

That's not to say that all discussion about OCD is overthinking/rumination and I do think that OCD is sometimes oversimplified here as if it is an isolated substance in a test tube rather than part of a complex tapestry of emotions, beliefs, schemas, comorbidities and so on - all of which interact.  

Edited by gingerbreadgirl
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Guest OCDhavenobrain

I don't feel that way at all and I am thankful for the overall approach offered here. I personally wont go down that rabbithole.

Hope you find some peace with or without further therapy.

Edited by OCDhavenobrain
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