*Please note that this is a fictitious case example, however, is based loosely on real individuals and their experiences with OCD.
Sandeep had always been timid for as long as she could remember. She preferred to keep herself to herself at school. She had a couple of friends who she spent break times with but tended not to get too close to anyone. The beginning of her childhood was fairly ordinary for the most part until things changed…
When Sandeep was 11 years old, something happened in her family that devastated her. Her grandmother, who had raised her like her daughter, died suddenly in a car crash. She felt feelings she had never felt before. She felt extreme sadness, desperation, and disbelief. She wanted to disappear. She wanted the world to swallow her up. Sandeep’s mother also struggled a great deal. She became withdrawn from the family and Sandeep felt that it was her responsibility to console her. Sandeep’s own feelings had to be buried as quickly as possible, there was no other way…for how could she look after her mother if she was unstable herself?
There was one feeling however that she couldn’t shake..the sense that she was somehow responsible for her grandmother dying. It didn’t make sense of course, but it felt true. This feeling kept her up at night and led her into the depths of despair. Over time this feeling seemed to become a part of her very core…that somehow she was a bad, unforgivable person for causing the death of her grandmother. She buried this feeling deep into her unconscious, because how could she ever allow herself to live if she remained conscious of it?
Shortly after her grandmother’s death, she witnessed the gradual decline of her parent’s relationship. She felt like everything was getting out of control and felt powerless and alone.
The beginnings of the OCD
As the years went by, Sandeep became more and more withdrawn. She could no longer face going into school and spent most days in her room alone. She became very fearful and on edge, and started to display strange behaviors like washing her hands repeatedly. She believed that she or her family would get very sick and die if she was unable to keep herself clean. By the age of 14 Satwant’s hands were red and raw from repeated washing. Each handwashing episode could take from 10 minutes up to 2-3 hours at a time.
Sandeep’s fears had become all-consuming. She would stay in her room for days without eating, bathing, or having any kind of social interaction. She did not ask her parents for help because she did not want to be a burden, however, things got so bad that her uncle urged Sandeep’s parents to seek help for her. Sandeep was eventually referred to an adolescent mental health team. This is where she was given the diagnosis OCD. Neither Sandeep, nor her parents knew much about what this meant, but they were somewhat relieved that there might be an explanation for her behaviour.
Sandeep was put on medication to see whether this would make a difference. It seemed to numb the anxiety, but it also numbed other feelings, happiness, and joy. Nevertheless, she continued to take the medication, as it seemed to keep her feelings at bay somewhat. She was offered talking therapies but did not take this up. Her parents were also skeptical, and they felt uneasy about Sandeep opening up to a complete stranger.
Over the next 10 years Sandeep was put on many different medications to see whether one would suit her better than others. She continued to have OCD, and perform rituals around handwashing. However, when the OCD was “bad” it seemed to spread to other things e.g. checking of sockets before bed and checking the doors were locked. During difficult periods, Sandeep would spend every waking moment checking and handwashing, to the point that she avoided coming downstairs at all, and would eat very little (1 meal a day).
There were other, better periods were Sandeep was able to hold down a part-time job, start engaging in hobbies (she loved photography), and was able to babysit her nephews and nieces, whom she loved spending time with. However, it was impossible to know how long the “good” periods would last, and every so often, there would be a setback triggered by different things, e.g. a work deadline, family conflict, bereavement etc.
When Sandeep was around 25 years of age, her family turned towards religion. They had always had an interest in their faith and attended the Gurdwara weekly on a Sunday, but they had increasingly sought solace in their faith, feeling that they had nowhere else to turn to. Sandeep began to accompany her mother to the temple weekly, and It wasn’t long before she started enjoying these visits and experiencing peace. She was still washing her hands excessively and checking, but had found ways of minimizing these behaviours when out. Sandeep learned the daily prayers and made an effort to wake early in the morning to recite them.
Somewhere along the line, however, she started to enter a bad patch again…the strong sense of guilt that was deeply embedded within her seemed to make an appearance again, but this time it was in relation to religion. She became obsessed with cleanliness and would recite her prayers over and over. She would obsessively pray to God for forgiveness for making mistakes during prayer. The OCD had taken over again. She began to think of herself as a bad Sikh, and was constantly asking God for forgiveness.
It all became too much for her, and she went back to spending long periods of time in her room, avoiding going out, and she had become emaciated from eating very little. She felt a constant sense of intense anxiety. No matter what she did she could not make this feeling go away. She was exhausted from hand washing, from checking, from repeating prayers over and over, and the constant guilt that she was doing something wrong.
Her relationship with her parents began to deteriorate as well. Sandeep felt extreme guilt over “burdening them”, and could not bear it anymore. She expressed to her mother that she would rather die than live a life like this. Sandeep had expressed suicidal thoughts and feelings before to her parents, however this time she seemed more desperate, and her mother knew that she needed to take action. Her neighbour had suggested that she see a counselor, so she looked one up online and made an appointment on her daughter’s behalf.
Sandeep was highly anxious about seeing a therapist. She was embarrassed about her difficulties and was worried about the therapist judging her. She was worried that talking about her issues might make them worse. Every part of her was telling her not to go, and she even missed the first two appointments that had been arranged.
Sandeep isn’t sure what pushed her to go, but she finally managed to attend a session. She was highly anxious, but the therapist seemed quite friendly and down to earth. Sandeep left the first session feeling surprisingly light. The therapist had asked her some personal questions about her, about the OCD, and a timeline of it from then till the present day. She didn’t probe too much and seemed happy to steer away from questions that Sandeep found too uncomfortable. She also spent some time talking with Sandeep about her goals/vision for her life, which Sandeep hadn’t thought about for so long. Talking about the future gave Sandeep hope that she might be able to overcome her difficulties.
Sandeep continued to attend therapy and learned a great deal about herself and the OCD. For the first time she felt like she understood why she might have developed OCD. The therapist explained that some people with OCD feel very aware of responsibility, and it’s hard for them to tolerate the possibility that they could be even partly responsible for something terrible happening. Sandeep’s thoughts turned immediately to her grandmother. Prior to therapy, she had buried these events deep into her unconscious, but as she spoke about them in therapy, she could see how she still felt a deep sense of guilt for not being able to keep her grandmother safe. She realised that she become convinced that checking and hand washing, were a way of her ensuring that she could keep her parents safe and alive. Sandeep and her therapist started to challenge her belief with logic.
Sandeep realised that for most people washing hands or checking sockets is not a matter of life or death, but for her, it was. She would have thoughts like “if I don’t wash, I will be responsible for spreading contamination, and I will cause harm to my loved ones”. Satwant would believe these thoughts to be true, and this would cause a great deal of anxiety. However, what she learned was that sometimes washing would help her to “feel better”, and sometimes it wouldn’t..or sometimes it would but only in the short term, until the next thought popped into her mind (which could be 5mins later). She realized that OCD was trapping her into a vicious cycle where she would feel the need to hand wash over and over until she “felt” she could no longer cause harm.
Sandeep realised that these thoughts/fears of contamination were not truths, that they were simply worries. She had to start trying to learn to let the worries go, which was very challenging at first. Sandeep and her therapist then moved on to helping her to test out her theories that her loved ones would die if she didn’t wash her hands, through experiments. She learned that not washing her hands did not result in her or her families death. She began to learn to tolerate the anxiety that came with not washing. Sandeep’s parents were also involved in the therapy and were taught how to best support Sandeep with her OCD.
Sandeep also made some lifestyle changes. She looked at her diet and exercise and started to make gradual changes in these areas. She also started to meditate daily using the app CALM which seemed to help her to become better able to let her fears and worries go.
Sandeep attended therapy on and off for a year. Near the end of therapy she was able to work part-time, she was spending more time with family and friends, and was pursuing her love of photography. She has built up a support network and is more open about her struggles. She still struggles with OCD symptoms, but they are minimal and she knows what she has to do to keep them at bay. She now has hope that she can continue to move towards her life goals.