Cause and effect

Scientists still don't fully understand what causes OCD, but it's thought to be the result of a combination of factors. These include genetics, psychology, life experiences and even possibly a chemical imbalance in the brain. The combination varies from person to person.

The degree of influence of each of these elements also differs: genetics might be the main factor for one person, while life experiences might be key for another. 

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The situation is further complicated by the fact that there are many different forms of OCD, including - amongst others - contamination fears, checking and intrusive thoughts, as well as my own perfectionism and obsession with order and symmetry. The cause of one type might be quite different from the cause of another, and can even be different in people with the same main form of the condition.

In short, there is no 'one size fits all' answer as to cause and it can be hard to identify even at an individual level. 

With me, there certainly seems to be a genetic predisposition on both sides of my family.

My dad has commented several times on how much he relates to the experiences I describe on my blog and provided examples of his own, similar behaviours. We also share an anxious temperament, which can make someone more prone to develop the condition. 

On my mum's side, her mother was extremely houseproud. Perhaps not unusual for her generation, but my parents have speculated recently that she might, in fact, have had OCD. 

There is certainly evidence of something rather obsessive in her behaviour. Prior to my birth, my mum conducted a spring-clean of our house, so as not to have to worry about cleaning during her first weeks with a new baby. When her mother came to visit, to meet me, she commented that the house was spotless - apart from a soapy residue behind the bathroom basin taps. Most people wouldn't even comment on the cleanliness of someone's else's home, let alone point out something as trivial as soap marks. And such a concern, on the day you meet your first grandchild, seems wildly misplaced.

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It may be that other family members only have - or had - some obsessive habits, rather than the full-blown condition, but in his last email to me, my dad was quite clear: 'We know where your OCD comes from.'

Someone with a genetic predisposition towards the condition still may not develop it, though, without the trigger of a life event. After all, my sister has shown no inclination towards even related habits, let alone the condition itself - though she has admitted to a recent spate of picture-straightening in public places.

In my case, marital difficulties and the horrible year that followed were undoubtedly the aggravating factors in developing my latent obsessive-compulsive tendencies.

Treatment of OCD doesn't dwell on its cause, but, as a sufferer, it's interesting to explore. If nothing else, knowing what might have caused your condition inclines you to be just that little bit kinder to yourself.

My world order

People often ask whether I'm compelled only to keep my own environment 'just so'. The short answer is yes. I'm concerned solely with maintaining order in my flat, in my car and on my desk, not the wider world. It's precisely because I can't control the wider world - people or events - that control of my own is so important. 

Controlling my surroundings serves to reduce my anxiety levels, so I need to be sure no one can undermine my efforts, as that would only exacerbate my stress. You can be sure, I won't be lining up labels on tins in a supermarket, just for other customers to mess them up again...and again...and again. 

My flat and car are, of course, subject to some interference from others, ie visitors and occasional passengers. Now, though, I'm able to resist my compulsions long enough to put up with temporary invasions - it hasn't always been the case. The discomfort is tolerable, when I know I'll soon be alone again and able to restore order. 

My desk is another story. 

I sit in the middle of a row of three, with another row of three directly opposite. My colleagues either side know not to cross the dividing line between our desks and are quick to pull stray items back across the border. I'm trying to be more tolerant, though: I recently allowed half a plastic fork to infiltrate my territory for a whole afternoon.

Colleagues coming to speak to me present a greater problem. They tend to perch on the edge of the desk or adjoining cabinet, blithely shoving stuff out of the way to make space. Sometimes, it's all I can do not to shove them off. The second they've gone, my priority is to re-establish order, irrespective of any work that might be screaming for my attention. 

As in other situations, the more stressed I become, the tidier my environment has to be. When my workload is out of control, I seek refuge in straightening my papers and stationery. The irony is, when people see a tidy - or virtually empty - desk, they assume the occupier isn't busy. For me, an empty desk is a warning sign to my colleagues: approach at your own risk.

Often, when friends find out I have OCD, they respond along the lines of 'You must think my house is a tip? Don't you want to tidy it up?' Actually, no, and no. If it's cluttered to a normal, homely level, I'm likely, instead, to be envious that they're able to live that way. Even friends who confess to being particularly messy provoke a degree of envy.

So, while I can't imagine living with anyone permanently, I'm happy to visit other people whose environment is nothing like my own. Such as my boyfriend, whose chest of drawers and sock drawer look like this:

Photos: Peter Gettins Photography

While mine - as you'll have seen from earlier posts - look like this:

It's not what you do, it's the way that you do it

There's method in the madness (sometimes)

In fact, the next time someone asks why we don't move in together, I think I'll just show them these pictures.

Little Miss Perfectionist

My teacher's report for my last year at primary school begins 'Helen is never satisfied with anything but the very best in her work...'

How, at the age of 11, had I already found myself on the path to a lifetime of measuring up to often unrealistic, self-imposed standards? What drove that skinny, introverted little girl to strive for perfection?

Photo: Peter Gettins Photography

The previous year, I had been one of eight children put up a class due to overcrowding in our year stream, meaning I did the final year twice. We were selected on the basis of being the brightest in our age group. Maybe I felt I had to work harder to prove I deserved that accolade, or simply to ensure I kept up with the older children.

Possibly I wanted to match my younger sister, who had to be given extra work to keep her stimulated at school.

Perhaps, though, it was the constant refrain of 'Just do your best' that set me off on the wrong track.

The words are meant to reassure; to prepare a child for low achievement or make them feel better in the face of failure: 'Don't worry, you did your best.'

Now I wonder whether this doesn't just confuse some children. How do you know what 'your best' is? Have you tried hard enough if you spend an hour trying to work out a maths' problem? Or a week writing an essay? If you get a grade E, was it because you didn't try hard enough, or because you're just not very good at the subject?

In my first year at secondary school, my chemistry teacher awarded me A for Effort and C for Attainment (generous, given that I got 28% in the end-of-year exam). I still wonder what system he - or any of the teachers - used to assess Effort and to determine that I was giving it my all, in spite of my poor results. From the primary school report above, it's also apparent that doing your 'very best' doesn't necessarily result in grade As across the board. 

Discussing this with a male friend, he suggested, somewhat tongue in cheek, that there is a gender difference in how children interpret 'Just do your best'.

'Girls think they have to be perfect,' he said. 'Boys think they just need to have a stab at it.'

Irrespective of gender, I'm sure that some children do take this the wrong way. I know that I, for one, have never quite figured out what 'good enough' means.

* * *

You'll notice that my worst grade on this report is for Creative Writing: C. I'd like to think my writing skills have improved since then. Check out the start of my novel and see if you agree.

Walking an inch in my shoes

People often say they're 'a bit OCD' about certain aspects of their life, without actually having OCD. This can be a source of frustration - or even anger - for many sufferers, who feel that such comments belittle their experience of the condition and fail to acknowledge its devastating impact.

There is, undoubtedly, a lack of understanding of OCD. However, we can't blame other people for misusing the terminology, if they haven't been educated about the condition, or had direct experience of it. The same is true of our understanding of anybody else's experience of life, whatever it is that determines that experience. 

For me, such comments actually offer a way in to talking about OCD with others. 

Photo: Peter Gettins Photography

So, when a friend revealed that he has 'a thing' about lining up drinking glasses and becomes agitated when they're in disarray, I took the opportunity to explain my experience of OCD. As it happens, I have the same compulsion, but while he orders his in ascending size, from left to right, mine are descending. Frankly, his version of 'order' is as wrong to me as if the glasses weren't ordered at all.

Another friend admitted to obsessively checking that her gas cooker is off, providing me with another jumping-off point to talk about the condition. 

In fact, the way she conducts her checks sounds a lot like an OCD compulsion: she jiggles the dial controlling the gas flow to each ring, while saying 'off, off, off', and has to start again if she's interrupted. That last element really struck me. It's very common in OCD to feel that you haven't enacted a compulsion properly if you're interrupted. Even a small noise can break my concentration and be enough to constitute an interruption.

My view is that if someone has one OCD-style habit, they may be more disposed not only to listen to, but also empathise with, sufferers whose lives are dominated by such behaviours.

And, hard as it can be for OCD sufferers to open up, we have to share our experiences. If we don't, others will continue to misunderstand, undermine or ridicule those with the condition.

* * *

If you don't have OCD, do you have any OCD-style habits? If you do have OCD, how do you respond to people saying 'I'm a bit OCD'?

Cinema Paradiso

One facet of my perfectionism is that I hate to have even the tiniest thing spoil a special occasion. 

Recently, I had the chance to see my all-time favourite film - the original,1963 version of Jason and the Argonauts - on the big screen for the first, and probably only, time. I was determined to ensure that nothing marred this unique experience. 

The screening was at a small, independent cinema, on a Sunday afternoon, and was prefaced by a documentary about the late Ray Harryhausen's stop-motion film techniques - his special effects being the film's main attraction. I expected this niche event to draw a small, well-behaved audience, rather than the popcorn-crunching, mobile-phone-addicted crowd that long ago put me off going to the cinema: this was truly a one-off for me.

There were, indeed, a mere two dozen of us, only one audible popcorn eater, and no mobile phone activity. There were, however, other distractions.

The first was the man behind me, who had both arms and one leg wrapped around the woman next to him, whom he was noisily kissing. As she didn't stop talking, he was only able to kiss her cheek, yet was somehow generating a revolting, wet, sucking noise.

Before the documentary started, I escaped by moving forward a dozen rows - only to realise that the green Exit sign to the left of the screen was now much more noticeable (I'm easily distracted by visual, as well as auditory, intrusions). As it seemed the lesser of the two evils on offer at that point, I opted to stay put. 

Photo: Peter Gettins Photography

That was, until I realised that two small lights illuminating the stairs on either side had crept into my peripheral vision. I had to wait until the break to relocate to the row in front. In the meantime, I was obliged to keep my head at an angle, so that the arms of my glasses blocked the lights.

As soon as I'd settled into my new row, I spotted popcorn on the floor, which I was convinced would keep catching my eye. In reality, once I was focussed on the screen, I'd have needed swivelling chameleon eyes to see it at all. I stood up and pretended to rearrange my fleece on the seat next to me, while casually stretching out my left foot to kick the popcorn under a seat. On reflection, I suspect it flew beyond the seat and into the row behind me, where a family of three were sitting.

No sooner had I sat down, than I decided my fleece would be better placed behind my neck, in case I wanted to slide down and rest my head against the wooden seat back.

And finally, just when I thought there was nothing left to bother me, I spotted a half-empty, plastic cup abandoned on the stage to the left of the screen (now there was a symbol if ever I saw one). I couldn't risk it being visible once the lights were down, so got up, walked four rows to the front and removed it.

Yes, it was embarrassing that there were witnesses to my perfectionist fussing, but that fussing made the afternoon a 9.5 out of 10. In my world, that's as good as it gets. 

And perhaps Ray Harryhausen, with his eye for detail and immense patience in perfecting his effects, would have approved of my efforts.