Obsessive Compulsive Disorder and Infectious Disease Fears
by Dana Terrell, LCSW, EMDRIA-Approved Consultant,
San Diego Counselor
What are Reasonable Precautions to Take?
Yes, for some sufferers of OCD, ebola in 2014 or the swine flu virus of 2009 definitely amped up their worries and rituals. But it could be any variety of threat that prompts OCD obsessions or compulsions. The question is: What are reasonable cautionary steps and what are part of my OCD? According to the Center for Disease Control, reasonable precautions include:
Cover your nose when you sneeze.
Wash your hands often*, especially after sneezing.
Use soap or alcohol based hand cleaner.
Avoid touching your eyes, nose, or mouth.
Stay away from obviously sick people.
Stay home if you’re sick.
Avoid unnecessary travel to areas where an epidemic is active.
Call your doctor for advice if you feel sick.
*Note: a reasonable “often” might be 5 to 10 times a day
Some of the following would be part of OCD spectrum:
Washing hands 20-30+ times per day
Washing for 10-20+ minutes each time
Using a “super germ-killings recipe” of soap, alcohol, and other harsh substances
Skipping work or other activities until the virus reports are down to zero
However, it is important to remember that OCD sufferers are all very unique, and often find it difficult to relate to someone who has a different obsession/compulsion from their own. To a person with OCD, her own obsessions seem very reasonable, while others are clearly irrational. One of my clients was highly anxious about contracting HIV from contact with a possible gay waiter, even though his rational mind knew that there is no known case of this happening. To his OCD mind, it seemed not only possible but imminently likely.
Sometimes OCD Behaviors Feel Comforting, Other Times They Cause Suffering
Another interesting point is that sometimes the term OCD sufferer is a misnomer. They will be suffering when the obsessions and rituals are blocked. But if their life allows unimpeded exercise of compulsions, they may feed quite comfortable. Their life can go this way, getting more and more controlled by obsessive thoughts and compulsive behaviors. This is especially true if they do not have a loved one or two paying attention to the compulsions and beginning to call them on the irrationality of their behavior. Occasionally, those with OCD enlist the help of loved ones in maintaining compulsions. They may draft helpers to keep doorknobs cleaned, to wash their own hands more frequently, or to help them with checking rituals, etc. Anxiety, subtle or not, tends to be the driving force in their decisions.
Personally, I have not had any of my current clients complaining about ebola or swine flu fears. But there are those with compulsions of different kinds. The treatment I use for treating OCD was developed by an EMDR therapist: Marcia Whisman, LCSW. She is an Anxiety Disorders specialist in St. Louis, Missouri. It is considered an experimental application of EMDR Therapy, because she is a clinician, not a researcher. However, I have found it to work very effectively.
New 2012 Research on EMDR Therapy for OCD:
The Journal of EMDR Practice and Research, Vol. 6, No. 1 for 2012 just published new research1 of two adapted EMDR protocols for OCD symptoms offered to 4 patients who had refused CBT therapy because they had tried it previously and failed. The first, called the Adapted EMDR Therapy Phobia Protocol focuses on the current triggers for obsessions or compulsions, and desensitizes them. Next the client is assisted to imagine successful future action. The 3rd step is to deal with any past-related memories that may have arisen during the earlier EMDR Thrapy processing. Final step of treatment is to develop and “install” the client’s new Positive Cognition or self belief. This change from the standard protocol is helpful for people who can get trapped in their thoughts. The thoughts are saved for last with this protocol.
It worked very successfully for these clients. Within 2-3 sessions they were noticing positive behavioral and emotional changes.
The second Adapted EMDR Therapy Phobia Protocol with Video Playback used full processing according to Standard Protocol an imagined video-playback of current triggers followed by past related disturbing memories and then the future imagining of successful action — a different sequence from the first Protocol mentioned above.
Research of Disabling OCD: Conclusion
“What is striking about this study is the fact that all four participants described experiencing symptom improvement within the first two or three sessions. These individuals had suffered with disabling OCD for many years and had attempted various other CBT therapies without achieving any relief. After 14-16 adapted EMDR individual sessions, each participant reported significant symptom improvement and a large decrease in distress, with the effects of treatment maintained at 4-6 months follow-up. Each young man also made substantial changes in life function and activities, reaching and maintaining a number of important personal goals.” p. 11
We do not consider OCD to be a curable condition. But the client can learn to manage her anxiety and gain the ability to discriminate: Is this a real fear? What real issues would I be addressing if I were not fixated on a compulsion right now? The EMDR OCD protocol integrates aspects of Cognitive Behavioral Therapy, which is proven to help OCD. But it also uses the bilateral stimulation of Eye Movements which has been shown in EMDR Therapy research to diminish the emotional distress associated with an experience, as well as the urge to act it out through compulsions or other kinds of impulses, such as addictions or anger problems. As the distress is first stimulated and gradually relieved through application of Whisman’s Integrated EMDR Therapy and OCD protocol, the client spontaneously begins to think more positively, realistically and adaptively. In the beginning of therapy, they may actually feel more anxiety than before, but they soon learn that they can handle it. As the close of treatment nears, the degree of anxiety felt is manageable, and correctly attributed to the real anxieties in their lives, which they are addressing proactively, rather than avoiding. It is very rewarding work for client and therapist.
Most Professionals Consider OCD to be Genetically Based
Most professionals consider OCD to be a genetically based condition, as it tends to run in families. However, trauma therapists conduct thorough histories of childhood and adult trauma and generally can find relevant traumatic experiences that engender anxiety in a growing child. One of my clients described a mother who was highly anxious about any little nick, scratch or cut. As she cleansed the wound, she said “we have to clean this really well so you won’t get sick and die.” Witnessing his mothers catastrophic thought patterns filled this young boy with anxiety. Even in adulthood as a capable and successful man, he lived for 15 years with hidden fear that grew worse with time, until he sought treatment for his OCD. Again, the interesting thing is he only feared AIDS, no other disease.
There is a need for much more research on OCD. It is listed by the World Health Organization as one of the 20 most debilitating illnesses.
If you recognize your own obsessions or compulsions as you read this article, and see that the circle of your life is constricting as your compulsions expand (try timing yourself on your excessive behaviors to see what the current state of affairs really is). Ask yourself, what would I rather be doing with my time? Which goals have I been neglecting as I tend to my obsessions? These questions are the beginning to facing reality and changing it. Best wishes to you or your loved one in improving your quality of life.
1John Marr, “EMDR Treatment of Obsessive-Compulsive Disorder: Preliminary Research”
Dana Terrell, LCSW, AC and a directory of other trained EMDR therapists can be accessed online at:
©2009 Dana Terrell, LCSW, EAC, San Diego EMDR therapist