Understanding OCD: Symptoms, Treatment, and Daily Challenges - Obsessive Compulsive Disorder

Dr Marianne Trent (: 00:00

Do you really know what OCD is? Spoiler alert. It is not just about being neat and tidy. In this episode, we uncover the truth about OCD, the distress it causes and the treatments that can help. If you or someone you care about struggles with intrusive thoughts and compulsive behaviours, this is one you are not going to want to miss. Hi, welcome along. I am Dr. Marianne and I'm a qualified clinical psychologist. Now, OCD does get spoken about by lots and lots of people, but often in quite a throwaway manner. This is not that I spend a great deal of my time as a clinical psychologist and providing therapy for people who are really have their lives very much affected by the far reaching implications of OCD. So this episode is all about what it is, how it can take hold, and we're trying to normalise and validate people's experiences so that they are more able to grapple with this and to be able to take control. If you find this helpful, wherever you are watching or listening, please do like subscribe, drop some comments and give this video some love. I'll look forward to catching up with you on the other side and I hope you find it really, really useful. Hi, just want to welcome along our guest for today, Faye. Hi, welcome along to the podcast.

Faye Wilson (: 01:41

Hi. Thanks Marianne. Thank you for having me.

Dr Marianne Trent (: 01:43

Thank you for pitching your idea for the episode to us. Before we crack on with our content, thinking about OCD and striving for careers career, could you tell the audience and myself a little bit about you please, Faye?

Faye Wilson (: 01:58

Yeah, so my name's Faye. I am a psychological wellbeing practitioner or PWP for short, very recently qualified. So just to give a brief overview, I work with people with common mental health difficulties, depression, anxiety, OCD, those sorts of things. And that's what I do as a full-time job. I've worked in mental health for a few years now in various different roles before I got into doing the PP work. And I am someone who also lives with OCD. That's a very important part of my role and me as a person as well.

Dr Marianne Trent (: 02:36

Thank you so much. If people did want to hear more about what PWPs are and how they can train as one and what the reality of working as a pwp is like, they can listen to the episode I recorded. That was out very recently actually with Ben Olson. But let's hear a little bit more about you and OCD. So when did that first become apparent, maybe not to yourself, maybe to other people, when was that first in your life?

Faye Wilson (: 03:03

So it's interesting, I think with OCD obviously what we often think of it is it can be really apparent to the people around you, but my OCD tended to manifest in more sort of mental compulsions rather than physical. So it wasn't always obvious to the people who were around me. I think probably looking back, it started maybe when I was around 17, 18 years old, but I didn't get diagnosed until later on until I was around 21, 22. So it was a bit of a journey to come to terms with that, what was going on. I didn't know a lot about OCD at the time that I started experiencing it. So for me it was very difficult to have that inward battle and feel like you are the only person in the world who's experiencing that. Just not knowing what was going on was really scary.

(: 03:56

So when I sort of started to think that maybe this might be OCD, I remember sort of googling a lot of my symptoms at the time and it would come up with all these different OCD forums and I thought, well that can't be made because I don't accessibly wash my hands. I'm not very particular about where I put things though I brushed it off for a really long time. And the more I sort of got into that Googling spiral as people with OCD often tend to do, it was becoming a bit more apparent to me that actually maybe OCD is something a bit more than just bit cleanliness and orderliness. So yeah, that's when I kind of started to notice.

Dr Marianne Trent (: 04:38

Yeah, you make such a brilliant point there that it's not just about switching on and off light switches or getting the gas dials on your ho just right what OCD is and how I explain it to clients that I work with. I should also say that you and I have never worked together therapeutically. This is a professional chat, so I hope that this feels okay, but please let me know if it doesn't and we can cut any bits out that don't work for you. As I explain OCD to everybody really, whether it's my clients or just people I chat with, OCD is an impulsive and intrusive thought that all of us might have. It might be a really logical thought about something that becomes distressing and it's then the activity that you take to neutralise and to bring that distress down with a belief that that will somehow help that to not happen or that it will make the likelihood of something else happen.

(: 05:38

So for example, somebody has a thought that, oh, it's cold out there, it's dark, and then they think it's a sense they make of that, oh, my loved one is actually still out at the moment. Then they begin to make their attributions to that. I'm worried that something might happen to them because it is so cold and so dark. Gosh, that would be awful. That would be horrendous. Or maybe I'll have to sit and do this all 15 times until it feels right. And I'm sorry for anyone the listening to that on MP three, I was clicking a pen. Now if you're not watching it on YouTube, I was clicking a multicolor pen. But it's that sense of until it feels right or until it feels manageable, and that might be different on different days. And what we know is that that can change. So what initially kind placates that and brings the distress down doesn't always work or the one strategy stops working over time and then you have to ramp it up and that's when it really begins impact on your wellbeing and sometimes your functioning and your ability to look after yourself and strive for normal basic functions, let alone a career.

(: 06:59

Does that encapsulate your experience of OCD? You understand if you're different?

Faye Wilson (: 07:05

Yeah, no, I completely agree with what you've said there. And the main thing is, and I think as explains quite nicely though, it's the compulsion that is the part that can really begin to take over your life. It's not the thoughts themselves, although they are really distressing. The compulsions are really what sort of has a big impact on sort wellbeing functioning. If you have a compulsion that you need to do over and over and over again and you can't move on to something until that compulsion feels right or it feels that you've done it enough times or that anxiety has eventually lowered, it impacts on everything. It impacts on your ability to work, it can impact on your ability to, there were times and lengthy periods of time where I struggled to get out of bed because I was going through these mental compulsions in my head and it took me so long that by the time that anxiety had lowered, it could have been minutes, hours later. And the thing is that that anxiety does eventually lower, but oftentimes what happens then is you've done that compulsion, you feel better and a few minutes later there's a new intrusive thought and you have to go through the whole process again. So it can be extremely time consuming and I think that is when sometimes it can start to become apparent to the other people around you as well, that something's not quite right.

Dr Marianne Trent (: 08:34

Yeah, distress is the word that probably isn't always spoken about enough with OCD, this is deeply distressing and it's not a case of as often people will try and help you come on, just stop it. Just stop it. It's not that easy. This is deeply distressing and often it will crop up. I heard you say that it was around 17 and I know that's a really key time for mocks, for as levels, for A levels perhaps for college stuff, but also people's health might falter, parents' health might falter and then it puts that stresses those cracks on. Or maybe the anxiety of having to be independent, get around to college. There can be so many things at whatever time of life it is that kind of leave that vulnerability for OCD to be able to get in. And even when in recovery and in remission or in between chunks of OCD, it's really important to kind of look after wellbeing and self-care to try and safeguard from finding its way in.

(: 09:40

Again, as a strategy, it is like if we're thinking of externalising it, it's like it almost whispers to you, this is going to make it bad. This is going to, it's going to make you feel better. This is going to help. And it kind of seduces you and before you know it, it's your best friend again. And it's telling you lots of stuff, but it's just really hard. And I realised when I was recording an episode, actually when I was doing some clinical work with a client, it wasn't a podcast that I had been doing something for 20 years or something, 20 years since my finals at uni, I'd been folding the clothes I sleep in and putting them under my pillow just right so that I would do in my finals. And then it was only when I was with them and we were talking about the kind of normal stuff that we do that I realised I'm still doing that and I've never had an OCD diagnosis, but this can crop up in normal life clearly wasn't affecting my functioning. But it's so easy for things to happen. Even kind of superstition beliefs about superstition not passing on the stairs that is rooted in OCD and it's omnipresent. Could you tell us a little bit about mental compulsions, please? Maybe not your own if that feels too intrusive or personal, but just as you've picked up along the time.

Faye Wilson (: 11:13

Yeah, absolutely. So mental compulsions, it covers a whole range of behaviours and I think the important thing to know about compulsions is they can be very different and they vary from person to person. And a big one for me was kind of this feeling of having to sort tell people sort of confession. So I had to period where I was very focused on being kind of morally correct and everything being perfect, never telling any kind of lies or anything like that. So it could be something as inconsequential as I told someone, oh, this person was wearing a pink shirt. And then a few minutes later I realised, oh, actually that person was actually wearing a blue shirt and that will cause me so much distress to the fact that I had not completely told the truth, that I would have to go back and correct myself and say to this person, actually I was wrong.

(: 12:09

I didn't tell the truth. That person was actually wearing a blue shirt, not pink shirt. And that would be what I would have to do to kind of, I suppose bring that anxiety down and make me feel better. So that is a huge part of it. Also, maybe asking for reassurance around things count inside your head is a huge mental compulsion for a lot of people sort of going over things mentally reviewing. And there's a huge subset I suppose, of OCD around maybe false memories. So kind of thinking, having an intrusive thought and believing that thought has actually happened in the past or you've done something wrong or you've done something bad. And having to mentally go back to that moment in time and review it and think, what have I done here? Did I do everything correctly? Have I done something wrong? And just going over that event over and over again. So there's a lot of different mental compulsions and they're not always visible to others or very apparent to others.

Dr Marianne Trent (: 13:08

That is a lot, isn't it? And I imagine it's quite hard to go to sleep as you are ruminating and processing over all of that. So it must really impact on every aspect of your life, your physical health, your mental health, your ability to do anything. How do you strive for a career when you've got that level of anguish going on on a minute by minute basis? Sometimes

Faye Wilson (: 13:35

It's a loaded question really. And I think part of me, I've always wanted to work in mental health, this was something that I was very passionate about and cared a lot about. So I think that always helps at the time, at my worst periods when I'm talking about these compulsions that I was doing, this was a few months long where it went on for quite some time and it was impacting my functioning. But at that time I was actually finishing off my undergraduate degree. We were in sort of that period of covid, the initial covid periods where it was locked down and you couldn't go outside and see people. So everything had moved online. It was incredibly, incredibly difficult. I won't sugarcoat it. I was doing my final year exams for university, getting around to do my dissertation. I found myself incredibly pressed for time.

(: 14:29

A lot of the time I wasn't studying. And actually there was a period of time where I did fail a lot of my exams because I could not get out of bed. I could not get to the point of studying or even going to my lectures. I missed a lot of lectures because of this. And I eventually actually reset one of the exams that I failed. And because I failed it a second time, I was dismissed from the university. This was sort of after my second year, so kind of getting kicked out essentially from uni because of the level of distress that I had and the fact that I couldn't really function very well. And at that time I didn't know what was going on. I did not know that this was OCD. So it was incredibly difficult and it's not easy to kind of strive for that at times. And there were times that I felt like kind of just giving up and throwing in the towel and saying, maybe this isn't for me. There were times that I thought that maybe I was just lazy or I wasn't as smart as other people. Why was I failing everything? Why couldn't I just get up and do these things? But it was because these compulsions and this distress was taking up so much time and so much energy that I did not have the energy for anything else.

Dr Marianne Trent (: 15:48

Yeah. Gosh, I'm so sorry to hear about that. And OCD takes so much from the people that it affects, but actually that's also a real financial impact as well, that that's two years of funding that you have presumably have to repay. And then to get yourself to where you are, you need to ultimately do another degree perhaps all three years again. And as you're talking, thinking about my experiences this weekend, I'm actually going to go and see my undergraduate friends. We're going to go and have a lunch and shopping date together. But it would've been, I don't know, you've lost out on those relationships with people. I hope you might still be in touch with them, but you lost the chance to be carefree and to do what everyone else who was your age was likely doing at that time because you were so distressed and so consumed by this. That's a really big deal.

Faye Wilson (: 16:50

Yeah, absolutely. I do think back on those times, and it is unfortunate that the time that I spent inside at home just not being able to get out of bed because I was all consumed by OCD. And I think the biggest part of it for me was not knowing, knowing what was wrong with me, feeling like I was the only person in the world that was dealing with this. And there was something really, really wrong with me because I couldn't do the things that other people were doing. And you're right, I really struggled with making relationships with other people because I couldn't spend that time. I was never fully present in moments where I maybe would've liked then. So it did have a huge impact on just my university life. And then obviously going back to university through covid that added another layer onto it where you couldn't go out and meet new people. So it did have a huge impact on that period of my life.

Dr Marianne Trent (: 17:54

It sounds like there was some missed opportunities along the way, actually, Faye, perhaps after your A levels or whatever secondary education you were doing, and perhaps student support should have really brought you in to think about what was going on because of the high number of missed lectures and just where you were hitting the mark academically compared to what your potential was perhaps. And do you have a sense of what might have made a difference?

Faye Wilson (: 18:25

Yeah, no, I think you're right. And I think you don't want to kind of dwell too much on it in the past because these things have happened now and I often look back on it and think that was the best thing that actually could have happened for me in that time. This is where I am now, but I think you are a hundred percent correct and mental health support, I think quite famously throughout secondary schools and moving up into higher education isn't always the best. So a bit of support probably would've gone a long way. I think in that instance. I think also as well, just acknowledging the fact that it wasn't so obvious to even to myself that particularly what was wrong or to other people. So people may have asked, and I may have just said, I'm fine and everything's okay, because I wasn't really sure what was going on.

(: 19:22

So it's interesting that you bring that up, but this is why it's so important to cultivate that awareness around OCD and bring it more into just the public lexicon and just get that understanding because what people think OCD is a very, very limited what it really is and everything that OCD encompasses, and it's still used to this day in quite a flippant way where people are like, I'm a little bit OCD or because they like to clean. And that has a huge impact on the people who are actually struggling with OCD because they don't get the chance to learn what this is. And they might be going through the same struggles that I did where they're having these thoughts, they're having these compulsions, but because they're not in line with what they know about OCD, they internalise it and they keep it to themselves and they don't seek out diagnosis knowledge that actually it can take years and years and years. I think it's something between up to 14 years, it can take someone to get an OCD diagnosis. And I think a huge part of that is to do with the fact that it's so misunderstood and it could just having that knowledge and raising that awareness could go a really long way in supporting people.

Dr Marianne Trent (: 20:40

Absolutely. Pathologisation of OCD being so common in people is something I've spoken about on online socials, but it's not OCD needs to impact on function. Risk wellbeing needs to be many, many problems, but if actually you really just like a very clean house, but you are able to do all of your things without denting your wellbeing, that is not OCD. That might be some beliefs around cleanliness and what dirt is might be a fear about what other people would say about you, but if you are able to be entirely functional, get everything done, your wellbeing is radiant, your house smells like Stacey Solomon wax melts or whatever, and you're not a risk to yourself or others, you don't always have to have risk to yourself or others for OCD, but it can become that because it's such distressing that sometimes people don't want to live anymore because it's so distressing, so much anguish.

(: 21:54

So yeah, I wish people would be more careful with their phraseology, but no, I think, yeah, we can't dial back time for you, but people listening to this podcast, perhaps working in student services can become more aware perhaps working in higher education, like, oh, this could be a possibility. How could I gently explore this? And red rural bleeding hands is a really easy way in or it can help join up the dots, but without that it can be really, really difficult to kind of help work out what's going on, but also you need to feel like you trust the person you're speaking to and that it feels safe to have that conversation. But it sounds very much like you were really trying to just keep yourself to yourself to get through each day.

Faye Wilson (: 22:49

Yeah, absolutely. And another thing about OCD and what not spoken about so much is those intrusive thoughts that might be actually a bit more taboo, thoughts around safety, people might have thought a really common one is that fear of losing control. So people might have a big fear around sort of knives because they think if I'm near that, I might lose control and I might harm myself, I may harm someone else. And to have those kinds of thoughts and to not know why you are having them and to not know that that is a really common symptom of OCD is incredibly, incredibly distressing. And if no wonder, as you said, people do get to the point of wanting to take their own lives because they think something is seriously wrong with them and they're a risk to themselves or to others when actually it's not congruent with how you actually feel with your values, it's very much OCD latches onto the things that you really care about. So if you really value your family, it may be that you then have intrusive thought of something bad happening to them or causing them harm. And that is why those thoughts become so distressing because you care about that and you don't want that to happen. So I think it's difficult in that sense because you don't want to voice those thought to other people because you're scared of what they're going to say.

Dr Marianne Trent (: 24:24

Absolutely. And whenever I'm working with anyone about intrusive thoughts and how powerful they can be, but also how we can't control them, I kind of get this out, which is like a sand. You're looking at the sand coming down and you can't control it. You might be able to watch it, but if we were to try to take, well, I can see through it lately, if we were try to predict what's going to happen or to make plans for what might happen if that bit falls or it really demonstrates quite nicely how intrusive impulsive thoughts work, but that we need to just get better at watching the leaves in the stream and knowing that we will have these thoughts. But if I was to throw you a tennis ball for example, you don't have to catch it or you can catch it and put it down or you can throw it to somebody else.

(: 25:17

You don't always need to take action with that and keep it with you. And before you know it, you've got 18 tennis balls up your jumper that you're trying to kind of juggle and balance. We've got to learn that we've got choices of what to do with our impulsive obtrusive thoughts. We just have to be able to build those stabilisation skills and the distress tolerance skills to not judge ourselves to know that we are capable of really wild thoughts, really wild ideas. And this is always where I sit for therapy and whenever I'm working with anybody, I'm not going to say it on camera because I don't want it to be used out of context, but every time I am working with a new client, I come up with a new possible awful scenario that I could reap havoc on my local environment using what I can see.

(: 26:11

So I'm not going to say it because I don't want it to suddenly go, Dr. Trent says that, but we are capable of generating things and the very, when we are looking at compassion focused therapy, which I know is often key for people with a CD, we are still humans and humans, we're in gladiatorial battles and going and watching all of that violence and cheering for it and all of the stuff that's happened in Nazi concentration camps, that's humans that have done that to other humans, we are capable of coming up with stuff that generates us thoughts, but we don't always need to run with those thoughts and those ideas. And that can be really, and it says so if you don't act upon the thoughts, it says nothing about you. And that's really powerful. Could you tell us about some of the approaches that have been instrumental for you overcoming or containing the OCD?

Faye Wilson (: 27:21

Yeah, absolutely. The first thing that I actually found really helped before I actually did any therapy for OCD was I did a lot of mindfulness meditation and I did that religiously. I would do that every day. I did it for a couple years without fail, I would meditate for at least 10 minutes every day. And with OCD, the reason that mindfulness is so helpful, and as you've just mentioned, it's kind of seeing those thoughts, acknowledging them, they've popped into your head, but a thought that is just the thought and there doesn't have to be any kind of meaning attached to that thought. So just observing it and letting that thought go because eventually it will. We have, I dunno how many thoughts, thousands upon thousands of thoughts in just one day. So that is just one of many, and it will pass eventually if we just see it, acknowledge it and let it go.

(: 28:25

Obviously the reason that OCD becomes so distressing is because we attach a lot of value to those thoughts, a lot of meaning to those thoughts and we try and get rid of them. But a really common analogy is that one of, if I were to say don't think of a pink elephant, the first thing you're going to think about is a pink elephant. So trying to battle those thoughts and push them away can be really counterproductive. So mindfulness was a really useful technique for me and just kind of letting those thoughts on not having it out with them, just seeing them and saying, okay, it's here and it will pass. And eventually they do. So it's really useful and it tied them really nicely to, I did eventually start doing a bit of exposure and response prevention therapy, which is the main kind of thing that they use in the NHS for treating OCD, which is essentially kind of exposing yourself to the fault or the thing that makes you feel that anxiety makes you feel that distress and not carrying out your compulsion. So the behaviour that you would do to bring that anxiety down. So mindfulness I found worked really well hand in hand with the RP therapy to make me become a bit more tolerant of that anxiety and make me feel a bit more comfortable in just knowing that it will pass and I don't have to act on anything. I don't have to do anything to make that anxiety go away. It just will. So that was a huge thing and that's been absolutely fundamental in treating my UCD.

Dr Marianne Trent (: 30:01

Good. I'm pleased that you found something that's really helped to take control, actually to take control back. And I know sometimes people are so distressed that actually medication helps take the edge off to be able to tolerate any distress at all or any more distress about not doing the activity. There's always so much distress anyway, but the idea of upsetting the apple cart is too much. So sometimes medication can help people to take the edge off to then be able to tolerate the therapy, but for anybody watching this, I want them to know this is not going to be flooding. This is not going to be us cussing you off cold Turkey. You're not doing that anymore. You just got to tolerate it. It isn't that that would be so inhumane. We need to build up so that the distress is tolerated and then build upon those blocks, but also know that with any setback, sometimes we need to work a little bit backwards before we can then work forwards.

(: 31:07

Again, this is compassionate, this is humane, this is working with you, not against you. And that is really important that really somebody is buying into not wanting to suffer this way anymore. And to find a way back to more balance, more wellbeing, less problems, less risks, because people deserve to have richly rewarding lives where they have careers where they have intimate relationships if they want them, where they have friendships where they can tolerate being around their own children or other, and just that life feels like it's worth living and it feels doesn't ASAP point in it.

Faye Wilson (: 31:52

Yeah, absolutely. And something that I always say to clients that I work with now who come in with OCD or with intrusive thought compulsions is that the therapy for OCD is difficult. You do have to put a lot of work into that and it can be really distressing at times. What was harder for me than doing the exposure and response prevention therapy was actually living day-to-day with OCD. So that was a choice that I had to make was am I going to commit to this and do it and have the support of someone there who's helping and guided me through it, or do I kind of live with this and with it becoming worse and worse with every passing day, because as you've mentioned earlier on, if it comes to a point where we habituate to those compulsions almost and we have to do more and more to make ourselves feel better, so the OCD only gets worse, worse, do I continue with that or do I commit to this therapy and this moment of the stress knowing that actually this is going to be really useful for me?

Dr Marianne Trent (: 33:08

Yeah, absolutely. And reaching out to ask the help can feel like a really brave step, but it's really, really important and people do get better from OCD. It might be that you use those strategies every day, but people get better and do have that meaningful, enjoyable life. Thank you so much for sharing your wise insights with our audience. Is there anything I haven't asked you that you think is important that we do cover or that we think about?

Faye Wilson (: 33:45

Yeah, I think a huge thing that is really important and something that I didn't know sort of a few years back was that OCD is treated really widely throughout the NHS. I remember going through a phase where I thought that this was really uncommon disorder and it was going to be really difficult to get help, but actually the talk and the services throughout the NHS across the uk, they all will bring you in and treat you for OCD and the practitioners there, they do have an understanding of OCD. So I know it's really incredibly scary and incredibly difficult to reach out for that support. And you don't always want to tell someone what's going on in your own head, but just please be aware that there are trained professionals out there who know what you're going through, who will understand, who will listen to you and will give you the help that you need.

Dr Marianne Trent (: 34:45

Yeah, absolutely. And just don't feel like you're struggling alone because people are just trying to make the best of worlds with these wild, tricky brains that we've got. We're just humans, and that's just how it is. Thank you so much. Wishing you well with your work as a PWP and beyond, whatever that looks like for you, and keep up with that mindfulness. Keep doing that.

Faye Wilson (: 35:17

I will. I will. Thanks Marianne. Thank you. You too.

Dr Marianne Trent (: 35:24

Thank you so much to our guest, Faye. I did forget to mention where you can catch up with Faye if you want to connect with her. She is on LinkedIn and she is Faye with an E, so FAYE Wilson. More about her and what she does mainly follow her journey in her career too. Please, if you are struggling with OCD or you care about somebody who is, please do book yourself a GP appointment or encourage someone that you love to do that, maybe offer to go with them if that would be useful. You can also come and connect with me on my social media channels where I am, Dr. Marianne Trent, absolutely everywhere, and I've got a sprinkling of different content that goes in different places as well. So do come and follow me everywhere. And of course, we've got the free Aspiring Psychologist community Facebook group where you can come and watch the exclusive videos called Marianne's Motivation and Mindset, which happen weekly on Fridays.

(: 36:27

If it's your time and you are in the psychology profession, you are ready for the next step. Please do also check out the Aspiring Psychologist membership, and if you found this video helpful, I know that you'll really find the one I did with Alexandra on OCD and Complex Trauma to be really useful as well. I will link that in the show notes and it will be on screen at the end of this for you to just click through and watch as well. Please also consider the Aspiring Psychologist Collective book, the Clinical Psychologist Collective book, and the brand new Kid on the block and autistic anthology, which is real life stories of people with autism diagnoses, talking about their experiences working in mental health. Thank you so much for being part of my world. Do be kind to yourself. If you're looking to become a psychologist,

Jingle Guy (: 37:23

Let this podcast.