By Rae Chen Elliman
e’ve all said “I’m so OCD”, myself included. It is used as a badge of honour for most of us who like things to be organised or tidy, but I had never considered the real meaning of Obsessive Compulsive Disorder until I was diagnosed with the condition.
Until then, my understanding of OCD was led by the mainstream media that teaches us those with OCD compulsively turn lights on and off, count things or wash their hands until they are raw.
What I would come to realise is that this sneaky illness could also tear at the interiors of your mind while remaining unnoticed at surface level. And though I had come to recognise that drinking was muddying my understanding of my mental health, it was only when I cut alcohol out for good that I was diagnosed with OCD.
Now, as the anniversaries of my last drink and my OCD diagnosis each approach their respective second years, I wonder whether the two are connected. Did OCD trigger my drinking? Or did drinking trigger my OCD?
At 25, a lifetime of intrusive thoughts had become so normal that I had never considered they could have been a signifier of a real illness. As long as I could remember, the creeping feeling that something bad might happen lay humming in the background of my mind and governed my actions.
I knew I’d always been anxious and that I’d experienced difficult bouts of depression. I knew I was ruled by an overactive mind, and that childhood traumas that stemmed from abuse would eventually need to be addressed in therapy. But I’d been putting it off, knowing that the floodgates opening would involve a huge commitment.
By the time I was 25, I had been drinking for over a decade. As a teenager, alcohol helped to lubricate the many social instances during which I felt paralysed by discomfort. As I approached my early twenties, I worked in nightlife to pay for food and rent during those less than lucrative first years of a career in fashion.
Working in nightclubs, alcohol was an immeasurable presence, available in endless vast supply and woven deep into the fabric of those around me at work and at home. Alcohol helped me to thrive in an environment I was perhaps not made for.
“Alcohol helped me to thrive in an environment I was perhaps not made for. Drinking dimmed my intrusive thoughts and held off the anxiety, at least for the evening.”
Paralysed with worry
Drinking dimmed my intrusive thoughts and held off the anxiety, at least for the evening, but as I approached my 26th birthday, the anxiety that followed the next morning was unmanageable. I was paralysed with worry.
In the words of Sex and the City’s Carrie Bradshaw, I had crossed the line from pleasantly neurotic to annoyingly troubled. Even a glass of wine caused concerning levels of anxiety the next day, at times severe enough to invoke suicidal ideation. And so, after a few false starts, I gave up drinking.
The first year without alcohol was transformative. It was the worst and the best of times. I started psychotherapy with a kind therapist who let me make jokes (the idea of humourless therapy filled me with dread), and realised soon after that without alcohol, my insomnia was impossible to ignore.
Although breakthroughs in therapy were some of the highlights of my days, at night, the rumination would begin. I was overwhelmed with the idea that one of my family would die, and unable to get the thought from my head, became convinced it was something that I wanted to happen, and even that I was willing it to happen.
My heart would pound, adrenaline coursing through my body. These thoughts were not new – I recognised them as one of the themes of my childhood. Certain that my dwelling on the thought would cause the unimaginable to happen, I would binge mindless shows on Netflix while scrolling through apps on my phone.
The combination of the multiple types of media did not stop the rumination but it could drown it out a little and, after a few hours, I would usually become tired enough to drift off, though it would be into a broken and restless sleep filled with nightmares.
After a few months like this, I was exhausted, and the episodes were only increasing in intensity, a cycle made worse by exhaustion. Then six months in, my therapist diagnosed that I had OCD. Although I’d maybe have described myself as obsessive, the words “compulsive” and “disorder” felt new, but as we talked more about the reality of OCD, it clicked.
Pure O, the particular type of OCD I have, has fewer physical compulsions, with sufferers primarily managing their obsessions internally. In my case, one example among many was the compulsion to force myself not to think about my family members dying, rather than to realise that my thoughts alone could not cause a tragedy.
OCD is estimated to affect 1.2% of the UK population (around three-quarters of a million people), but I had never known what OCD really was until my diagnosis; that it could be a crippling and debilitating mental illness that lurked unidentified in many, and that it could come in so many complex forms.
It is impossible to gauge how many people suffer from types of OCD, such as Pure O, without being diagnosed. Its impact is so severe that in 1990, the World Health Organization ranked Obsessive Compulsive Disorder in the global top 10 leading causes of disability in terms of loss of income and quality of life, yet its reality and debilitating nature are widely misunderstood.
Many Pure OCD sufferers experience obsessions that make them question their entire being. An extreme example is Pure O sufferer Rose Bretécher, who detailed her experience in The Guardian in 2013, explaining how her OCD caused sexually explicit images of children to flash through her mind so frequently that she became concerned that she might be a paedophile.
She writes: “Pretty much everything about Pure O is secretive, '' and Pure O is perhaps so difficult to diagnose because the content of your obsessions feel impossible to say out loud, thus causing the mind to continue to compulsively self-manage.
“It’s hard to admit that you’re filled with thoughts about how someone might die, or that you’re overwhelmed by the possibility that you could throw yourself from a train platform. It’s hard to identify even that you grapple internally with whether you actually want those things to happen, let alone admit it.”
“At night, the rumination would begin. I was overwhelmed with the idea that one of my family would die and, unable to get the thought from my head, became convinced it was something that I wanted to happen.”
OCD’s impact on relationships
Another common kind of Pure OCD I have suffered from unknowingly is Relationship OCD (ROCD), which causes the mind to obsess unmanageably about whether your relationship is “right”.
No matter how stable and loving the relationship, thoughts such as “Is this the right relationship for me?”, “This is not real love!”, “Do I feel ‘right’?”, “Is there someone out there who is better for me?” and “Does my partner really love me?” fill the sufferer’s mind in a vicious cycle, triggered by the anxiety it causes. In some cases, the relationship breaks down as a result, a self-fulfilled prophecy fuelled by OCD’s cruel mind games.
Trickier still is that when you do admit such concerns, most responses come from minds that do not understand OCD. This makes OCD and, in particular Pure O, near-impossible to diagnose.
If, for example, you expressed to a friend that you thought constantly about causing yourself harm, it is likely that the friend would not recognise the thought as obsessive, and would instead confirm your fears by advising that it sounds like you do in fact want to harm yourself and should seek help for self-harm.
If you expressed to a family member that you thought constantly about whether your partner was right for you, they would likely advise that it sounds like the relationship should end. As my rumination strikes at night, formerly cocktail hour, I wonder if drinking had been my compulsion.
Covert drinking and thinking
Both my drinking and my rumination had remained covert in unison – confessing to a girlfriend over a glass of wine that you are constantly unsure about your relationship would certainly be hard to identify as Pure OCD at work.
Yet only when alcohol was removed from the equation could I identify that extreme anxiety caused those thoughts. It was only without the haze of alcohol that I was reintroduced to the abnormality of my obsessions. Like all compulsions, the alcohol had helped the obsessions to seem manageable, but in reality had merely distracted me momentarily. Under the surface they raged on.
It’s taken two years without alcohol, two therapists and many agonising months of trial and error with different antidepressants to reach a point where my OCD is manageable. It’s not a permanent fix, OCD is not considered curable, but keeping my anxiety levels as low as possible with therapy, medication, diet, exercise and thoughtful boundaries makes a huge difference.
There are hurdles to overcome, both day to day, and in the future; many women with OCD suffer from postpartum OCD if they go on to have children, fearing they might want to harm their own baby. What I do know now is that OCD hates confrontation. Talking about obsessions, writing them down and learning more about the condition robs OCD of its beloved ability to be secretive.
In the early days, OCD meme accounts and threads on Reddit helped to normalise some of my thoughts and even identify new compulsions in a lighthearted way. These are small steps towards disarming OCD, but it is also key to remember that mental health is personal beyond belief. Many of the intrusive thoughts mentioned that plague someone with OCD can also occur infrequently within the minds of people without OCD, and there is a fine and nuanced line between occasional anxiety and an anxiety disorder.
Although we might identify similarities with one another, the solutions we find are often unique to each of our own journeys, and they will need changing to match our evolutions. As for me, I know for now that my OCD loves a drink. The alcohol kept it safe, masked tipsily during the late hours of the day. So, until further notice but maybe forever, my recipe for keeping OCD at bay is regular therapy, openness and honesty with my loved ones, finding the right SSRI antidepressants and drinking kombucha tea at cocktail hour.
Header image by Hector Aponysus
For years, Rae Elliman suffered from intrusive thoughts and drank to alleviate her anxiety until she was diagnosed with Pure O and could get the help she needed.
By Rae Chen Elliman
The ‘Pure O’ or ‘purely obsessional’ type of OCD is characterised by distressing, intrusive thoughts and mental rituals to cope with them. Rae Elliman shares her experience of living with – and learning to manage – these hidden compulsions