Sport & Fitness

Paul Salkovskis can spot someone with Obsessive Compulsive Disorder at 20 paces. ‘There are three distinct areas of suffering: ruminators (those plagued by unwelcome thoughts), washers, and checkers with a lot of cross referencing,’ says Salkovskis, professor of clinical psychology and applied science at Maudsley Hospital. He has been treating sufferers since 1971 and is considered the leading expert on OCD in the UK. ‘I see people washing in public toilets, sometimes for as long as 15 minutes, which is a giveaway.’

The image of the compulsive washer is the one most commonly associated with OCD, but Salkovskis is adamant that washing and checking is a symptom rather than the root of the problem. ‘One confusion that occurs around OCD is that people think it is doing things repeatedly. It’s actually an anxiety disorder [consisting] of intrusive thoughts,’ says Salkovskis. Compulsive behaviour rituals – like spending eight hours a day washing because you think you’ve touched something contaminated, endlessly checking irons are unplugged, and saying prayers or silent chanting – are attempts to control it.

OCD was first given its label in the 1960s, but symptoms and sufferers have been around for centuries. ‘Lady Macbeth’s hand-washing was almost certainly a manifestation of OCD,’ says Salkovskis. He also identifies John Bunyan, author of ‘The Pilgrim’s Progress’, and religious reformer Martin Luther as sufferers. Feature continues

Over time, the focus of unwelcome thoughts has shifted. ‘Three hundred years ago the invisible menace was religion. [People believed] they’d think the wrong thing and God would strike them down.’ Since then it’s evolved from religion to germs (think of the stories about the billionaire Howard Hughes, perpetuated in Martin Scorsese’s biopic ‘The Aviator’). In the late 1940s and ’50s radiation was a great fear while the past few decades have seen a rise in HIV and mad cow disease.

While Salkovskis’s research has yet to reveal an exact type of person who develops OCD, he feels that particularly sensitive people, those he terms ‘of tender conscience’, are more likely to get it. A religious upbringing can also still play a part. ‘People brought up to believe that thinking the wrong thing is wicked or evil and that you can sin by thought are prone,’ he says. However, an increase in responsibility, like having a baby, leaving home or getting a promotion, can also be a factor. What is so astonishing is how many sufferers continue to battle the condition despite its debilitating effects.

‘People with OCD feel responsible for things they can’t actually control. In treatment we help people discover how the world really works,’ says Salkovskis. ‘I once treated a man who worked in a bank who was arranging objects in the office to make sure the bank wasn’t robbed. One day he came in and said “You’ll never guess what happened today: two guys walked in, blew a hole in the ceiling with a sawn-off shotgun and robbed us.” And I looked at him and he said, “Well, it was nothing to do with the paper clips. They were all in order.” ’

Sufferers themselves are not unaware of the dark humour of OCD’s manifestations. Their understanding of the illogicality of their illness highlights just how debilitating it is when desperate fears overpower a person’s rationality. As Salkovskis says, ‘OCD makes a ghastly sense on the inside.’

Case studies
Colin Putney, 50
‘I was five, growing up in Hampstead, when I started having intrusive thoughts. I was a skinny little kid and quite naturally sensitive, with a tendency to over-analyse things. [I felt] I had to do things a certain amount of times otherwise some harm would come to me or my family. I used to have to open windows a certain number of times and turn the lights on and off. I remember locking myself in the bathroom to carry out the rituals. In my twenties I was getting these thoughts about 400 times a day.

‘I didn’t like anyone touching me. There was always this idea that I would be harmed or affected in some way. What I had to do was to touch them back to make it feel right, which was obviously difficult. I was working in television back then and there were these working-class, tough-guy types who would always grab hold of you and hug you or shake hands with you. I used to have to go into the toilet afterwards and calm myself down. The toilets were like little OCD offices.

‘OCD latches on to something totally innocuous and blows it up 10,000 times. If I step in front of someone on the tube or push in front of them I automatically assume they’re going to harm me and my family.

‘There’s a direct rule with OCD that you can give in to it and make it worse, or you can resist it and make it better. I was ultra-determined and I battled it although at times it used to bring me to my knees. I used to swear at it internally to keep it at bay.

‘I still get thoughts, sometimes as often as every two to three minutes. What OCD sufferers look for is dead certainty. And there’s just no such thing.’

Alison Hargreaves, 40s
‘When I was 11, I started going back into the bathroom to check the taps to make sure I’d turned them off. I’d walk out of the bathroom and a thought, like a little hook, would pull me back to check again. Each time it would get worse. I thought that there would be a bad “consequence” and that I’d get into trouble with my parents. In my mind I could see the room flooding. Even though the tap was off, my mind wouldn’t acknowledge it.

‘My lowest point was when I was working in a factory. It was my job to put a certain number of products into a box, spray it clean and then seal it. My OCD would trip me up and I’d start doubting that I’d done it properly and I’d have to redo it. I hated it – I’d get in trouble for not completing as many as other people.

‘Since I’ve had cognitive behavioural therapy I’m a lot better but I still have certain rituals. If I go to the shops I have to check that my keys, my purse and my phone are all safe in my pockets. With me it’s all about safety. I think that I’ll lose my keys and as a consequence I’ll lose the house. Sometimes I wear a fleece under a coat and the other day on the bus I kept fumbling with it so much I worried that people were thinking that I was a terrorist. I’ve damaged zips the amount of times I’ve checked. I’ll always have traits but it’s more manageable now. It’s like being on a bit of elastic – you always get the thoughts – it’s just whether you get reeled in.’

Peter East, 56
‘When I worked as a gas fitter, images of the graphite grease we used and the dirt began to plague me. I used to come home looking like a glorified chimney sweep and then spend a couple of hours a day in the bath and wash my hands about 30 times a day. I’d have to remember everything I’d touched – doorknobs, chairs, stairs – and clean them once I’d got myself clean.

‘I resigned in the end. I couldn’t take buses and tubes because I felt I might come into contact with gas-fitter grease. I thought someone who had had work done in their house might have come into contact with it and left a trace behind. I couldn’t even look at gas vans – I’d feel contaminated. I love football but I was so worried about being touched by someone contaminated in a crowd at the game that I stopped going to Spurs matches. I was treated using exposure and response prevention, where you set up a hierarchy of things that are hard to touch and work towards touching them all over a two-month period. There’s no real cure, but I’m 80 per cent better now.

‘People who don’t suffer find it hard to understand how frightening it is. But think of your deepest fear – rats, cockroaches – that’s how I felt about touching simple dirt and grease.’

For further information contact OCD Action on 0845 390 6232 or online at www.ocdaction.org.uk.