The following feature by Deputy Editor Niamh Devereux, which first appeared in our May|June edition, won the Shine Mental Health Media Award in ‘Print and Online, Special Interest’
If you’re being completely honest with yourself, have you ever uttered the phrase, “I’m so OCD”, because you enjoy a pristine kitchen or organise your shoes by colour coordinating them? Such a seemingly innocuous phrase, which continues to be used in casual conversation, in fact grossly minimises what is a debilitating and often terrifying condition – one that is widely misunderstood.
Obsessive Compulsive Disorder is a mental health condition, characterised by recurring, intrusive thoughts – or obsessions – which trigger intense anxiety, leading to repetitive behaviours or rituals (compulsions). These are performed to alleviate discomfort and fear, and are driven by the belief they will prevent harm, even if there is no logical connection.
It can present in different forms, or subtypes, including obsessions without visible compulsions. OCD is something that affects thousands of people across Ireland, and yet many still associate it with the stereotypes they’ve been fed through pop culture, where it’s been reduced to a quirk or a punch line.
Director of OCD Ireland, Ian O’Brien – who lives with the condition – says this is hugely damaging. “The misconception that OCD is just about cleanliness or being overly organised means that many people don’t even realise they have it, because their obsessions don’t match these stereotypes,” he says. “Obsessions are as varied as one can imagine; people can have intrusive thoughts (or images and urges) related to sex, violence, blasphemy and so much more.
“Unfortunately, many people don’t recognise these as symptoms of OCD and instead assume something is deeply ‘wrong’ with them. This can lead to years of silent suffering.”
Persistent impact
To get a deeper understanding of OCD, I met with Professor Jim Lucey. The Inspector of Mental Health Services at the Mental Health Commission of Ireland and a revered clinical psychiatrist and author, he has studied OCD for over 30 years.
“This is a mental health difficulty that is clandestine and very private,” Professor Lucey says. It tends to be equal in males and females, but the context of it tends to be different; the issues can totally vary.
“Ultimately, the bar for having OCD is if it is getting in the way of how you live independently, work productively and love empathically,” he says. “If you’re a bit of a fusspot, but you can get on with life – sure we’re all a bit like that in these worried times. This is different; this is something that really does limit your ability to live, work and love in a very constrained and persistent way.”
Professor Lucey explains that it is a condition that impacts people in a myriad of ways. For some, it is a chronic course spanning over decades, with waxing and waning severity; for others there is an episodic pattern throughout life. “This tends to be in conjunction with other mood difficulties, such as depression,” he says.
He adds that there are also those who develop OCD as a child. “At a certain stage of development, we count the pavements on the walk to school and avoid the cracks; we have magical words and focus on numbers of things,” he says. “It’s how we learn reality testing; what is and isn’t fantasy. Then, you walk on the crack and you say, ‘Oh gosh, nothing happened’ and you move on – that’s all very normal and healthy. But, for other children, they develop a degree of concern about that crack in the ground, which goes on to limit their ability to function.”
Dark thoughts
Professor Lucey has looked after thousands of people with OCD in his career. He recalls some of the turmoil his patients have faced, which highlights just how insidious this condition is: those controlled by uncertainty, unable to even make the decision to buy the newspaper. The people ruled by fears of contamination, about anything from intimacy and birthing to all manner of illnesses – Professor Lucey was inundated with panicked messages about the monkeypox outbreak, for example. The intrusive, dark thoughts that drum up fear and a distrust of self; thoughts about “harm, contamination or impropriety” which contradict their beliefs and values and are something they are extremely unlikely to ever act on.
“One of my first OCD patients was a nun, in the 80s, who had this fear that she was going to shout ‘f**k’ in public. I’ve known people going around and around in their heads because they weren’t sure if they killed someone; they went over a bump in the road and then obsessed over the thought that they have driven over somebody,” he says.
“Another convinced himself he was a sexual criminal – he wasn’t, but he reported himself to the police and he was happy to be put on a register, so that he could be monitored. He felt safer that way. So, this is very serious. These ideas, thoughts and images that intrude upon the mind, despite resistance, can totally dominate the person’s life.”
OCD also tends to shrink a person’s world, OCD Ireland’s Ian adds. “The fear of being a danger to themselves or others can cause individuals to withdraw from relationships, avoid activities they once enjoyed, and struggle with even the simplest of daily tasks. Sadly, all of this secrecy and avoidance only serves to make a person’s OCD worse. It thrives on isolation and self-doubt, making you believe that you are different, broken, or even dangerous. But that is not true.”
Life-changing treatment
The light at the end of the tunnel is that this is a condition both experts describe as highly manageable. “If you think you might have OCD, please reach out for help,” Ian says. “Talk to your GP or a mental health professional – but be sure they have the right training and understanding of OCD – because evidence-based treatments exist and they can be life-changing.
“While the journey can be incredibly difficult, it is possible to reach a place where OCD no longer takes centre stage. Speaking from my own experience – having gone through therapy and reached a much better
place – I’ve learned that while OCD may always be there, it can very much fade into the background. When you get to this place, life can be as big and beautiful as you can imagine.”
Cognitive Behavioural Therapy (CBT), particularly Exposure and Response Prevention (ERP), is the gold standard for managing OCD, he notes, adding that medications like SSRIs can also be considered effective and helpful for those with moderate to severe symptoms. While some respond well to ERP alone, others may achieve the best outcomes with a combination of therapy and medication, Ian adds.
Professor Lucey also emphasises the effectiveness of CBT. “Therapy works; CBT in particular alters the brain. It not only makes people feel better; it changes the brain and how it functions. Brain surgeons aren’t just the ones carrying out brain surgeries! People think mental healthcare is a bit like the confessional and the mental health professionals are like the priest, but it’s not the case. There’s no judgement; it’s just helping you to realign your brain, your mind and your self-esteem.”
He urges those who think a loved one may have OCD to take the same approach. “I encourage the act of active listening; you don’t judge, you just listen and let them know they are supported,” he says. “And, in a compassionate way, you make sure life goes on, and you let them know they can come with you, if they like. You don’t force or control; but you can empower and create opportunities.
“I always say that the best way to manage the challenges we face in life is to ‘chime’: to connect, to remain hopeful, to keep your identity, to find your meaning, and to empower others to do those things, too.” Something that encapsulates all of these elements are the free monthly support groups by OCD Ireland, for people living with the condition and their loved ones, too (both in person and online at ocdireland.org).
“A common theme in the feedback we receive is the immense relief people feel when they realise, they are not alone,” Ian says. “Hearing others openly share their experiences can be extremely validating; people see that their struggles are understood and shared. It can start to take away some of the secrecy and shame that so often come with the condition.”
Voices of OCD
The following are the lived experiences of three Irish women with OCD, which some may find upsetting to read.
Brigitta Fitzpatrick, 49, Co Offaly
“My earliest memory of experiencing symptoms of OCD takes me back to my teenage years. I was about 17 when we went to the cinema with my school to watch the movie Schindler’s List. Watching the story play out on the big screen had a profound effect on me – unfortunately not in a positive way.
“The following two years were a surreal period in my life as I found myself completely overwhelmed, obsessing about thoughts of the Holocaust, of images of Jews marching to the gas chambers or being shot.
These thoughts kept going around my mind without a break, which caused a great deal of anxiety in me on a daily basis to the point where I felt physically sick. This was the first time in my life when I experienced obsessive thoughts, although at the time I didn’t realise it was OCD.
“My type of OCD is called ‘Pure O’, or ‘purely obsessional’, which means that the OCD plays out only at the level of thought, with no compulsion of a physical ritual following, and the theme is ‘harm and suicide’. This means that I experience obsessive intrusive thoughts of committing suicide or harming my loved ones. These thoughts, which primarily present themselves as images, make me feel highly anxious and scared. As a result, I often experience a pressure in my chest area, palpitations and shortness of breath.
“There are countless particularly challenging moments that I can recall. One of them is holding my newborn baby in my arms and being tormented by the never-ending flashes of images of me killing her, while feeling absolute dread and terror at the same time. Another one is being alone in the house and feeling the urge to put my hands around my neck and choke myself until I’m dead, while feeling scared out of my mind at the thought. Yet another memory is me endlessly walking the corridors of the local psychiatric unit (where I spent six weeks at the end of 2023), while praying to God to have mercy on me and kill me with a heart attack or a stroke there on the spot, because I simply couldn’t take any more.”
“Those living with OCD are intelligent and sensitive people who can be absolutely crippled under the weight of this tormenting condition. The World Health Organisation ranks OCD as one of the ten most disabling conditions, in terms of lost earnings and diminished quality of life. It is not a quirky little personality trait like that displayed by the charming Detective Poirot in Agatha Christie’s novels. As for the specific type of ‘Harm OCD’, I would like everyone who reads this to know that sufferers of this condition are some of the most gentle and sensitive people out there, who hate any form of violence. That is exactly why obsessive intrusive thoughts of harm are so scary to them.
“For a long time, I thought that OCD was my greatest enemy; a condition that I had to wrestle to the ground in order to be able to live my life to the full. I tried ERP but realised it was making me feel worse, so I started seeing a psychiatrist who prescribed me medication, which I have been on since for 19 years. They have been a real lifeline for me. Having said that, over the years I’ve realised that medication could only get me so far and that no magic pills would cure me of OCD.
“Now, having been practising mindfulness for nearly a year, and focusing on bringing more presence into my daily life, whenever I experience an OCD episode (yes, I still have those), I say to myself, ‘OK this is an opportunity to practice acceptance of what is’. I acknowledge that this is a moment of anxiety, and even bring my attention to the physical sensations; holding my hands over my heart and breathing into the discomfort. And you know what? The anxious sensations slowly subside. Acceptance is the key.”
Lauren Martin, 30, Co Kilkenny
“My first memory of OCD is how ill I became from my first spiral at the age of six. I remember telling my mam and dad, ‘I’m having thoughts but they’re not me and they’re scaring me’. This would be consistent throughout my life: ‘scary thoughts’.
“They can be about anything, but the ones I felt most shame about were harm thoughts or vulgar thoughts, which I couldn’t understand why I was having. I had constant stomach aches from guilt. I was taken to the
doctor and he said I’d grow out of it. The overall feeling was that I made my mam and dad sad and I needed to stop this.
“I went through my whole childhood and teens not telling a soul and believing I was an awful person. I was terrified of the thoughts, which could also make me believe things that were untrue; like ‘I have HIV and I’ll give it to everyone I love and they’ll die’, or ‘I have an aneurysm and will die’.
“It was the loneliest feeling in the world. I was a child dealing with a very adult problem and I felt shamed into keeping it to myself. OCD is known as ‘the torturing disorder’; as an adult I find it debilitating, and I don’t know how I survived as a child. I believed I was evil because of the thoughts, and became a people pleaser to make up for it.
“OCD was prominent in my childhood and early teens but no one would know; I hid it well unless you saw me perform a compulsion like praying or tapping in sequence. However, I completely fell apart at 19. I became afraid to leave my house and wouldn’t even speak to my family; I was housebound for two years.
“Then, my 29th year was the hardest of my life. One week I didn’t sleep for seven days, I feared the thoughts so badly. My biggest breakdown came after a night out. I’d been drinking to self-medicate and it caught up to me. I ended up in the biggest spiral of my life and tried to take my life.
“I’d credit Bryony Gordon, author of Mad Girl, with saving my life. To read someone having been through what had been torturing me my whole life was such a relief. It felt like I found my answers, finally. I wasn’t evil; I had a disorder.
“However, it took a trip to my GP where I broke down saying If I don’t get an OCD diagnosis and help, I’ll die. He sent me to a private psychiatrist (which cost €500), who was great and diagnosed me. I feel blessed this was an option for me with the help of my parents, but it’s not always the case for a lot of people.
“If I could go back to my younger self now, I’d hug her and tell her she’s not bad; she has a mental illness and her thoughts don’t mean anything about her. I’d strongly encourage anyone suffering to please get help – if possible, find a psychologist and therapist who specialise in OCD. ERP therapy really helped me realise my thoughts aren’t me – they’re intrusive and unwanted.”
Kate Quinn, 25, Co Wexford
“My OCD presents itself through contamination fears, such as a fear of germs, and checking compulsions, like repeatedly ensuring doors are locked. My earliest memory of experiencing symptoms dates back to the swine flu period, when we started bringing wash bags to school. I felt significant anxiety about touching taps and towels and have a vague recollection of needing to count to specific numbers. This memory is a bit hazy, and it seems my symptoms subsided for a few years. However, when my gran fell ill and sadly passed away in 2016, that’s when the strongest memories of OCD symptoms resurfaced and persisted.
“It’s hard to understand OCD when you don’t have it, given that OCD brains are generally wired differently. But if you can imagine a first-person shooter game where the player is always scanning for threats, living with OCD for me is similar. It involves continuously being on the lookout for potential triggers and overthinking even the smallest details.
“Every minute can differ drastically; one moment might be calm, while the next is tumultuous, akin to having a loud, relentless bully in my mind. The more attention given to these thoughts, the more doubt they sow.
“For years I suspected I might have OCD, but it was my therapist who motivated me to seek a formal diagnosis. In 2023, I spoke with my doctor, who was empathetic and patient. Receiving the diagnosis was affirming; it allowed me to acknowledge my condition openly. I joined a support group, which led me to a community of people who truly understand what living with OCD is like. We share laughs and insights, and it’s a rare joy to connect deeply with people.
“OCD is not a cute acronym for liking neatness; it is a debilitating issue which requires empathy and acceptance. By fostering awareness and open conversations about mental health, we can break down misconceptions and promote a more compassionate approach to supporting those with OCD.
“For example, public places, particularly toilets, can cause significant stress due to narrow cubicles, taps that don’t stay down, and inaccessible bins. These elements can be anxiety-inducing, especially as I observe people mindlessly touching dirty surfaces.
“I recently attended a show at the Gaiety Theatre, forgetting that their cramped toilets are on my personal ‘block list’ due to the stress they induce. Navigating the tight space, my jeans brushed against the toilet, triggering a panic response. Throughout the day, I felt unclean, compulsively wiping seats wherever I went, and was relieved to change clothes once I got home. Amidst my struggle, my friend remained unfazed.
“To me, it was monumental – her lack of judgment and abundance of empathy were truly impactful and rare. Designers should ensure public spaces accommodate diverse needs; it may seem insignificant, but little things like this can push an OCD mind over the edge.”
The illustration by Sarah Gray was inspired by the idea of a woman with water slowly rising up around her face, to symbolise the feeling of being trapped and overwhelmed by obsessive or intrusive thoughts.
In our December edition, the final chapter in a special three-part series on violence against women shines a light on sexual violence – and what needs to change to better support survivors in Ireland.
Shine’s Media Programme recognises excellence in Irish media coverage of mental health across all platforms. The awards celebrate journalists, producers, editors and content creators whose work improves public understanding of mental health, challenges stereotypes and fosters informed discussion.
