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**Disclaimer: This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of obsessive compulsive disorder, consult with a mental health or medical professional. I am speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider.
**This is how I am conceptualizing and would begin with a client, but every situation is very different in every way.
OBSESSIVE-COMPULSIVE DISORDER
"Obsessive-Compulsive and Related Disorders (OCRDs)," which also includes body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, hoarding disorder, substance/medication-induced OCRD, OCRD due to another medical condition, and other specified OCRDs -https://www.ncbi.nlm.nih.gov/pubmed/24616177
These probably have similarities in polyvagal terms
RUMINATION vs OBSESSIONS
Obsessions are different than rumination in anxiety -
Ruminating is simply repetitively going over a thought or a problem without completion. -https://www.psychologytoday.com/us/blog/depression-management-techniques/201604/rumination-problem-in-anxiety-and-depression
Basically, rumination means that you continuously think about the various aspects of situations that are upsetting. -https://www.psychologytoday.com/us/blog/overcoming-self-sabotage/201002/rumination-problem-solving-gone-wrong
Rumination is: stuck thought due to a stuck state. Stuck flight energy with no direction leads to anxiety which leads to repetitive thinking, searching for a solution but there is none. Because story follows state.
Perceived danger trigger or stuck anxious state →
Neuroception of danger leads ANS to shift into sympathetic flight energy. →
Thoughts change to match. (“Story follows state”) →
But there’s no actual danger, so the state gets stuck. Which means the thoughts get stuck as well.
Different than an actual danger trigger, then shifting, then using the energy to get to safety
Rumination is also grounded in real world events. It’s anxiety placed onto events from the real world, like with the recent coronavirus pandemic.
Compare this to an obsessive thought:
“I couldn’t do anything without my rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times because three was a good luck number for me. It took me longer to read because I’d have to count the lines in a paragraph. When I set my alarm at night, I had to set it to a time that wouldn’t add up to a ‘bad’ number.”
“Getting dressed in the morning was tough because I had to follow my routine or I would become very anxious and start getting dressed all over again.” I always worried that if I didn’t follow my routine, my parents were going to die. These thoughts triggered more anxiety and more rituals. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me. I couldn’t seem to overcome them until I got treatment.” https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over/index.shtml
An obsessive thought is disruptive of daily life, chronic, attached to a solution
CRITERIA A: Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
"Persistent thoughts" - "story follows state" (Deb Dana)
If the state doesn’t change, the story stays
The state is persistent, so the story is persistent
But to a much higher degree than a ruminating thought
Intense thoughts from intense stuck energy
Persistent urges/impulses
this seems like it should be under Compulsions since there is a somatic element of doing
Extreme sympathetic flight/fight energy, probably freeze
Critical thinking is not available when in a severe defensive state
All or nothing thinking
Also seems to be an element of shutdown, which would be present in freeze
Thoughts are from the outside, perhaps a disconnection from the self when immobilized with sympathetic energy
2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Judgment and evaluation, rather than being with the self in the present moment
Not easy in this situation and I generally don’t recommend crisis management as the only tx option
Attempt to ignore, neutralize or suppress
That’s part of the problem!
Our general somatic experiences need to be felt, witnessed, noticed, loved, embraced and allow to go through their process.
It’s the opposite of ignoring, neutralizing or suppressing
I’m not exactly recommending the person dx’d with OCD to just sit with their feelings, it might be too much, but it’s something that can be worked towards
Flight/panic energy → Do this thing, so something in the future doesn’t happen = future oriented, anxious/panicky
We need to be in the present moment both physically and mentally
Physical bodies are always in the present moment, we need our emotional and cognitive selves to be in the present moment also
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
Rules = control
When in flight/panic, we need things to be definite, predictable
Rules can be a part of this - predictability, order
Misdirected energy
There is an urge to do something to relieve the distress
We all do this on some level, like working out, tapping our feet, grinding our teeth
But we have to do so mindfully for the energy to actually discharge
The rules create a channel for the energy, but not an exit
Like a pipe that feeds right back into itself
There may be a sense of momentary completion, but not of relief or actual energy discharge
2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Preventing or reducing anxiety or distress
Versus welcoming the underlying body sensations
Anxiety or distress are conscious experiences, but there’s more underneath
But we have to be in the moment to access that. With obsessions, it’s about the future, preventing something...
Preventing some dreaded event or situation
Again the difference between and anxious rumination and OCD reality-based thoughts
CRITERIA D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).
Yet comorbidity is common: Depression being the most common comorbidity
MDD is 10x more prevalent in OCD clients than general population
“depressive symptoms seem to be more strongly associated with obsessive than with compulsive symptoms”
Also much higher in Bipolar Disorder clients than general population
Suggesting the element of shutdown, which is present in freeze as well
Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
Reminds me of someone who is doing some level of their own work, whatever that looks like
Part of the problem of insight based therapy without the somatic pieces attached to it
So they get it on some level, but their stories persist, due to a stuck state
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
HOMEWORK -
Practice being in the moment outside of a crisis
Focus on the thing that brings you joy, peace, connection or calm
MESSAGE FROM A SUPER FAN
I’ve just said to my 9 year old daughter, ‘we’re going to listen to Brene today whilst we’re building the desks.’ Her reply, ‘ah why can we not listen to the guy. I like him better.’ Turns out she was talking about you. Shrug emoji, laugh emoji, orange heart emoji -Anonymous
