Clinical psychologist Caitlin Claggett-Woods has a six-month waitlist for patients with obsessive compulsive disorder. But the GOAL Group meets every two weeks.
Justine De Jaegher’s torture was craving certainty in an uncertain world.
Is the door locked? She just checked. Check it again. What about the windows? Better be certain. Was she absolutely sure she checked the door?
Around and around in an endless cycle, one painfully familiar to the estimated one per cent of people afflicted by obsessive compulsive disorder.
It’s a crippling and isolating disorder, but De Jaegher and others in Ottawa have found comfort in a biweekly support group for people with OCD. Called the GOAL Group, it was started by clinical psychologist Caitlin Claggett-Woods, a specialist in treating OCD.
“I started attending because I had OCD and was looking for additional support,” De Jaegher said. “Then I realized, ‘Oh! I’m meeting other people with OCD.’
“People don’t wear OCD like a name tag. I didn’t know anyone with OCD, or at least I didn’t know I knew anyone with OCD. So the first thing that struck me is that sense of community: Here are people who will understand. They’ll get it. There’s that shorthand there. There’s no judgment. There’s more openness. You feel safe.”
De Jaegher, 34, first began experiencing symptoms of OCD in her early 20s, when she was living in Winnipeg.
“In my case — and it doesn’t manifest itself this way for everyone — it was harm coming to my friends and family and it all being my fault,” she said. “Maybe it was my house burning down due to my negligence and everyone dying in a fire. Or leaving a door unlocked and there’s a home invasion and everyone is killed horribly.”
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Those fears led to what De Jaegher calls her “sticky thoughts” — a compulsion to check and recheck her home’s security.
“A lot of people will say, ‘Oh, I check my doors before I go to bed.’ But you’re not checking for hours on end because maybe you’ve done something wrong. Or maybe the latch is broken. Or maybe, maybe, maybe. It gets to the point that it impacts your life, your ability to get to work or to get to school.”
De Jaegher didn’t realize what was happening, nor did her doctors. She began to cope “in some really unhealthy ways” until she finally ended up in a hospital emergency room.
“That’s when I realized there was something else going on here and I need some sort of specialized care.”
Such behaviour is known as “ego-dystonic,” says Claggett-Woods, who treats OCD patients at her Ottawa clinic. The waitlist is six months long.
The person with OCD knows their thoughts are irrational, but is powerless to stop them, she said. Though some compulsions are common — fear of germs, constant hand-washing or door checking — some of the intrusive thoughts are dark and sinister.
“It shows up in so many ways that are not talked about that people are left thinking that they’re monsters,” Claggett-Woods said. “What if I sexually assault someone? What if I harm someone? What if I drive my car into oncoming traffic? What if I get condemned by God because I didn’t do something correctly? We can’t emphasize enough all the different ways it manifests.”
Many people have such thoughts, but they’re fleeting and quickly ignored, she said. Someone with OCD assigns them a deeper meaning.
“What if I jump off this balcony or push someone onto the subway tracks? It’s the difference between acknowledging, ‘Oh, that’s a funny thought’ versus believing it and thinking, ‘Do I actually want to do this?’”
A mother may have intrusive thoughts of harming or molesting her own children, even though she loves them dearly and would do anything to protect them. In the mind of someone with OCD, the ‘What if?’ is inescapable.
De Jaegher’s road to recovery came through medication with anti-anxiety drugs and exposure-response therapy under a therapist’s care — the gold standard for OCD. She challenged herself to take short walks, knowingly leaving her door unlocked. Eventually, she walked around the block. Later, she could leave her house for the entire day.
“It was hard, very hard. That first walk was awful,” De Jaegher said. “The fact that I can now walk around the block without checking the door? That’s the best. And I only got here by doing the hard stuff.”
An effective exposure-response therapy has the person confront their intrusive thoughts head-on, Claggett-Woods said.
“One person had fears about molesting her daughter, so her challenge was to give them a bath with the door closed.”
Someone with intrusive thoughts of suicide, for example, could be challenged to walk across a bridge, even stop and look down to the water below.
“We can get pretty creative,” Claggett-Woods said.
Confidence builds as the person confronts their greatest fear and the most terrible thing they can imagine doesn’t happen.
Frequently, friends and loved ones will try to reassure someone with OCD or be dismissive of their fears.
“Your instinct is you don’t want to see your loved one in pain,” De Jaegher said. “If the question is, ‘Am I a bad person? Have I offended God?’ A well-intentioned family member will say, ‘No, no, no. Of course not. You’re a great person. You’d never hurt anyone.’
“That might sound like a nice reassuring thing to say, but how can they know for sure? They can’t say with 100 per cent certainty that if you leave a door unlocked that someone isn’t going to break into the house and kill everyone inside. What someone with OCD has to learn is that they can live with that uncertainty.”
Though De Jaegher’s OCD is now under control, she has had relapses. Ever the shape-shifter, OCD can take more than one form. For De Jaeger it crept back in with what psychologists call “religious scrupulosity” — an absurd commitment to her church and to God.
“It shows up in things like compulsive prayer. The need to say prayer perfectly and either attending or avoiding religious services or looking up scripture to try to justify certain thoughts, behaviours,” she said.
“OCD is all about seeking certainty and that’s a realm (religion) where there is no certainty at all.”
Religious scrupulosity is common enough that Claggett-Woods is making a presentation to the Archdiocese of Winnipeg this fall to help priests recognize OCD.
“I can just imagine being in the confessional and hearing someone say, ‘I’m having these thoughts of molesting my child’ and that being interpreted as very dangerous rather than someone having these intrusive thoughts that are causing them so much distress.”
The GOAL Group helps its members attempt and meet those exposure challenges. Claggett-Woods started the group with online virtual meetings during the pandemic when fears and feelings of isolation were at their peak. It has since continued with in-person meetings on the second and fourth Wednesdays of the month and virtual meetings on the first and third Tuesdays.
“It’s called GOAL for a reason,” De Jaegher said. “We set goals for ourselves, exposure goals. It could be, ‘This week I’m going to take three 10-minute walks where I leave the door unlocked.’
“There’s that accountability mechanism. You get to come back to the group and say, ‘I did it!’ And, if you didn’t do it, you have a safe space where you can talk about why you didn’t do it and what were some of the barriers you faced. Why was it so difficult? What supports would you need in the future to be successful?”
On Sunday, people with OCD, their friends, families and supporters will join clinicians and other healthcare professionals in the annual OCD Walk leaving from Hintonburg Park at 11 a.m. The walk in Ottawa is part of a global event put on by OCD International. help raise funds and awareness about the disorder.
“Unfortunately, it’s a very misunderstood disorder,” De Jaegher said. “People will say, ‘Oh, I must have OCD because I’m organizing my pencils.’ But we’re trying to raise awareness about what it is. It’s awful for the person experiencing it, but there is a lot of hope. There’s really effective treatment available. There’s support groups like ours across the country.”
“Exposure-response therapy is hard, but having OCD is harder,” she said. “And it’s not something you have to do alone.”
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