The Man Who Couldn't Stop by David Adam, book review: What it's like to live with OCD – and to try to find a cure

 

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The Independent Culture

David Adam is a successful writer. He also has obsessive-compulsive disorder, OCD. This condition is thought to affect two-to-three per cent of the population at some point, meaning a million people in the UK will experience it. It is a disabling condition, with those who have it more likely to be unemployed, unmarried, celibate, divorced, and childless. Few recover without treatment, yet two thirds never seek psychiatric help. The condition involves frequent irrational, intrusive thoughts which cause distress, and rituals, or compulsions, which are usually physical but can be mental, to try and banish the thoughts. The compulsions offer only temporary relief, and in the long-term, accentuate the obsessions.

Research has shown that intrusive, irrational thoughts are common, and occur in a significant proportion of the normal population, but with OCD life becomes governed by these thoughts and the associated compulsions. Studies have revealed that when someone tries to restrain an intrusive thought, the thought later occurs more than it would have had the person not tried to restrain it.

Adam's own OCD centred around an irrational fear of contracting HIV. In this book he covers the history and aetiology of OCD, the various treatments that have been tried without success, such as Freudian analysis, or behavioural aversion therapy, and his experience of cognitive behavioural therapy, CBT, which was greatly helpful. He differentiates between OCD and obsessive compulsive personality disorder, a personality trait in which people are meticulous about orderliness.

It has been shown that in OCD, the more checks a person performs, the less they trust their memory. Altered perception also plays a part. People with OCD often have an excessive sense of threat and personal responsibility, perfectionism and an inability to tolerate uncertainty, and a belief in the importance of controlling their thoughts.

Adam also mentions conditions on the same spectrum, such as body dysmorphic disorder, in which the person is convinced part of their anatomy is hideous; and trichotillomania, the compulsive pulling out of one's own hair. Through imagining techniques such as functional magnetic resonance imaging, it has been shown that in OCD there may be abnormal activity in a part of the brain known as the basal ganglia; both genes and environment may play a part.

This well-written account of a debilitating condition suggests that the encouraging results of CBT mean it should be in wider use.

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