My Definitions

For those of you reading this book who are not familiar with OCD, or associated mental illnesses, I thought I would give you a bit of a basic understanding of these illnesses. As I have previously mentioned, I am not a mental health professional, I do however experience Mental Health issues, as such this information is not to be used as a basis for treatment, and/or diagnosis of any mental illnesses. This information has come from personal experience, and my own research, and understandings of such. I am providing this only as a basis of understanding what I am referring to when using these terms, and also to provide information as to how seemingly similar terms and illnesses differ, so as to clarify the differences and minimise miss-understandings when I refer to these illnesses and terms.

OCD
OCD stands for Obsessive Compulsive Disorder. OCD is an anxiety disorder. OCD’s has 2 primary Characteristics, which are somewhat obvious as the name of the disorder implies. Firstly, Obsession, secondly Compulsion, however, I personally believe that obsession, within the term of this disorder is somewhat miss leading. The reason I see this as miss-leading is, whilst an OCD suffer does obsess, the initiating issue is not obsession as the name implies, it is intrusive thoughts.

An intrusive thought, is a thought, image, idea, or urge, or series of such, which are persistent, unwelcome, involuntary and deemed inappropriate by the suffer, which cause the suffer distress or anxiety.

An intrusive thought is generally not associated with normal real-life/real-world situations, or issues. Intrusive thoughts are normally a product of the sufferers mind, and the suffer recognises them as such. For instance, an intrusive thought would not be, Fuck, ive been shot, an intrusive thought is, if I wear a red shirt someone is going to shoot me.

Whilst a sufferer may obsess on, or about these thoughts, it isn’t so much the obsession which causes the initiation of anxiety, but the intrusive thought itself, which triggers the OCD cycle. I can however, understand why obsession is thought to be the primary instigator of the OCD cycle as everyone has intrusive thoughts at some time, however for a person with OCD, we become fixated on the thought, or the reason why we had the thought, or trying to suppress the thought.

I may see the thoughts as the instigator of the cycle, because, as most OCD sufferers I view the thought as the issue, not my response to the thought.

As the sufferer attempts to control the thoughts, to suppress, and to minimise the anxiety associated to having the thoughts, compulsions arise. These are the outward manifestations of the internal conflict. Compulsions, or the symptoms of OCD can include, but are not limited to;
Repetitive checking (Locks, lights etc),
Washing or cleaning oneself, hands, items, rooms, etc. which is deemed to be unusual or excessive in its duration, or repetitiveness.
Hoarding
Fixation on certain numbers, series of numbers, or pattern of numbers.
A focus on, or preoccupation with violent, religious or sexual thoughts or imagery.
Rituals, which may or may not include any or all of the above symptoms. Opening and closing doors in a certain way, or number of times, checking the door is locked a certain number of times, Washing ones hands in a certain way, for a set period of time, or certain number of times.
Repetitive mental actions such as prayer, saying certain words or phrases, or counting,

This is a very short list of possible compulsions which can be associated with OCD, realistically I could write another entire book just listing all the possible compulsions people could and can experience as a result of OCD, and still not cover them all.

When discussing compulsions in relation to OCD, there are vital differences between a compulsion relating to OCD, and habits, or superstitions. The compulsion in regards to OCD is an action (Mental or Physical), used to suppress, mitigate, limit, control or prevent anxiety, or some event from occurring and are generally not realistically connected to the intrusive thought(s) they are intended to for.

When a person carries out certain activities due to habit, it is not to prevent, or mitigate associated anxiety. They would also likely not become distressed if they were unable to, or did not carry out their habit due to external or internal factors for example, forgetting to carry out the habit, or having to take a different route to work because of road works.

Superstitions are different because it is in relation to avoiding bad luck. While this seems similar, the bad luck being avoided is generalised, where OCD is more specific. For example, touching wood to avoid bad luck, compared to touching wood a set number of times, so to stop a loved one dying.

OCD can be extremely time consuming, either due to obsessing, or carrying out compulsions. It can also cause financial, emotional, and inter-personal issues (Both in maintaining and making relationships).

From my research it appears that it is most common for OCD to initially present in childhood, or teenage years. However, I would like to mention, that whilst it may initially present in the early years of life, that it may be diagnosed at any stage of life, as the sufferer may have not sought treatment, or discussed the issues with family, friends or medical staff. It should be noted also that it appears to me that OCD is an evolutionary illness, by this I mean that over the years the intensity increases, or the distress associated with the rituals or thoughts intensifies, due to increased regularity or the thoughts, the thoughts themselves morph, or the rituals become more complex.

The important part that you should take from the above is, just because someone does not appear to have OCD, the external signs are not identified, or the anxiety is not expressed in the early years of life, does not mean that a child does not have OCD, nor that at a later point in life they would worsen and be diagnosed. Also that OCD symptoms may change, evolve, worsen, get better etc though out the sufferers life.

It is estimated that OCD affects approximately between 2 and 3 percent of the population, however only a small proportion of those with OCD are actually diagnosed at any stage in their lives.

Pure Obsessional OCD
Pure Obsessional OCD, also known as Pure-O or POCD is basically a variation of OCD, with the primary difference being that a person who suffers from Pure-O generally does not have external manifestations of OCD, the compulsions are mental activities not physical. Pure-O from my understanding is not a standardised medical term, but it is commonly used to describe OCD, where compulsions are internalised not externalised.

Obsessive Compulsive Personality Disorder
People with OCPD have a desire or need for order, interpersonal and mental control, and perfectionism, generally at the expense of efficiency, flexibility and openness, and will generally view their behaviours as appropriate.

People who experience OCPD are generally viewed as being very controlling, and inflexible. Tasks, and activities are meticulously planned out. This may cause social, and occupational issues.

It is possible for a person with OCD, to also have OCPD. However, OCD and OCPD are very different to each other. People with OCPD find pleasure in their actions, or activities, and they are generally not carried out ritualistically, or repetitively.

Depression
Most people have experienced a period of time wether an hour, a day, a week or months where they have felt down, been upset etc. However when consider Depression there are a range of markers which determine wether a person is depressed (in the sense of sad), or has depression (in the sense of a disorder).

Someone with depression may experience symptoms including ;
Loss of interest, or pleasure in things which would normally be pleasurable
A low, or depressed mood, which is ongoing, or occurs nearly every day
Feelings and thoughts of worthlessness, hopelessness, helplessness, suicidal thoughts.
Significant weight change, either gain, or loss, when not intended
Sleep disturbances, or changes, insomnia, or hypersomnia (unable to sleep or sleeping significantly more than normal, and/or would be normally acceptable.
Difficulty with thinking, concentrating and/or decision making
Fatigue, headaches and in some cases physical issues such as digestive problems, psychomotor agitation

When diagnosing depression, these markers above is used to assist in determining wether the patient has Depression, and the nature of said Depression, Major Depressive Disorder, Major Depressive Episode, etc.

Whilst it may appear to be a common concern, with a substantial proportion of the population having experienced some form of Depression, which would not be attributed to just feeling down, Depression can be a serious mental health issue, with far ranging impacts in both social and non-social aspects of life.

Anxiety (Disorder)
When most people think of the word Anxiety, they would generally associate this with stress. Whilst there is some overlap between the two terms they are significantly different.

Stress and anxiety have very similar symptoms, however anxiety primarily revolves around fear, and stress primarily revolves around pressures. Anxiety, and stress are normal, and can be considered healthy. Without the feeling of anxiety, we would never have learnt that when approached by a Lion one should run the fuck away, or have a really big stick and know how to use it. Without stress we would never be driven to improve at our jobs etc, to ensure promotions, stability etc.

When Anxiety becomes an issue, it is called an Anxiety Disorder. Anxiety becomes an issue when the anxiety is in relation to unrealistic/unknown trigger, it impairs daily function, and persists with or without triggers being active or present.

Panic Attack
A panic attack is an acute period of an intense sense of fear, distress and/or terror, that occurs as a result of a perceived threat, wether real or not. Generally a panic attack begins with no or minimal warning, and reach the peak of intensity within 10 minutes. However, the duration of a panic attack may last from a few minutes, to hours. The experience of a panic attack can be extremely upsetting, terrifying and may take days to fully recover from.

Panic attacks have been mistaken for other conditions, such as a panic attack, and in instances where the sufferer is unaware that what they are experiencing is a panic attack, may call for emergency medical attention.

When someone has panic attacks which reoccur, this is a symptom of a panic disorder. People suffering from a Panic Disorder as stated may suffer repeated Panic Attacks, however between these Panic Attacks the sufferer may also experience Limited Symptom Attacks. These are similar to a Panic Attack, however are less sever in intensity or as the name suggests present with less symptoms experienced.

Some symptoms of a panic attack are;
Accelerated heart rate, a feeling like your heart is pounding
Sweating, when it would not normally occur, such as during exercise
Trembling or shaking
De-realization
A numbness, or tingling sensations (pins and needles)
Sudden feeling of being hot or cold
Feeling short of breath, or as if you are being smothered or shoked
Pain or discomfort in your chest
Nausea or abdominal distress.
There is some evidence to support that some symptoms of Irritable Bowel Syndrome (IBS) may be related to Panic, or anxiety disorders.

It should be highlighted that if you are near, or see someone who is experiencing a panic attack, that caution should be taken that you do not try to, or be perceived, by the sufferer, to restrain or block the exit or escape route of the sufferer, unless there is an immediate danger to life. The reason for this, is whilst experiencing a panic attack the sufferer may rapidly become violent, whilst they frantically try to escape from the threat they perceive.

To try and get an understanding of a Panic Attack, imagine being in the corner of a room, with no door, no windows and a very low ceiling. You have no apparent means of escape, the walls, ceiling and floor are 10 foot thick reinforced concrete, and you have left your jack hammer in your other pants. Now imagine in the other corner is hyena, which hasn’t eaten for weeks, has been getting poked and prodded with a stun gun, pointy sticks and called names like tinkerbell, and daisy. Now imagine that Tinkerbell is on a chain which has been attached to the wall using a very unsecure looking bolt, and that with every rush that little Tinkerbell makes at you, that bolt creeps ever so slightly further from its place in the concrete.

If you can imagine that, and how you would really, truly feel in that situation, you might just understand what the few minutes or so is like when someone is having a panic attack, and the peak of intensity is going to hit at the 10 minute mark. Now, imagine that feeling occurring repeatedly, or lasting hours.

You can understand from that analogy why a person who is experiencing a panic attack has the potential to become rapidly hostile, and why getting in their way, whilst this occurring could have unwelcome side affects for you.

Agoraphobia
The common held belief is that agoraphobics can not handle being outside, or in unconfined spaces. This, whilst can be the case, is not actually correct. A person who suffers from Agoraphobia, has a phobia or fear of certain places, wether open spaces, shopping centres, some buildings etc, or of uncontrollable social situations, such as parties, etc. It is the fear of having a panic attack in the environment, or in the situation where the sufferer has a phobia of being. Sufferers often will go to extraordinary lengths to avoid these situations, or environments, in some cases they may become unable to, or unwilling to leave their home.

Apart of the theme of Agoraphobia is that it is safe in a certain place, typically at home, and it is not safe outside of these safe zones. So for example, when in a war zone, the army has a green zone. This is a zone which is deemed to have acceptable and minimal risk to the lives within this area. Outside of this zone, no such determination has been made, and as such, upon leaving the Green Zone, you are at greater risk than you where whilst within the Green Zone area.

Mental Disorder
Mental Disorder, Mental Illness or Mental Health issues, are associated with anxiety, distress and/or disability, which may present in behaviour, or mental/cognitive function. Mental Disorders can range in the impact to a persons life, and in intensity. However, when considering defined traits a person either has the trait or not.

There are over 400 different mental disorders, that are defined within the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is one of the most common diagnostic tools used to determine if a person has a mental illness or not.

When I am using the terms Mental Disorder, Mental Illness, or Mental Health issues I am referring to an impairment, or abnormal function of the mental faculties of a persons mind which can lead to abnormal, inappropriate or the disturbance of reasoning, judgement, social interaction, activates, behavioural patterns or thought patterns within the cultural, and generally accepted norms of a society. It should be noted, that in this instance I am not talking of a society as a small, or minority group, am referring to a society as a whole. For example, Western Society, which has a general, standardised and similar pattern of interaction, thought, beliefs and behaviours. Whilst, within Western Society each nation, or state has some differing opinions, behavioural patterns etc, which make the people of that nation unique, overall there is a similar philosophical, and behavioural ideal or identity of the persons who are within this society.

It must also be noted that what constitutes definition as a mental disorder changes. At one point in time, it was accepted that Homosexuality was a mental disorder, however is no longer considered to be one. What is considered a mental disorder is often disagreed upon within the Mental Health Care professions. With each update of the DSM there is changes as to what symptoms or how many symptoms , must be present to diagnose a Mental Disorder. Also, there is debate regarding the validity of Mental Disorders in general as most are regarded a disorder according to generally accepted norms within a society, so as such can the person be regarded as “unwell” as they do not adhere to what is determined as normal.

My personal feeling on the matter is that if a persons mental status, or function impacts upon their ability to carry out desired activities, causes them distress or discomfort, impairs, or disturbs their lives significantly, and on a continual basis then this can be classified as a mental disorder, mental illness or mental health issue.

In my opinion mental and physical illness(es), or disorder(s) are fundamentally the same, the only difference being that one is attributed to the minds abilities, and one is attributed to physical abilities. The other difference is that medically and scientifically we understand the cause of most physical illnesses however, we can not say the same for those of the mind.

Personality Disorder
Personality Disorders are personalities which do not conform to normal social interactions. Whilst no two people are the same, we do have generally accepted social norms within our societies and cultures, of which those with a personality disorder either do not, or do not naturally adhere to.

This should not be confused wit a person having a bad day, or a short period of time in which external forces cause a pre-occupation with them, causing traits which could be similar to those found in people with Personality Disorders. For a person to be diagnosed with a personality disorder, the personality traits must be persistent and enduring patterns and traits which are significantly different to those found in the average person, within the culture or society from which the person is associated with.

Schizoid Personality Disorder (SPD)
A person who has SPD prefers, desires or tends towards lifestyles with minimal or no social interactions, or relationships. They are generally secretive, emotionally lacking, apathetic. However they may also experience full and elaborate imaginative lives.

People with SPD may appear to emotionally unreactive in situations where it would be expected that emotional response(s) would be shown or they may appear to have minimal, or restricted emotional responses. They may be, or appear to be unsociable, eccentric, timid, nervous, indifferent, self reliant and lacking depth.

Generally, people with SPD feel the need to be independent, and free from emotional, and/or intimate relationships. It is no so much that they want to avoid people but the emotional requirements that people may or will impose upon them.

Whilst it is possible for a person with SPD to form relationships, but these relationships are generally on their terms and based on relational types that require minimal, or no emotional intimacy, such as intellectual or occupational relationships.

SPD can present somewhat differently to the above as well, they can appear to be sociable, interested in others, and friendly. However, remain emotionally unavailable, and hidden within their imaginative life.

Typically, a person with SPD will have few, if any close friends. Minimal desire for sex, interpersonal interaction, or display of emotion. Prefers solitary activities, and may preoccupied with their imaginative lives, and introverted thoughts. They may also seem to have minimal responses to either praise or criticism.

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