A most common question…
For the many years that we have been running this blog, probably the question that I am asked the most is “do you think I have rOCD?”. My standard answer has always been that “I am not qualified to make a clinical diagnosis. This should be done by a qualified professional”. It is true that many people present with typical OCD symptoms and describe these very clearly on their emails but the responsible thing to do is always to advise them to look for a competent OCD professional. It is also true, that sometimes, some professionals do not take relationship OCD “seriously” (especially if they have no experience of OCD or see OCD as a mostly compulsive disorder) which can make things a bit more complicated. I don’t believe that they do this intentionally but it is rather a byproduct of lack of experience or other factors as we will see below.
The difficulties in diagnosis start here…
Before any type of treatment is undertaken, it is important to have the right diagnosis. A common mistake that many rOCD sufferers make is to focus on the relationship aspect of the disorder rather than the OCD aspect. For example, when they go to a professional they might explain their obsession as ” I am not sure if I love my partner”. There is nothing wrong with this if it is followed by ” I think about this all the time; maybe more than 8 hours a day”. For the discerning OCD professional, the issue is the obsession, not the question itself. This will lead to many other questions to see if OCD is the problem. For the non-discerning professional, this might be interpreted as relationship problems or many other things like “if you are questioning then it might not be right” type of statements. The fact that the obsession is taking over your life might go unnoticed.
As explained above, a lot of people focus on the relationship aspect but the real problem is the obsessive aspect (OCD) and this is what needs to be diagnosed. The relationship difficulties or distress are a symptom, not the real disease. Imagine this – someone has a brain tumor. This tumor causes horrendous headaches. We keep on taking headache pills and trying to solve the headache problem when this is just a symptom of something bigger.It is not going to be very effective. This is why I have used the designation rOCD and not ROCD throughout this blog.
Although I am not clinically trained (psychology/psychotherapy/medical), I believe a lot of sufferers go on misdiagnosed or not diagnosed at all. This is partly due to two reasons:
Reason 1 – the “newness” of the condition leading to a lack of awareness from mental health professionals AND
Reason 2 – because rOCD can also overlap with “normal” relationship problems and other mental health issues.
My diagnosis story
Let me talk about reason number 1 first. The first time I experienced rOCD symptoms I looked for help from a qualified professional. Emotionally, I was very distraught and I did not understand what was happening to me. I lived in a perpetual state of confusion. I was hoping that this professional would “sort things out” but I only ended up having two sessions. Our sessions were turning into psychoanalysis sessions e.g. how my parents’ relationship affected me and so on. I wanted some quick relief of my symptoms not a never-ending talk about the past.
In the meanwhile, I was also looking for help from my family doctor (GP how we call it in the UK). I knew that I had had some depression symptoms in the past and I always managed to manage it. Everyone has some bad days, right? What was slowly “killing me ” was the sleepless nights due to anxiety and sometimes panic attacks. When I first went to see my GP, she signed me off from work for a while to get some rest. I thought I was possessed because I felt “bad” or uneasy all the time (apparently feeling possessed is a common description of anxiety among religious people). Funny enough my girlfriend’s sister picked up on this when I was trying to break up with her sister (now my wife!) due to my anxiety symptoms. She gave me some calming medicine which helped and advised me to look for medical help.
So I was on the road to “fixing” some of my physical symptoms. After I dropped the word depression in my GP’s office, I did a computer test for the severity of my depression and I was prescribed a drug Citalopram. It was a rough ride in the beginning but it did help with my anxiety and depression in the long run. Now I am off my meds.
After deciding to look for another therapist, I ended up going to my local University’s help center run by psychologists and other mental health professionals. There I was, a grown man in his 30’s having to ask for psychological help having postponed my post graduate studies for a while. Unfortunately, the two psychotherapists that I saw had no knowledge of rOCD and approached my therapy sessions from a CBT point of view. That is – teaching you to change the way you think to change the way that you feel. I felt I was closer to the answer but I wasn’t there yet. It was kind of helping with my anxiety and depression but I was running scared of losing my girlfriend.
Then I decided to look for help online by googling my symptoms and found out about rOCD. I found a professional that understood rOCD, had 4 sessions costing me around £300 but “finally” had found an answer to set me up on the right track. Once you know what you are fighting against, your chances of winning greatly increase. I felt I was on the right path but I had to end at the 4 session mark because I could not afford more. This was all done on the phone using the regular 50-minute talk format. I picked up a lot of things from it, made me move forward with hope and had a new resolve in life.
Applying the lessons learned in therapy and taking charge of my recovery
One of the things I learned about in the previous process was mindfulness. I went back to the University center and enrolled on a short course on mindfulness. It was great and helped me gain a better understanding on how to tackle rOCD.
Now for reason number 2, how to distinguish rOCD from “normal” relationship problems? This might be the thing that keeps most rOCD sufferers awake at night and what drives anxiety and the constant barrage of thoughts. If this is the case, in my experience, most likely it is rOCD. It does not help when everything and everyone else tells us otherwise:
- Bad advice from friends – “If she/he was really the one, do you think you would be having these doubts?”
- Bad advice from Hollywood, TV and magazines that set unrealistic expectations about “real love” i.e. if it is true love, they will live happily ever after
- Bad advice from our inner self – Our misconceptions about love and relationships caused by our own perception or poor role models
- Bad advice from our brain that is constantly looking for exceptions and making associations e.g. “if this was love I would not be feeling this way”
The math does not add up and a word of caution
If you add all of these factors together then the perfect storm forms. In other words, reason no.1 + reason no.2 = real confusion in diagnosis. How to best approach this? The answer: Seek an (r)OCD specialists AND find the answer for yourself.
I say “and” because even with my diagnosis being made by a specialist rOCD therapist, I had a lot of trouble accepting it. Sometimes the symptoms are there screaming rOCD but it is very difficult for rOCD sufferers to even accept the diagnosis. How can we be sure about something when the problem IS being sure about something? Confusing? Yes, we both know it is. First, we have to put the brain in a better place to get there. This is one of the reasons why we have started an online course and life coaching sessions. To help sufferers in their own road of self-recovery.
There is just one thing that supersedes or is more important than the rOCD diagnosis. When physical or emotional abuse is present in the relationship. Often times sufferers want to improve or salvage their relationships but OCD gets in the way. In very few occasions, partners might
Diagnostic tools, the YBOCS scale, and other disorders
If you are in the US you might have heard about the DSM-V manual. If you are in Europe, you might have heard of the ICD-10 manual. These guidelines establish certain rules or criteria for diagnosis. With these in mind, the OCD professional will be able to assess severity and diagnosis. Once an OCD diagnosis established, a course of treatment and/or therapy can be recommended.
Another tool that is used often by OCD professionals is the YBOCS scale (Yale-Brown Obsessive Compulsive Scale). Even though it is not strictly a diagnostic tool, it can be used to assess the severity of symptoms over time i.e. if you are getting better.
Lastly, from my personal experience, I also think that depression and anxiety should be tackled for better management of OCD. Anxiety and depression can greatly affect our OCD patterns and the best way to think about it is by imagining a triangle. Each vertex representing either OCD, anxiety or depression. By changing one vertex we can effect the two other vertices.
Developing our own research tool
From our interaction with many OCD sufferers, we have developed a research tool to assess the severity of OCD symptoms and associated compulsive behaviors. Even though we do not recommend using this tool for diagnostic purposes, it might be useful to use it as a discussion point with your therapist or doctor. Or it might be useful for pre and post therapy to see how you have progressed.
You can access the quiz form here.