Mark stands at the bathroom sink in his suit, gelling his hair in the mirror. He stops and feels his sticky fingers and grimaces. Steam rises from the sink but he continues to wash them in scalding hot water, flinching, until his hands are raw. It is only a scene from a fictional drama but for sufferers of Obsessive Compulsive Disorder (OCD), such experiences are all too real.
OCD is a form of anxiety disorder in which obsessional thoughts force themselves repeatedly into the sufferer's mind."I call them chewing-gum thoughts," says lan Puleston-Davies, who co-wrote Dirty Filthy Love (ITV), and on whose own experience Mark is based. "They just stick there whatever you do." The thoughts are so persistent and intrusive that the sufferer feels compelled to do something physical to get rid of them. "You know it's irrational but you just want to complete these actions to get rid of the thought," says Puleston-Davies.
Fear of contamination leading to repeated and aggressive washing - Puleston-Davies's own hands became gnarled at one time - is a common form of the disorder. But OCD can express itself in many ways. Fear of endangering or harming others, of contamination or of leaving something undone are typical. "The fears can be very specific," says lndia Haylor, a counsellor with the OCD Centre. "One of my clients used to fear she'd unknowingly knocked over a cyclist. She would have to retrace her journey repeatedly to check that it hadn't happened." Although her fear was irrational, at least her response to it was rational: it made sense to drive back if she thought she had caused a fatal crash. But, for many sufferers, the obsessive thought triggers a compulsion unrelated to the fear.
Dr Jim Lucey, a consultant psychiatrist from St Patrick's Hospital in Dublin, treated a theatre technician who, every morning, would check and double-check the wiring in all the plugs at work. "These irrational habits are very troubling to sufferers who are otherwise clear-sighted and often clever people," says Lucey. "Because they are very aware of the absurdity of their behaviour, sufferers try to cover it up."
Other sufferers' compulsions can be even more dissociated from the fear, such as having to touch a specific object or count to a certain number. Women tend more towards obsessive hand-washing and cleaning while counting and ordering are more common in men.
"It's called the secretive disorder and we're masters and mistresses of disguise," says Puleston-Davies. "We become very skilled at hiding our habits. Part of the horror is that
you know what you're doing is ridiculous but you still can't stop. You can't explain it, so you hide yourself away." He once got thrown out of a nightclub because he was "OCD-ing" in the toilet cubicle.
Sufferers' sense of shame is compounded by ignorance because so many people think they are "freaks" they feel unable to confide in anybody, so the average length of time they leave it before seeing their doctor is 11 years. As re-enacting the compulsive behaviour reinforces it, the cycle becomes more difficult to break with time.
Although there is no cure for OCD, there are ways to interrupt the cycle. "Psychological therapy is only about 40 per cent successful and standard anti-depressants, which many GPs prescribe, are rarely effective in themselves," says Lucey. "But some tricyclic antidepressants, such as clomipramine [Anafranil], work on the specific mechanisms of the brain implicated in OCD. "That does suggest a biochemical imbalance in the brain is responsible," says Lucey. His belief - now widely shared - is backed by studies using brain scans, which show that in OCD sufferers certain nerve cells stimulate the emotional part of the brain when it should be the rational.
Evidence that OCD has a biochemical cause and so is not the individual's fault may have helped to break down the stigma surrounding it. A number of well-known sufferers, including Paul Gascoigne, Frank Bruno and Harrison Ford, have now all come out. Puleston-Davies, who is now "85 per cent better", also says he has noticed a lot of actors who suffer. But why should it disproportionately affect people in the sports and arts?
"OCD sufferers are often highly sensitised to the fine detail around them, a valuable quality in an actor or painter," says Haylor. "They're also adept at repeating and focusing on a single thing, a crucial attribute in elite sports."
But there is a positive side to the disorder for the ordinary sufferer, too, says OCD Action's Colin Putney, whose wife is a sufferer. "She can work harder for longer than me because of the ability her OCD gives her to concentrate intently on one thing." |
I just can't help it
Obsessive-compulsive disorder traps sufferers in a world of strange rituals and irrational perfectionism. Could a new therapy finally end their nightmare, asks Sharon Walker
Less than a year ago, David Smith, 33, was seriously questioning the point of his life. “I was a marketing director for a blue-chip company, but from the way I behaved, you’d have thought I worked for MI6,” he says. “I was secretly taping all my conversations, I refused to sign my name — everything had to be paid in cash — and I couldn’t even send an e-mail without my secretary checking it. Anything I wrote was photocopied and kept as ‘evidence’. I couldn’t stop thinking that I might mistakenly sign some sort of death threat or blurt out something menacing,” says Smith, who would spend up to 2 hours driving a 10-mile journey on a traffic-free road because he was convinced that every minor bump was a dead body, and that he had run someone over by mistake. Yet this straight-talking, conscientious man would be the last person to commit an atrocity — even by accident. He isn’t mad, or even mildly eccentric, but he suffers from “responsibility OCD”, one of the more common forms of obsessive-compulsive disorder, or OCD, as it is usually known.
For all its comic value (think of the Jack Nicholson character in the film As Good as It Gets, who can’t step on the cracks of a pavement), OCD is a serious problem. “Up to 20% of sufferers are housebound or hospitalised at some point,” says India Haylor, the director of the new OCD Centre in Knightsbridge. It’s also extremely common. OCD is now recognised as the second most prevalent mental-health problem, after depression — and the number of reported cases is soaring. Experts estimate that 2%-3% of the population suffer from the full-blown syndrome, with as many as one in five suffering from a milder form. And nobody is immune to the misery of OCD. Jane Horrocks has admitted to making herself ill with obsessional swallowing, Harrison Ford has a fixation about colour-coding his socks, and David Beckham is said to suffer from a mild form of the condition — he prefers the cans in his fridge to be arranged just so (and in equal numbers). Now Martin Scorsese is making a film, The Aviator, about the cleanliness-obsessed recluse Howard Hughes.
OCD sufferers are tortured by obsessional thoughts, such as worrying that their hands are contaminated by germs. “It very quickly narrows the world you can move in,” explains Haylor. “It starts with fairly obscure fears, but quickly morphs to everyday situations, and gets progressively worse.” The terrible anxiety is only relieved by performing a particular set of behaviours. Unfortunately, any sense of relief is short-lived, which is why the behaviour must be repeated again and again. In contrast to those with psychotic delusions, OCD sufferers know their behaviour is irrational, yet feel powerless to stop.
Common treatments include antidepressants such as selective serotonin reuptake inhibitors (SSRIs), including Prozac, or old-school behavioural methods that expose the patient to their fear while preventing them from carrying out the compulsion. About 60% of patients show some improvement, but neither therapy is ideal: 20%-30% find the idea of behavioural treatment too traumatic, and SSRIs can have distressing side effects. More recently, practitioners have had greater success with cognitive behavioural therapies that teach patients to challenge self-defeating beliefs and develop positive new ones.
However, a new treatment from America is bringing fresh hope to sufferers. Pioneered by the OCD guru and neuropsychiatrist Jeffrey Schwartz — the man Scorsese called in to help Leonardo DiCaprio prepare for the role of Howard Hughes — the Four Steps programme employs meditation techniques with the goal of teaching sufferers to manage OCD symptoms by themselves. Schwartz, who is research professor of psychiatry at the UCLA School of Medicine, and also works with Haylor at the OCD Centre in London, believes that we can literally force our brains to override dysfunctional circuits by choosing what we focus on.
“The goal is to learn to override false brain messages,” explains Schwartz. Patients might be encouraged to engage in conversation rather than follow through with their usual compulsion, such as repetitive washing.
There are different theories about what causes the condition. Most experts recognise a genetic element that can be triggered by a stressful event. Schwartz believes that the OCD “worry circuit” is a direct result of faulty brain chemistry, an idea that has gained acceptance through brain scans showing “overheating” in the emotional areas. “People with OCD have increased energy in a specific region of the brain called the orbital frontal cortex,” he says. “This area is involved in making emotional assessments of the environment. An increased metabolism in this part of the brain gives a sufferer the feeling that something is wrong.” The good news is that once patients understand what is going on, they can start to take control of their illness and focus on more adaptive behaviours.
“When someone experiences an OCD thought, one part of the brain knows quite clearly that the hands are not dirty,” explains Schwartz. “Some part of the brain is standing apart from the symptoms, reflecting on the sheer bizarreness of it all. The objective is to harness this impartial spectator so that patients can use the healthy part of their brain to resist the compulsions.” Schwartz is keen to emphasise that his programme enhances, rather than replaces, traditional cognitive behavioural therapies and medication, and believes his Buddhism-inspired methods can be used to lower drug doses and reduce therapist intervention. “At the OCD Centre, we teach you to become your own therapist. And, over a period of months, it becomes possible to lower medication doses and professionally supplied therapy.”
David Smith, for one, is delighted with the results. He had tried transactional therapy, hypnotherapy, behaviour therapy, even reiki, and was about to give up when he discovered Schwartz’s book, Brain Lock. “Schwartz’s programme makes you aware of what’s going on by calling it what it is — a biochemical imbalance. It alters your perception and allows you to see what’s happening. For the first time, I know how my brain really works,” he says. With the help of the OCD Centre and telephone counselling, Smith has reduced his intake of Prozac to the lowest possible dose.
“There was a point when — although I would never commit suicide — I was so low, I thought, if all these fears do come true, nothing can be as bad as how I’m feeling anyway. Now I can sign cheques without a problem,” he says brightly. “And I don’t photocopy them, either. OCD used to feel like a huge stigma, but I don’t feel handicapped by it any more. Some people have bad feet; I’ve got OCD. You just deal with it.” |
INSIDE THE MIND OF AN OBSESSIVE
What makes mothers terrified that they're 'contaminating' their children, or women feel the need to shower six times a day? Sharon Walker explores obsessive compulsive disorder
'I would drive around town five times just to check if I had knocked anyone down: admits Deirdre O'Shea, 37, who, like 1 million other Britons, suffers from obsessive compulsive disorder (OCD). 'It all started when I was driving home one day from my parents' house and I suddenly had a feeling that I might have run someone over. From that moment on, I couldn't get the thought out of my head.'
Soon, Deirdre couldn't walk along the road without thinking she might accidentally push someone under a car. 'I'd have to look over my shoulder and check, maybe three, four, five times, until they were out of sight,' she says. 'The sight of vulnerable people - toddlers, old women, babies -, would always set me off.'
OCD is a brain condition which results in distressing, repetitive thoughts. Sufferers worry, for instance, that their hands are dirty or that they might accidentally hurt someone. One of Deirdre's symptoms was that she often considered turning herself in to the police and spent hours scanning the local papers for news of hit-and-runs. The irony is that OCD sufferers are least likely to commit such a crime. 'People with OCD have high morals and an intolerance of imperfection: says psychiatrist Dr Jim Lucey, who runs the OCD unit at St Patrick's Hospital in Dublin.
This causes some victims to feel compelled to follow rituals, which they believe have 'magic' protective powers, so they repeat the same behaviour over and over until it is 'safe' to move on. This might be switching a light on and off, repeating everything they say or washing their hands 50 times a day. Having OCD, say victims, is like having mental hiccups that won't go away.
'OCD also tends to feed off the Zeitgeist: says Lucey. 'In the 1980s, I had a rush of people obsessed with Aids. Now, people are terribly worried about the Internet and that they might download something incriminating.'
For Sharon Harris, 25, OCD began at the age of six. 'We lived in a really old house with lots of gas taps. They weren't connected, but I still worried we were going to be gassed. Then, when I was eleven, I saw an Aids awareness leaflet which said something like: "Don't die of ignorance". I remember being very scared, but my fear of HIV didn't affect my life really badly until I went to university. Then, I'd have six showers a day and would worry a lot about who slept with whom. It wasn't rational, as I had a boyfriend and wasn't planning to sleep with any of these people. But I couldn't touch anyone in case I caught HIV. It got to the point where I would want to go up to people in the street and I was terrified of Aids. I'd want to go up to people in the street and say, "Please have an HIV test because you've just brushed past me." I was always worrying that I might step on a syringe or sit on one on a bus. Even picking up a book in a library was a problem if it had sharp corners, my mind would tell me it must be a needle. That was miserable - I couldn't enjoy anything.'
'OCD sufferers know their behaviour is odd, but often they don't know what it is or what to do about it: explains India Haylor; director of the OCD Centre, a new London clinic. 'It's a terribly misunderstood condition and very under diagnosed.'
Haylor is an OCD sufferer herself, but her disorder is now under control. She believes the condition is hidden because victims are ashamed of their bizarre symptoms. But not everyone who has obsessional thoughts is in danger of becoming ill. Most of us indulge in the odd ritual and don't think twice about it, whether it's touching wood or always putting your left sock on first. The difference is that, for OCD sufferers, these irrational superstitions take over and stop them living a normal life.
'OCD puts a massive dark cloud over everything.' says Sharon Harris. 'In a cinema, I'd spend more time obsessing about who was behind me and whether they were infected rather than concentrating on the film. I couldn't hug or kiss anyone, I couldn't even touch them, so paying for things in shops was impossible - I was more worried about whether an assistant had touched my hand than whether I'd spent £500 I couldn't afford.'
Twenty years ago, OCD was considered extremely rare - it was thought to affect less than one in 1,000 people - and almost impossible to treat. Now, thanks to studies in America, doctors know OCD is very common. Two to three per cent of the population will develop the disorder at some point in their lives, and experts believe many more are affected by a milder form of the disease.
Social status, friends and a stable family background offer little protection. Actress Emily Lloyd took a three-year career break when OCD flared up after she was bitten by a dog. Jane Horrocks has admitted to an obsession with swallowing and counting her blinks. Even golden boy David Beckham compulsively straightens the cans in his fridge.
Despite growing awareness, OCD is still frequently misdiagnosed as depression or stress. Occasionally, because of the bizarre obsessions, sufferers are labelled schizophrenic or psychotic. 'My GP didn't have a clue what the matter was: says Harris. 'He just asked: "How's your relationship with your boyfriend? How's university?" It was just a tick-list of questions about why someone might be upset.'
It's hardly surprising that OCD sufferers are slow to seek treatment - it's not unusual for some to wait as long as fourteen years before consulting a doctor, usually because they're ashamed of their bizarre symptoms. As a result, victims are often anxious and depressed, but anxiety is simply a component of the illness, rather than the cause. 'Some become depressed intermittently, making their OCD worse. Others only get OCD symptoms when they are depressed: Stress can also influence symptoms and make them worse.
OCD: The symptoms
OCD sufferers tend to worry compulsively about: contamination (e.g., getting their hands dirty) leaving doors unlocked or electrical appliances on, harming others by mistake, symmetry and order (e.g., arranging everything in alphabetical order), that they might molest or rape someone, throwing things away, even rubbish, resulting in the hoarding of items such as bus tickets.
What causes OCD?
Sufferers have abnormal activity in an area of the brain known as the orbitofrontalstriatal circuit, which is responsible for emotions and the smooth flow of movement and thoughts. OCD frequently appears at the same time as other brain problems
and can be triggered by a head injury. Sometimes, sufferers get their first attack after a bout of strep throat - the antibodies produced during this illness are thought to attack neurotransmitters in the brain. The disorder also tends to run in families.
The good news is that there are effective treatments available and sufferers can go on to live successful, happy lives.
Traditionally, treatment relied on behavioural techniques, which forced patients to confront their worst fears. In more barbaric times, those with contamination fears might have been encouraged to rub their hands around the toilet bowl or put urine on their hands and face. But cognitive behavioural therapy (CBT) is now the primary treatment for OCD. It continues to use some 'exposure' techniques, but also teaches sufferers to replace obsessive thoughts with more productive ones. 'Now, when I start worrying, I get out my mobile and call a friend or just concentrate on my work: says Harris. OCD can also be treated with medication, usually antidepressants like Seroxat or Prozac. Many patients benefit from a combination of medication and CBT, although traditional 'talking' cures like counselling and psychotherapy generally don't work, since repeatedly discussing fears-can make the condition worse.
While there's no cure for OCD, most learn how to manage their symptoms effectively. Haylor; who uses both CBT and self-help strategies from the US, believes up to 80 per cent can expect to make a complete recovery.
Harris is delighted with the progress she has made at the OCD Centre. 'Part of the treatment was picking up rubbish in the street, putting my hands on bins and even visiting a hospital, which was horrible. Now, I'm much less scared of putting something in a bin or touching people, because I've done so much worse. If I get obsessive thoughts now, I distract myself or ignore them, and I'm no longer depressed or anxious. I can't say it's gone completely, but it no longer rules everything I do.'
'I washed my hands in boiling water 40 times a day'
Herman Bailey, 34, had OCD for two years, but is now 90 per cent recovered. She lives in Hampshire with her husband and four sons. 'I'd always been a relaxed mum, but when I gave up work to look after the children, I suddenly kept thinking something awful was going to happen to them. My brother committed suicide eleven years ago and I hadn't grieved properly. Feelings of loss and guilt that I should have done something to stop him overwhelmed me. Soon, I had convinced myself I was dirty and that I would pass something on to the kids, so I began washing my hands in scalding water up to 40 times a day. These rituals were the only way to ease my anxiety. 'After six weeks, my husband, John, started to cook for the children, as I was sure I was contaminating their food and would throw their dinner in the bin. My anxiety levels shot up, making me heave when I tried to eat. Soon, I wouldn't allow the kids anywhere near me. I felt I was doing the best thing for them, but I also felt such a burden. 'By the time my sister Carol dragged me to my GP, I was a wreck. When he explained I had OCD, I'd never heard of it. But it was a huge weight off my mind to know this was a physical disorder and that I wasn't going mad. 'I was put on medication, but the nightmare didn't stop there. The most frightening thing was developing a fear of broken glass. If I saw any oh the road, I had to pick it up. I couldn't stand the thought that someone could hurt themselves. Looking back, my brother's death had left me with a huge sense of responsibility. 'A month after my diagnosis, I got counselling and I've never looked back. Just to talk to a stranger was such a release. We discussed my brother, and I realised his death wasn't my fault and nor was having OCD. 'Two years on, I still check things more than most people, but my self-esteem is much higher and the fear of contamination has stopped. 'I'm writing a book to raise awareness about OCD and mental illness. It's about normal people being ill, rather than them being abnormal. I thought I would be ill forever, but now I see there is help out there; you just have to be brave enough to ask for it.'
'Before going to bed, I had to flush the loo four times'
India Haylor is director of the OCD Centre in London and has suffered from the condition since the age of six. 'I've had rituals since I was a child - I'd brush my teeth in certain directions - but it wasn't until I was in my mid-twenties that it got really bad. I'd split from a boyfriend and set up my own business. I was very anxious and, when I was alone, the rituals took over. I'd have to do things four times to feel OK - I'd repeatedly get in and out of bed or put on my clothes and take them off again. fortunately, at work, I managed to keep it under control. 'Then I left my job and got married. I was happy, so my OCD improved. But when I started working from home, it got really bad again. I was worst between the ages of 26 and 28. Going to bed could take up to three hours: I had these rituals about cleaning my contact lenses and I had to flush the loo four times. Soon, it was multiples of four. My husband didn't realise anything was up, because he'd already be asleep. 'Soon, I was barely getting any work done and I got a reputation for being late and very flaky. It was only when my panic attacks started that I finally sought help. 'I went to see a few counsellors and a psychotherapist and they all thought my OCD was secondary to other problems. The counsellor taught me breathing methods to help the anxiety, but the psychoanalyst delved into my childhood looking for the origins of the OCD, which was useless, because I had a happy childhood. 'Then, I found a cognitive behavioural therapist, and she taught me that terrible feelings were all part of the panic attack and didn't mean I was going to die. But CBT works by changing irrational thought patterns, and with OCD you already know the thought is irrational, so the treatment had to be adapted. 'The turning point was reading Brain Lock by American OCD specialist Jeffrey Schwartz [£7.99, HarperCollins]. I started to ignore the obsessive thoughts so, instead of reacting to the anxiety with a ritual, I would do a crossword or practise piano scales. 'Now, I only get an OCD urge every couple of months. I feel an enormous sense of freedom at just being able to get dressed. Even getting into bed without all the rituals is a luxury.' |
