First Post

[Niamhalexandrax]

Hi, I’m new to all of this so not really sure how to put all of this together haha.

I have recently been told I have OCD and I’m on a long waiting list to be seen by a mental health service & have also been given a prescription for tablets that I am reluctant to take(wasn’t given much info about them). Nothing has really been explained to me in any kind of simple terms it’s all been very medical and I’ve been left confused and pretty lost. Just wondering if anyone could help to explain what sort of things to expect from your first psychology/therapy appointments, any information / websites that might be good to look at? Or even any where I might be able to get support from online whilst waiting, bit scared to google as I know the internet will say 1000 different things and I don’t want to become even more confused. 

Thankyou  x

[dksea]

Hi Niam, welcome to the forums!  Sorry to hear you are going through a tough time right now.  A diagnosis of OCD can be both scary and also a relief. On the one hand you have this "thing" you now have to live with, on the other hand, at least all the problems you were having has a name and other people know about it and what to do about it.

You are already a step up on a lot of people knowing that Googling/internet research can be a bad idea.  If you want to know more about OCD there is great information on the main OCD-UK website (the charity that runs this forum) that I encourage you to check out: https://www.ocduk.org
You can find info on what OCD is, what treatments are available for it, and for those in the UK how to get access to treatment through the NHS.  There's also advice on how to talk to your doctor, what to expect from therapy, etc.  Its a great resource and Ashley and the team do a great job of keeping it up to date.

As for OCD itself, in simple terms, OCD is a disorder (hence the D in OCD) where sufferers experience unpleasant thoughts  that just won't seem to go away (Obsessions) and engage in behaviors to try and feel "right" or "ok" (Compulsions).  The tricky part with OCD is that it seems like we should be able to ignore these unwanted thoughts, we often realize how ridiculous they are, but at the same time we still feel anxiety because of them.

For example, a person with OCD might get stuck on the thought "my hands are contaminated and dirty".  No matter how much they try and convince themselves that their hands are fine, they still feel doubt and anxiety.  To try and relieve that anxiety they start washing their hands.  Once, twice, ten times maybe.  For awhile they might feel relief, feel clean again, but the doubt comes back and they have to do the whole washing process all over again.  So the obsessive thought is "my hands are dirty" and the compulsive response is hand washing.

Compulsions can be obvious and external (washing hands, counting things, having to check the door to make sure its locked a certain number of times), but they can also be internal as well.  Many people engage in a compulsion called rumination.  In this compulsion you analyze a situation over and over and over, trying to understand it or explain it enough to yourself that you feel its OK.  For example, maybe you have the anxious thought "what if I have a brain tumor".  You might spend hours going over your physical symptoms in your head, checking and rechecking that you are thinking a certain way o not feeling a certain physical pain, etc.  There are many types of compulsive behavior that OCD sufferers can engage in.

The root problem with OCD is that something in our brain just isn't working right.  Its like a door that won't quite shut all the way, or a switch that you have to try a couple times before it turns on.  In a non-OCD brain a person has a thought, they analyze it, decide its not worth worrying about and the brain sends the "All Clear" signal and you can't stop worrying.  Often this happens without you even realizing it, hundreds, perhaps millions of times a day.  But a person with OCD can sometimes get a thought that gets "stuck".  Instead of sending the "all clear" signal so we can stop worrying, it just sits there in our brain, and we start worrying more and more.  Even though we TRY to move it into the non-worry pile, it just keeps slipping back in to the worry side.  Our brain has developed a bad habit so to speak.  Doctors and scientists still aren't 100% sure why this happens.  There is strong evidence that the core of OCD behavior is from a biological cause, i.e. there is something wronging our genes that causes our brain not to work quite right, just like a person with asthma has lungs that don't work quite right.  But as of yet we don't know the exact cause for sure.  And environment and behavior can also contribute.  Many people start suffering OCD after a specific, sometimes traumatic or troubling event.  Stress can make things worse.  Certain objects/events can trigger OCD worry in different people.  So the bad news is we don't entirely know what causes it and we can't, so far, cure it permanently.

However there is good news, while we can't yet cure OCD, we CAN treat it.  People can learn to manage their OCD and go on to lead fulfilling and rewarding lives.  Treatment for OCD largely comes in two forms, therapy and medication.  They can be used separately but are very often used together.  

Therapy is generally the main approach, and the therapy that is effective for OCD is a type called Cognitive Behavioral Therapy or CBT.  CBT differs from traditional talk therapy that you may be familiar with.  In talk therapy (aka Freudian therapy) the patient tries to resolve some inner conflict or struggle, often through questions posed by the therapist.  While this is helpful for some problems it has been shown to not benefit OCD suffers much.  CBT focuses on understanding the thoughts we are having and changing the way we respond to those thoughts.  Basically the goal is to train your brain to respond to intrusive thoughts (obsessions) in a more normal fashion.  Like a person learning to speak again after having a stroke, we have to adapt and relearn behavior that would otherwise be automatic in non-OCD people.  CBT has been proven to be highly effective in treating OCD and many sufferers use therapy alone to treat their OCD.  Working with your therapist/psychologist you would learn and practice techniques for how to respond when you experience an intrusive thought and learn to think about them in a different, more healthy, fashion.  Another component of CBT that many people use is Exposure and Response Prevention or ERP.  In ERP a person is intentionally exposed to a situation or object that triggers their anxiety and they force themselves not to respond with compulsions.  For example a person who worries about their hands being dirty might touch a dirty rag and then avoid washing their hands.  Of course at first they feel intense anxiety, but over time the anxiety becomes less and less as they get used to the situation.  This is the same way some people get over phobias.   It is called habituation.

Medication is the other tool most often used to treat OCD, and often is combined with therapy.  Unlike say antibiotics that can completely eliminate a bacterial infection, OCD medication doesn't completely remove OCD, it just helps relieve the symptoms while you are taking it.  Some people take medication while they are doing therapy to help make the therapy easier, while other people take medication for the rest of their lives.  If OCD is like a door that gets stuck, medication is like oil you use to make the door move a little more smoothly.  The primary type of medication used for treating OCD are a group called Selective Serotonin Reuptake Inhibitors or SSRI.  Serotonin is a neartransmitter, something that your brain uses to help transmit messages and function properly.  SSRI's increase the amount of serotonin that is available and for reasons that are not 100% clear alleviates symptoms of anxiety, depression and OCD.  Currently there are 6 different SSRI's on the market that are used for the treatment of OCD.  Each person responds to each one differently, so it is a bit of trial and error sometimes to find the right drug and dosage level.  It is very likely that the drug you were prescribed is one of these type of drugs, if you feel comfortable sharing the name we can confirm, but the six currently on the market go by the generic names of:

• citalopram
• escitalopram
• fluoxetine
• fluvoxamine
• paroxetine 
• sertraline

The commercial names of each drug differ from country to country (for example Escitalopram is known in some places as Lexapro, others as Cipralex).  
If you are taking one of these drugs you will probably start at a lower dose.  Full effect can take a few weeks to occur as your body adjusts to the medication.  At first you may experience some increased anxiety and mild side effects, though most people find these go away after a short time.  If you experience significant symptoms of course talk to your doctor.  It may be that the first drug you try isn't a good fit for you and you may switch to another.  Its frustrating but try and be patient and allow the drug a chance to work.  You'll hope to feel better quickly of course but just because it doesn't happen right away doesn't mean it won't help.  It can be scary taking a new medication, but as someone who has been on SSRI's for about 25 years now I'll tell you they can make a world of difference.

Sorry to ramble on a bit, but I hope this information has been helpful to you!  Feel free to ask any questions and jump in on the forum, people here are generally helpful and friendly with lots of experience and good advice.

[Niamhalexandrax]

Ah thankyou! That’s really helpful, fluoxetine is the one I’ve been prescribed but all the dr said was ‘it might make you worse for a bit, it might not come back in a few weeks’ and that was it brushed off for me to deal with myself ... I’m on the waiting list to see someone more expert but it’s a long waiting list! I’ll check out the places you suggested, thanks