David Beckham, a former English professional footballer, has arguably scored his most important goal by agreeing to disclose his struggles with OCD in an upcoming Netflix documentary. Beckham suffers from the tiring and often debilitating effects of OCD due to his inability to refrain from compulsions that cause him to clean and organize his home.
The discussions that occur when a well-known person shares their struggles with a condition like OCD makes the celebrity relatable and brings light to something otherwise relegated to the shadows. As a result, many people who suffer from OCD are able to learn about the condition and even recognize if they need help.
Obsessive-Compulsive Disorder (OCD)
The Diagnostic and Statistical Manual for Mental Health Disorders, 5th Edition, classifies OCD as an anxiety disorder. A person with OCD experiences unwanted intrusive thoughts or urges (obsessions) that generate anxiety, followed by the use of rituals to try to reduce or eliminate the anxiety (compulsions). In my practice, I have found that this is a good basic definition, but it is more complicated. A detailed description of OCD and how it affects you is found in this video.
It is not uncommon to hear someone today say, “I’m so OCD.” While they typically mean no disrespect, what they mean to say is that they like things to be neat or orderly. This basic desire for order is far from the true debilitating distress that someone with OCD feels. An OCD sufferer will have obsessive thoughts that lead them to feel distress and the only way they know to relieve that distress is to perform some sort of compulsion, perhaps cleaning or organizing. They will be the first to tell you that they do not want to do this, but they can’t help themselves.
Obsessive-Compulsive Personality Disorder (OCPD)
Oftentimes, OCD is confused with Obsessive-Compulsive Personality Disorder (OCPD). OCPD is a mental health condition that causes an extensive preoccupation with perfectionism, organization, and control. The difference between OCD and OCPD is that in OCD, the patient does not want to have obsessive thoughts that lead them to perform compulsions. In OCPD, the patient wants things to be orderly and is not distressed by their actions and desires. OCPD doesn’t sound so bad, then, does it? People with OCPD take things to an extreme and need so much control that they become debilitated. Imagine how hard it would be to function if you had to make sure that things had to be perfect all of the time.
Types of OCD
OCD comes in many types, too many to actually list here. In my experience, I often find that at least one other person in the patient’s extended family had OCD (or was suspected of having it). I also see a fairly common split between patient types; those who report always having some sort of OCD obsessions throughout their life and those who have had some traumatic type of event and then develop OCD usually requiring them to compulse by rumination or worry.
A very common type of OCD is Contamination OCD, where the patient is obsessed with avoiding dirt or chemicals because they may make them ill. As a result of the fear of contamination because “I just touched a public door knob,” they feel enormous distress, so they compose by washing their hands. Compulsions temporarily reduce the distress, but eventually, it hits back with its trademark “yeah, but … what if” as in “you just washed your hands? Yeah, but what if you didn’t remove every single germ? You better go wash them again, and better this time.” And thus, the patient enters the endless cycle of repetitive hand washing.
A second type is a Just Right OCD. In this type, patients have thoughts and/or feelings that something is not quite right or that something is incomplete. When asked, the best description they can give is that “it just doesn’t feel right.” An example could be that they washed their hands, but it just didn’t feel right, so they go back and do it again until it does feel right. The reason for the hand washing is entirely different from contamination OCD where the reason is to remove contamination. The difference is more than just semantic. A clinician treating OCD needs to understand the obsessive thoughts behind the compulsive reaction in order to provide treatment.
If that’s not confusing enough, let’s talk about Symmetry OCD. Patients with symmetry OCD have thoughts that if things are not lined up just right, then something bad could happen. As a result, they compose by lining things up in symmetrical order. This sounds like OCPD, but the main difference is that in OCD, the patient does not want obsessive thoughts and the resulting need to compose, whereas, in OCPD, the patient is not bothered in the same way. A patient with OCPD will feel that it is a good thing to have things lined up symmetrically.
In David Beckham’s case, while it is never appropriate to diagnose a patient from afar, one could assume that he may be suffering from one or more of the above-described types of OCD.
How is OCD treated?
The good news is that OCD can be treated. I have personally treated patients who got over their obsessive doubts after just one session. Of course, that is not the norm. I usually see a majority of patients make marked progress in a relatively quick time. The most common treatment is called Exposure and Ritual (or Response) Prevention (ERP). In ERP, a clinician will begin by conducting an assessment. One of the most common instruments is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Such assessment sets a baseline for care. After the clinician understands the types of obsessive doubts and compulsions, they work with the patient to develop a hierarchy of exposures. Exposures can be offered in real life (in-vivo), imaginary, or even through virtual reality.
The purpose of the exposure is to trigger the patient’s distress and then help them master what is called Inhibitory Learning. The client learns through a process called Habituation that distress does not last forever and will go down over time. They also learn through Disconfirmation that the things OCD says will happen do not happen or are extremely unlikely to happen, and they learn Mastery, that they can tolerate doubt, uncertainty, and the presence of unwanted thoughts without having to change or suppress them.
Other treatments involve Inference-Based Cognitive Behavioral Therapy, which does not use exposure but aims to bring real resolution to obsessional doubts by showing the client that obsessional doubts arise as the result of a distorted obsessional narrative.
Additionally, medication can be helpful in some OCD patients. Typically, SSRI mediations are used for OCD but in much higher does than are typically used to treat anxiety or depression. The International OCD Foundation provides an article online that gives a detailed explanation of medications used for OCD.
In my practice, I use my own methodology, that I call DRIL for Doubt Reduction and Inhibitory Learning, which uses a combination of treatment methodologies.
Accommodation
The one thing that loved ones and caregivers need to learn when they share their life with someone with OCD is that they cannot accommodate that person’s compulsions. As an example, one patient I had composed by asking his parents for reassurance about things that caused him distress. “Mom, are you sure the dishes aren’t contaminated?” He would ask repeatedly. As a result, we used the Accommodon’t Method and agreed that he would write down his questions on a notepad, and his mom would answer them one time. After that, whenever he would ask the same question, his mother would refer him back to the notepad to see the answer.
The good news is that It is coming out of the shadows. The more it is talked about, the more those who need help can find it. And since there is treatment available, there is no reason that anyone with OCD should have to suffer from their obsessions and compulsions.
Resources
There are many resources available for those with OCD and their loved ones.
Basic information about OCD is found online at:
The International OCD Foundation iocdf.org
Anxiety and Depression Association of America adaa.org
OCD support groups, many free, are listed at OCD Support Groups.
I run a free OCD support group for those with OCD and/or their loved ones at stopmyocd.com
Videos about OCD, causes, types, and treatments can be found HERE.
On June 1, 2023, there is a free online OCD discussion with syndicated cartoonist Donna Lewis, who writes “Reply All” and “Reply All Lite” Free Registration
Virtual Speech Therapy is the Best Option for Communication Disorders(Opens in a new browser tab)
Andrew E. Colsky, JD, LPC, is a mental health counselor and specialist in treating OCD and anxiety disorders. He is a clinician, speaker, and educator known for his groundbreaking methodology and treatment innovations. Contact him at stopmyocd.com.