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Recovery Really Is A Possibility


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What any one of us needs to do will vary, and the psychological tools may also differ.

But the essentials that come with cognitive behavioural therapy will be a part of the recovery process.

What IS OCD? It is a mental illness where the sufferer experiences obsessional recurrent intrusive thoughts which they try to " fix" by carrying out compulsions, but which action only worsens and maintains the resultant disorder.

The intrusions will usually be false  exaggerated or repulsive, and may suggest the opposite to the sufferer's true core character values.

This cycle of obsession plus compulsion equals disorder is self-perpetuating, unless we break it.

And we can do this, gradually, when we learn why the intrusive thoughts are wrong, not to believe them, not to connect with them. Then gradually wean ourselves off carrying out compulsions. 

Only when we don't believe  and don't connect with the intrusions, and stop the carrying out of compulsions  are we going to see those hated intrusions ease off, and our anxiety levels reduce.

If we have been through a course of CBT and yet we are struggling to make these thinking and behavioural changes  then we  need help to reach that process. But it is ALWAYS going to be down to we ourselves  the sufferers, to take on board the therapy, and start changing things around.

Hope springs eternal - and with the right degree of psychological help  and the necessary effort to overcome the sayings of OCD, we really can significantly improve our status.

 

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You’re so right regarding being able to recognise intrusive thoughts and learning to manage. It takes a lot of strength and I find the need to do mental exercises each day otherwise I start to relapse. Have a great day 

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12 hours ago, taurean said:

What IS OCD? It is a mental illness

Obsessive Compulsive Disorder is a disorder.  Are all instances of OCD an illness?

In my own case, depression is my illness.  Therefore my OCD is treated as part of that illness.

I remember an aquaintance several years ago who had a period of experiencing OCD as a result of a specific life event.  The OCD was treated using CBT and was successfully stopped.  When the life event was over and the OCD had been treated this person went on to live a healthy and productive life.  Throughout the the period there was no diagnosis of any mental health illness.

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41 minutes ago, northpaul said:

Obsessive Compulsive Disorder is a disorder.  Are all instances of OCD an illness?

In my own case, depression is my illness.  Therefore my OCD is treated as part of that illness.

I remember an aquaintance several years ago who had a period of experiencing OCD as a result of a specific life event.  The OCD was treated using CBT and was successfully stopped.  When the life event was over and the OCD had been treated this person went on to live a healthy and productive life.  Throughout the the period there was no diagnosis of any mental health illness.

I think it's good to open up a debate about this. I think there is a difference between OCD as a tempoary disorder as the result of a specific trauma or event, and some other cases of long term OCD.

Also as @taurean says 'what any one of us needs to do will vary'. It's obvious that each person is unique, the unique nature of their combination of illnesses and the unique structure of their OCD means each person has to be treated individually.

If as I now believe, long term OCD is a physiological, neurological, psychological issue. Then it needs to be addressed by examing and 'treating' all those elements. So with the physiological aspects that could just mean relearning how to deal with stress and anxiety on a personal level. The neurological element would require stress management of daily life, and the psychological element can be treated by therapy in a form that relevant to that individual.

I don't really understand what I perceive as some people thinking that OCD is some external element or that any thoughts a person has aren't theirs. When people say 'intrusive' I imagine they mean unwanted. But where do some people think these 'intrusive' thoughts are coming from. Was it say external in terms of a news article, or does it come from culture or religion and then it becomes internalized.(I'm curious).

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OCD can have root in a seeding event, the same as a Phobia.

But the Phobia only causes a problem at the time of needing to face that particular situation again, whereas with OCD it becomes an ongoing, disorder-inducing, obsession.

 

Edited by taurean
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The NHS says mental health conditions rather than mental illness. I think mental health conditions, mental illness and disorders are in practice synonyms.

Not sure what the difference is between physiological and neurological conditions.  If OCD is a neurological condition then people should have MRIs scans to confirm the possibility - we have the fewest number of these machines per capita in Western Europe - as part of a diagnosis. I have had a couple. The psychiatrist was told off.  Too expensive. But she came from a country with many more machines than us.The limited availability of the machines in the U.K. and the trained operatives to run the machines as well as interpret the results makes this a practical impossibility.  Presumably treatment would be chemical for a neurological problem?

For me, managing stress is a psychological issue. Though some stress is very difficult to cure or ameliorate such as sexual or physical abuse especially if they occurred in the early years of life. A lot of stress can be alleviate by having sufficient money, living in good conditions and a family not living in one room. Stressors are things in the environment. Intrinsically stressful things cause mental ill health for example living in a war zone where  we need to do much checking out  for the sniper and other perils. I can imagine war trauma causing OCD along with other mental problems. Always having to keep a eye out for danger. The other side really wants to kill you.
 

 

Edited by Angst
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1 hour ago, taurean said:

OCD can have root in a seeding event, the same as a Phobia.

But the Phobia only causes a problem at the time of needing to face that particular situation again, whereas with OCD it becomes an ongoing, disorder-inducing, obsession.

 

Yes I can see that a phobia is a reaction to a real event, so would it be right to say that the event triggers an emotion. It seems to be a survival mechanism that sometimes over reacts. So I imagine in therapy a phobia can be rationalized until less emotional.

It seems like OCD affects people who are naturally anxious and the anxiety finds obsessions to latch on to.

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A friend has a big Bbig Phobia which prevents her from travelling in the rear of a car.

She is perfectly fine in my passenger seat, but absolutely won't travel in the back.

But she doesn't know why, not consciously, anyway. 

There is clearly a massive fear involved, and there is likely some known event behind this. It is possible the event was so traumatic that she has wiped it from her conscious memory, but it is still there in her subconscious, creating the Phobia.

I dare say, if she wanted to have this treated, a specialist could place her into an induced trance, and discover the hidden trauma- I have read about this being done.

My sister has a Phobia about travelling on escalators  and her best friend has one about going in lifts.

When they go out shopping together, and change floors, they each have to travel by the mechanism about which they don't have a Phobia - then meet up again!

I think this would be treatable using CBT including ERP - but neither seem keen to tackle it.

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24 minutes ago, taurean said:

I think this would be treatable using CBT including ERP - but neither seem keen to tackle it.

Regarding your description of the two behaviours you have described above, if you are saying this is OCD then is this classed as a disorder or an illness?  (I ask that in relation to my earlier post in this thread).  

Edited by northpaul
punctuation correction
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1 hour ago, taurean said:

A friend has a big Bbig Phobia which prevents her from travelling in the rear of a car.

She is perfectly fine in my passenger seat, but absolutely won't travel in the back.

But she doesn't know why, not consciously, anyway. 

There is clearly a massive fear involved, and there is likely some known event behind this. It is possible the event was so traumatic that she has wiped it from her conscious memory, but it is still there in her subconscious, creating the Phobia.

I dare say, if she wanted to have this treated, a specialist could place her into an induced trance, and discover the hidden trauma- I have read about this being done.

My sister has a Phobia about travelling on escalators  and her best friend has one about going in lifts.

When they go out shopping together, and change floors, they each have to travel by the mechanism about which they don't have a Phobia - then meet up again!

I think this would be treatable using CBT including ERP - but neither seem keen to tackle it.

Yes it's interesting; when does a natural fear become a phobia.

I think if some people don't want to treat their phobias it could be that it's those subconscious memories linked to the event that they fear uncovering.

But also some people see their various mental disorders as a part of their identity.

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These are phobias  not OCD. Why? Because it only bothers the two women when they are out in the shops,otherwise it is completely forgotten about.

Now  my sister does also have OCD - and this is all about focusing onto things  then playing mental games with them - e.g., she will look at a lightbulb, then be compelled to imagine taking the light bulb, mentally, apart- then putting it back together again.

There is absolutely no point to this exercise, she knows that, yet she is compelled to carry out this pointless mental activity. The obsession is the focus in on the lamp bulb, the compulsion is the mental activity of imagining taking it apart and putting it together again.

And this exercise is of no actual value whatsoever, so causes distress as she is obliged to carry out the mental exercise.

Another act she felt compelled to do was  in a supermarket  if she picked up an item her OCD set a rule that she MUST read the whole of the packet before she was allowed to decide to buy it or not.

Trips to the supermarket were taking ages. But the good news is that  her OCD therapist did manage to help her break free of this obsession and compulsion.

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I have a phobia of rodents specifically rats and mice. When I was receiving therapy for OCD depression and hoarding my therapist said that it was probably not worth getting specific therapy for it as it was only triggered by specific sighting of a rodent.
 

The classic text is Living with Fear by Issac Marks this book deals with phobias very well. My therapist agreed with this. It is pure behaviourism - exposure therapy. You are desensitised to the phobic object.

This is done in a graded way you see a picture of a rat to seeing a rat. You get used or habituate to each stage to your fear is ‘extinguished’ to use the behavioural term. The only ‘compulsive element’ and I don’t think it could be defined as compulsive it is running away from the phobic object. It is a short term expression of visceral fear.

However there was perhaps a compulsive element to my phobia. After a sighting I check my environment. However, pest control companies do say after a sighting or signs of rodent activity  such as rodent poo, grease marks and bait uptake.

So behavioural therapy for phobias is quite different to ERP. After a while the thoughts die away and elaborate compulsions are not built up.

Personally I see no point in finding the cause of the phobia. Exposure to the fear according to Marks will reduce the fear when confronted by the phobic object.
 

Behaviourism teaches us that human beings can induce phobias in others. The Little Albert Experiment by the behaviourist Watson induced fear of rats in a young infant using classical conditioning. It is worth a Google. In days when there was little or no ethics in psychology research.

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2 hours ago, Angst said:

The NHS says mental health conditions rather than mental illness. I think mental health conditions, mental illness and disorders are in practice synonyms.

Not sure what the difference is between physiological and neurological conditions.  If OCD is a neurological condition then people should have MRIs scans to confirm the possibility - we have the fewest number of these machines per capita in Western Europe - as part of a diagnosis. I have had a couple. The psychiatrist was told off.  Too expensive. But she came from a country with many more machines than us.The limited availability of the machines in the U.K. and the trained operatives to run the machines as well as interpret the results makes this a practical impossibility.  Presumably treatment would be chemical for a neurological problem?

For me, managing stress is a psychological issue. Though some stress is very difficult to cure or ameliorate such as sexual or physical abuse especially if they occurred in the early years of life. A lot of stress can be alleviate by having sufficient money, living in good conditions and a family not living in one room. Stressors are things in the environment. Intrinsically stressful things cause mental ill health for example living in a war zone where  we need to do much checking out  for the sniper and other perils. I can imagine war trauma causing OCD along with other mental problems. Always having to keep a eye out for danger. The other side really wants to kill you.
 

 

The physiological effects are down to the areas of the brain;  left orbitofrontal cortex, amygdala, hippocampus and temporal areas being underdeveloped during infancy and leaving the child unable to deal with stess and to feel anxious.

'the brain develops regulatory neural pathways which are the foundation of emotional well being. Those children know how to distact themselves from uncomfortable thoughts or feelings, how to soothe themselves, how to manage stress, anxiety and fear'.

So it's the physiological under development that limits the development of the neural pathways and with the over production of different hormones/neurotranmitters due to the resulting stress that damages the neural receptors. That of course then effects a person psychologically.

 

 

 

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7 minutes ago, howard said:

The physiological effects are down to the areas of the brain;  left orbitofrontal cortex, amygdala, hippocampus and temporal areas being underdeveloped during infancy and leaving the child unable to deal with stess and to feel anxious.

'the brain develops regulatory neural pathways which are the foundation of emotional well being. Those children know how to distact themselves from uncomfortable thoughts or feelings, how to soothe themselves, how to manage stress, anxiety and fear'.

So it's the physiological under development that limits the development of the neural pathways and with the over production of different hormones/neurotranmitters due to the resulting stress that damages the neural receptors. That of course then effects a person psychologically.

 

 

 

I assume that these findings were discerned by imaging technology in samples published in research papers. Would you agree that the use of scanning should be expanded. We have a rhetoric of biological psychiatry  but diagnosis relies on brief consultations and verbal exchanges. I agree with you, damaged lives are reflected neurologically and psychologically. Did you get the quote from the ‘Emotional Brain’. 

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14 minutes ago, Angst said:

I assume that these findings were discerned by imaging technology in samples published in research papers. Would you agree that the use of scanning should be expanded. We have a rhetoric of biological psychiatry  but diagnosis relies on brief consultations and verbal exchanges. I agree with you, damaged lives are reflected neurologically and psychologically. Did you get the quote from the ‘Emotional Brain’. 

There are various research papers referenced; 'Tomarken, A. Davidson..'Individual differences in anterior brain asymmetry and fundamental dimensions of emotion'.

I'm looking at a few ideas at present. 'The suprisingly dramatic role of nutrition in mental health' is a Ted talk that's interesting.

Part of that is the idea that pharmaceuticals can give temporay relief, CBT can help with a temporary disorder, but as we can see on here, that doesn't always work.

So seeing it from a stress management perspective will also help. But they have had some positive results with high strength nutrition on conditions like ADHD.

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5 hours ago, howard said:

I think it's good to open up a debate about this. I think there is a difference between OCD as a tempoary disorder as the result of a specific trauma or event, and some other cases of long term OCD.

Thank you for that point.  That is how I see things in relation to the question I asked as below:

6 hours ago, northpaul said:

Are all instances of OCD an illness?

 

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5 hours ago, howard said:

I think it's good to open up a debate about this. I think there is a difference between OCD as a tempoary disorder as the result of a specific trauma or event, and some other cases of long term OCD.

Not really a debate. That is simply not the case. 

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Sorry, was on my phone and pressed enter before I had finished typing..   What I meant to add to that was that OCD is OCD, there is no such thing as a different type of OCD based on how OCD was caused.   Sometimes knowing how it was caused may help, but more often than not when we do pinpoint it, it makes no difference to the recovery.  I am not sure I now believe calling OCD a temporary disorder is helpful or accurate.  Not helpful because of how society views/trivliaises OCD, so labelling it a temporary disorder will do nothing to add to that problem. That's not to say it's not treatable, absolutely is, and for some people that treatment may be quick, but for others may take decades.  How the OCD originated makes no bearing on that I am afraid.

 

 

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Care is needed here.

OCD is not a temporary disorder. Whatever the reason may be that OCD manifests itself in an individual, it is not going to go away in the same way that a phobia can with sound exposure and response prevention.

And, as I know with two of my wife's phobias which I have assisted her to overcome, phobias can have some logic to them, a rationale. Expose that rationale and successfully challenge it and you can beat that Phobia.

Tackling the illogical false exaggerated or repulsive beliefs behind obsessional thinking is a much more challenging scenario. And the obsession sits there, churning away- it's not something which only occurs when an event is being confronted, as with a Phobia. 

The brain is " plastic" - it can learn new pathways, it can stop going over old ones.

We have to train it to do this. We have to change our response to obsessions, not react, learn to move away from that thinking, and stop carrying out compulsions.

When we really start to do that, our OCD is very likely to ease down and we will be on the recovery path.

We might not fully recover, but there is every chance that we may recover sufficiently that OCD is no longer wrecking our daily lives.

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7 minutes ago, taurean said:

We might not fully recover, but there is every chance that we may recover sufficiently that OCD is no longer wrecking our daily lives.

And this is absolutely a realistic proposition. We all have different opinions on what recovery means to each of us, and we are all at different phases of our recovery. But what Roy writes here should always remain our approach either in therapy with help or living our life using our therapeutic techniques to improve our quality of life when and where we can. 

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2 hours ago, Ashley said:

Not really a debate. That is simply not the case. 

Ashley, looking back at my entry earlier in this thread which I have copied below, the case of my aquaintance shows no evidence of illness but only a disorder.

9 hours ago, northpaul said:

I remember an aquaintance several years ago who had a period of experiencing OCD as a result of a specific life event.  The OCD was treated using CBT and was successfully stopped.  When the life event was over and the OCD had been treated this person went on to live a healthy and productive life.  Throughout the the period there was no diagnosis of any mental health illness.

No diagnosis of mental health illness was noted.  This was a disorder.

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3 hours ago, taurean said:

Care is needed here.

I agree. It is wise to be careful when making sweeping statements.  :dry:

 

8 hours ago, taurean said:

the Phobia only causes a problem at the time of needing to face that particular situation again, whereas with OCD it becomes an ongoing, disorder-inducing, obsession.

Not strictly true. :no:

OCD doesn't have to be there 24/7 either. OCD symptoms may only arise when facing the particular triggering situation/ item. And a phobia can result in compulsive avoidance and in ruminative thinking separate from, and in the absence of, the phobic stimulus.

 

3 hours ago, taurean said:

OCD is not a temporary disorder. Whatever the reason may be that OCD manifests itself in an individual, it is not going to go away in the same way that a phobia can with sound exposure and response prevention.

Again, not strictly true. :wontlisten:

OCD very much can be a temporary disorder.

A change in thinking (making different cognitive choices) and change in behaviour (ERP and stopping compulsions) can eliminate OCD completely.

Not in every case maybe as it depends on many factors, including how well the changes in cognitive choices are applied and the duration the OCD has been present for. (Habituation of thought patterns/ neurorigidity, if you like.)

 

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phobias can have some logic to them, a rationale. Expose that rationale and successfully challenge it and you can beat that Phobia.

 

:wontlisten:  Phobias can also be completely irrational. Indeed most phobias are irrational.

The person with a phobia uses the same thinking process of attempting to rationalise it as people with OCD use when they believe there is a rational need to take precautions.

Simply showing someone their OCD/ phobia is irrational doesn't make either one go away. Both conditions require the application of a change in thinking. Both require a change in behavioural response. As you said yourself Taurean, 'and successfully challenge it'. So that isn't any different to OCD.

 

Are they different disorders? Yes. Can you define them by saying  'Phobias are treated this way and temporary but OCD is treated that way and is permanent'

-no. :no:   Absolutely not.

That's using the wrong parameters to define them and separate them as distinct diagnoses.

 

10 hours ago, northpaul said:

Obsessive Compulsive Disorder is a disorder.  Are all instances of OCD an illness?

Now there's an intersting question! I think it depends how you choose to define it. :unsure:

Calling it an illness has social consequences (ability to claim sick leave/ sick pay, medicalisation of treatment/therapy/support etc. ) If you subscribe to the idea that OCD is caused by neurological, anatomical and chemical changes in the brain then you're more likely to consider it an illness. Calling it an illness implies it is beyond the person's control which elicits compassion from others. So there are benefits to this approach.

But, we know OCD is definitely not something beyond a person's control. (Even though we can't stop intrusive thoughts from occuring and even though the ruminating can feel automatic.)  With insight, therapy and self-application it is possible to reverse the 'underlying' neurological, anatomical and chemical imbalances. So perhaps OCD is only an illness until the thought processes and behaviours which make it OCD are addressed?

 

Calling it a disorder focuses on the mechanism causing the symptoms. ie. There's a change in the person's thought processes and in their behavioural responses. Much more accurate, more flexible, and - in my opinion - a more useful way of defining it. :)  The disorder can be either temporarily or longterm.

 

Another interesting question with social consequences: - does OCD qualify as a disability? :unsure:

Depends if the individual is dis-abled by it or not. So sometimes yes, sometimes no.

 

4 hours ago, howard said:

 it's the physiological under development that limits the development of the neural pathways and with the over production of different hormones/neurotranmitters due to the resulting stress that damages the neural receptors. That of course then effects a person psychologically.

I'm looking at a few ideas at present. 'The suprisingly dramatic role of nutrition in mental health' is a Ted talk that's interesting.

Part of that is the idea that pharmaceuticals can give temporay relief, CBT can help with a temporary disorder, but as we can see on here, that doesn't always work.

So seeing it from a stress management perspective will also help. But they have had some positive results with high strength nutrition on conditions like ADHD.

These are possible contributory factors to why some individuals develop OCD and alternative perspectives on how best to manage it. They don't help to explain what OCD is.

 

OCD is a thinking disorder

which results in anxiety (or other negatively charged emotion)

which in turn leads to behaviours aimed at reducing/ removing those emotions

and in turn those abnormal and unneccessary behaviours maintain the problem

which results in the person having a disorder.

 

If we focus on those three things (thinking/ feelings/behaviours) then the cause becomes irrelevant. Which perspective you come at it from becomes irrelevant - interesting, but not necessary to know in order to treat/ recover from OCD.

That's why I like the (in bold) definition of OCD. It simplifies everything, gets rid of all extraneous distractions and focuses us on what we can do to help ourselves recover from this disorder.  :)

Just my tuppence worth. :whistling:

 

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We might not fully recover, but there is every chance that we may recover sufficiently that OCD is no longer wrecking our daily lives.

And on that point we are surely all agreed. :yes:

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Which leads us nicely back to my headline - recovery really is a possibility.

For many of us, and I include myself in that, a pattern of doing better, then relapsing, eventuate- and we lose faith.

So I wanted to get over the point that, if this does happen, then we shouldn't despair.

We need to look at how we are maintaining the problem, and how we can eliminate that.

Try other things on top of the CBT - in my own case there was no failing in the CBT knowledge, but I needed additional tools beyond it in order to fully  apply it.

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13 hours ago, taurean said:

Which leads us nicely back to my headline - recovery really is a possibility.

For many of us, and I include myself in that, a pattern of doing better, then relapsing, eventuate- and we lose faith.

So I wanted to get over the point that, if this does happen, then we shouldn't despair.

We need to look at how we are maintaining the problem, and how we can eliminate that.

Try other things on top of the CBT - in my own case there was no failing in the CBT knowledge, but I needed additional tools beyond it in order to fully  apply it.

So you're saying that CBT worked for you and 'recovery really is a possiblity' for you. Do you know how your OCD started or when?

But CBT and other therapies don't work for everyone. I've seen different figures which say that about 75% of patients with OCD feel better after therapy and lower percentage success with depression and anxiety. So I do believe that CBT can help, but it's clear from several posters on here that their problems are not purely psychological.

So I'm wondering if a more holistic approach is more helpful for those who find their OCD becoming over whelming even though they might have had a number of CBT.

Remember our understanding of these conditions is still growing. CBT is accepted because of it's high success rate, but that shouldn't exclude those people who think their OCD developed along with their developing mind from looking at complimentary therapies and strategies.

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On 10/06/2022 at 12:49, northpaul said:

Obsessive Compulsive Disorder is a disorder.  Are all instances of OCD an illness?

In my own case, depression is my illness.  Therefore my OCD is treated as part of that illness.

I remember an aquaintance several years ago who had a period of experiencing OCD as a result of a specific life event.  The OCD was treated using CBT and was successfully stopped.  When the life event was over and the OCD had been treated this person went on to live a healthy and productive life.  Throughout the the period there was no diagnosis of any mental health illness.

 I'm sure depression and OCD affect people differently and it sounds like your therapy helped. I came to see depression as a state of 'non feeling'. I think because of my family, it was dangerous to express emotions, so I buried them, but also lost contact with them. So if I felt down, I found by sitting quietly for half an hour, I could shut off my mind and feel what was troubling me. Like 'feeling emotions' in a healthy way, learning to rationalise anxiety and anger, etc

According to this book I've been referencing there are also links between an over active stress system and chronic depression. As she says, it's a biological as well as a psychological condition.

The over active stress system leads to a predisposition which then includes psychological ideas(about confidence and hopelessness) and events. I found one idea interesting; if an individual finds themselves at the bottom of the social pecking order then life is very stressful. So that could be in a family situation, where the supposed 'black sheep' withdraws and shuts down because they can't handle the stress.

 

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