Question: I suffer from OCD and have a fear that everything around me is contaminated. I can't eat or touch food with my bare hands - I always use a knife and fork. I rarely prepare my own meals and pay great attention to making sure that crockery and cutlery are 'clean', sometimes using disposable ones. I am a 27-year-old woman and have lost 10kg in the past year and am now hovering around the 20 BMI mark. I can't afford therapy (I'm a masters student), and won't take any medication or supplement as I think they are somehow contaminated, too. What can I do to help myself before I waste away? Will I always be stuck in this black hole of constant worry about the food I eat?
The CBT specialist
David Veale
The psychological therapy recommended for OCD is cognitive behaviour therapy (CBT), and this should be available free by referral via your GP. CBT focuses on changing the way you think about your thoughts. It means working with a therapist you trust so that you come to fully embrace unpleasant thoughts, such as yours about contamination, rather than trying to avoid and control them, as you do, by controlling the way you deal with food. You may feel that by doing this you can prevent yourself from being harmed in some way. This logically leads to the way you avoid food, but in fact this makes you more vigilant and therefore anxious and fearful. CBT will lead you on to eating food that your mind is telling you is 'contaminated' when it is not. Unfortunately this involves experiencing some anxiety but trying to control and avoid anxiety makes it worse in the long term.
· David Veale, consultant psychiatrist at the South London and Maudsley Trust and the Priory Hospital, is co-author of Overcoming Obsessive Compulsive Disorder
The psychoanalyst
Cyril Couve
Some patients sense that their phobias and fears have a resonance within their emotional life and relationships. Others just want to be free of their symptoms quickly. Psychodynamic psychotherapy (available free on the NHS by referral) works with the relationship between therapist and patient, and establishes links with current or past life situations. It would be wild analysis for me to offer any interpretation of what your contamination fears mean. To understand more, I would need to be attentive to your expressions of thoughts, fantasies and dreams, and your feelings of guilt or shame. Then it might be possible to understand parts of your self that you feel are dangerous or dirty. Patients with contamination fears are often frightened that emotional contact is a source of danger owing to the passionate feelings that are unleashed. It is safer to be tyrannised by an impersonal thing outside of the self than to face the internal situation.
· Cyril Couve is a consultant clinical psychologist at the Tavistock clinic and a practising psychoanalyst
The dietician
Jacqui Lowdon
Here are some practical short-term suggestions that may make eating easier and will help control weight loss while you seek treatment. They are not a long-term solution, however, and you should discuss them with your therapist. Try healthy-eating readymade meals. Or could family or friends prepare and freeze meals which you could microwave and eat with cutlery direct from the container? Add tinned or frozen vegetables, which just require heating. For carbohydrates, try boil-in-the-bag or frozen cooked rice or instant mash. There are many instant puddings: yogurts, fromage frais, readymade milk puddings in tins or pots, mousses, tinned fruit, ice cream. Cereal and milk can be managed without hand contact. If weight loss remains a problem, there are various ways to help, including prescribable liquid drinks. Discuss this with your GP, who will be able to refer you to a registered dietician.
· Jacqui Lowdon is a spokesperson for the British Dietetic Association
· If you have a question for our experts, email health@observer.co.uk
