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Insights into Obsessive-Compulsive Disorder with Francesca Eldridge

Francesca Eldridge's picture

Insights into Obsessive-Compulsive Disorder with Francesca Eldridge

Those with obsessive-compulsive disorder (OCD) are often the victim of ill-informed stereotypes and lack of compassion for the internal agony they're suffering. Helping patients with OCD can mean peeling back the layers of guilt, shame, self-doubt and paranoiac behaviour that obstruct their ability to function in everyday life.

In today's podcast we are joined by Francesca Eldridge, who shares her own journey of healing from OCD and how this ignited a passion within her to compassionately support others with this condition through natural medicine. Francesca shares the expertise she's gained as to what dietary, lifestyle, nutrient and herbal choices to consider for those living with OCD. 

Covered in this episode

[00:45] Welcoming Francesca Eldridge
[03:23] Francesca's journey with OCD
[12:00] Defining OCD
[26:09] Catalysts of OCD
[29:28] Standard therapies for OCD
[32:03] Research: nutrients for mental health
[34:14] Clinical assessment of OCD
[39:14] Finding specialised OCD therapists
[40:18] Differential diagnosis with other conditions
[43:06] Complementary medicine considerations


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Francesca Eldridge, who's a registered clinical nutritionist, and OCD survivor. She's based in New Plymouth, New Zealand. She has a special interest in offering knowledgeable support for OCD, obsessive-compulsive disorder, anxiety disorders, all types of depression, and trauma recovery. She also offers informed support for hyperhidrosis. 

Francesca is motivated to help increase understanding amongst natural health practitioners of what OCD actually is, and how we can best support our clientMary Reeds and believes that holistic support for mental health conditions offers the best chance of successful management and recovery. 

This year, Francesca is launching her first online course for people living with anxiety disorders, called The Gateway to Anxiety Recovery, and the course launches in June, 2018. You can find more out about that on her website called francescaeldridgehealth.com. Welcome, Francesca, to FX Medicine. How are you

Francesca: Hello, Andrew. I'm good, thank you.

Andrew: You're good, you're recovering.

Francesca: Yeah, I'm just getting over a cold. But yeah, otherwise I'm quite happy. I'm actually sitting in a pool of sunlight, and I've also got the fire on because this year, we've sort of just come into winter proper, here in New Zealand.

Andrew: I was just going to say that. New Plymouth, can you explain to our listeners where New Plymouth is in New Zealand, please?

Francesca: Sure. New Plymouth is the main city in the Taranaki region on the west coast of the North Island. And if you were to travel there from Auckland, which I think most people are familiar with, our big city in the north, you would...it would take you about an hour by plane to get from Auckland to New Plymouth. 

Andrew: Ahh. 

Francesca: And then we've also got a beautiful volcanic mountain that sits, sort of right in the middle of that Taranaki white land mass. So we're very lucky here, in that we've got a two and a half thousand-meter mountain…

Andrew: Wow.

Francesca: And then we've got...and then that's surrounded by native bush, and then we're surrounded by beautiful coastline. So it's a very beautiful and underrated part of New Zealand. And because it's not particularly on the way to any other major tourist attractions, it doesn't get visited as much as it should. But people who come here do tend to fall in love with it.

 Andrew: And tell us a little bit about your career. What started you to become a clinical nutritionist? And then, I guess we need to branch into your experience of obsessive compulsive disorder, OCD.

Francesca: Sure. Yeah, so...well, to be honest, you know, I would still consider myself a relatively new graduate. I graduated just over a year ago. So, I completed my diploma in nutritional science with the Naturopathic College of New Zealand. I completed that part-time, over five years. So it was quite a long haul of study, and it was a big relief to graduate. 

But my journey towards wanting to support people with OCD actually began before that. So, when I was 10 years old, I developed symptoms in myself, of OCD. And looking back, it was mostly checking symptoms, not that I think the label is particularly important, but that's helped, again. And for me it became severe sort of almost overnight. My symptoms, you know, sort of ramped up a thousand-fold. And around age 14, OCD basically took over, you know, my brain and my life. 

And so everything from schooling to relationships, friendships, you know, social life, study, day-to-day living was severely affected. And I...you know, I will be completely honest and say I wasn't in a situation where I was being supported. So that, of course, made things a thousand times harder. 

And it was a pretty, pretty dark time in my life. You know, I have a lot of empathy for teenagers who are struggling with mental health because I've been there. And yeah, I really hit rock bottom. And the thing that sort of got me through it, and I know this, you know, probably sounds a little bit corny, but I just had this gut feeling that things would get better, and that there was something ahead of me in the future. You know, there was something good ahead of me, and I just had to hold on.

So yeah, I had a pretty traumatic time through my teenage years. And as I sort of got towards the end of my teenage years and came into my early 20s, my symptoms really reduced. And with hindsight, I can see that that was possibly influenced by environmental changes, dietary factors. For example, I stopped drinking Coca Cola every day, that probably helped.

Andrew: Ahh, yeah.

Francesca: All that caffeine and refined sugar, and the effects on endocrine function and nervous function. And I also probably just began, in some ways, eating better, and in some ways not. I'd become a vegetarian at that point in my life. So I was probably getting a lot more veggies, but also getting a lot less fat and protein. 

And for me, OCD just, it just ebbed and flowed through my 20s. And I guess what I was hoping was that it would just go away, that I would outgrow it. And I suppose because it ebbed and flowed, you know, every time it ebbed, you think, oh, great, you know, it is going away. But it would always come back. And when I got to my late 20s, you know, I was forced to acknowledge to myself this isn't going away. It not only keeps coming back, but it's getting worse. I was having my second rock bottom moment. I'd got to the point where I was struggling to leave my house, it was having...the illness was having huge impact on my marriage. My poor ex-husband was suffering a lot. And yeah, I just didn't really have much in the way of a social life. And you know, I just, I knew that I had talents and gifts to bring to my life, but I wasn't able to live them because OCD was just holding me back in so many ways.

And at that point, I also had a lot of stuff going on with my physical health as well. Including, you know, things that you just wouldn't expect to be dealing with at the age of 29. You know, I had urge incontinence, migraines were a regular thing for me, my PMS, you know, kind of had me on the couch at least one day a month. I had acne all through my 20s, even though I hadn't had it in my teenage years, I was bloated all the time. I basically never slept, pretty much throughout my teenage years and my 20s, I didn't get a lot of sleep. And, you know, it was at that point where I could be...I mean, hysterical is really the only word I can think of to describe it, you know? The OCD sort of drove me to hysteria on a daily basis. And it was around age 29, after an honest conversation with my now ex-husband and an honest conversation with myself that I realised, you know, I can't go on like this. 

Andrew: Yeah. 

Francesca: I want to live. I want to get better. And you know, I've just had enough. And so that's when I started looking into my options. And I'd always had a respect for natural medicine. I didn't know a lot about it, but I had a lot of respect for it. And my father had died, when I was quite young, from cancer. And the experience of watching what he went through had sort of put me off Western, you know, the medical model for life. 

Andrew: Yeah, yeah. 

Francesca: You know, so many aspects of it, the way my father was treated in the hospital, the lack of empathy, you know, just so many aspects of it. And I think kind of partly from my father's death is where I just found more respect for natural medicine, and I'd only ever had positive experiences with natural health professionals. And this is not to say that I'm, you know, completely against, you know, the medical model. I'm not. I think that we should be friends and work together, but this is just how it was for me, back then. 

And so, when I started looking for help, I knew that I didn't want to take medication. I wasn't convinced that that was the way forward for me. And so I kind of knew that my option at that stage was therapy or something else, but I didn't know that something else was.

And thank heavens for the internet, I found a naturopath in the United States, Mary Reed, and I got in touch with her. And yeah, she specialises in supporting people with OCD. And I ended up working with her over the internet and over the phone for about 18 months. I still keep in touch with her to this day, although I'm, you know, no longer seeing her as a client. 

But yeah, she got me started not only on the path to getting my life back and improving my mental and physical health, and ultimately achieving about 90% reduction in my OCD symptoms. 

Andrew: Wow. 

Francesca: But she also ignited, helped ignite in me a passion for natural medicine. And you know, she did a lot of webinars and classes and things, and so I started going to all the webinars, and I started learning and taking notes. And then I decided I want to become a natural health professional, and I want to help people with OCD. 

So, that feeling of wanting to become a nutritionist and support people with mental health conditions, particularly anxiety disorders, that probably was born around, I guess, around 2011. And it was towards the end of 2012 that I began my prerequisite studies formally, in anatomy and physiology, before I then moved into the diploma in nutrition science.

Andrew: I'm so glad that you had this burning light inside you. You had...you could see the light. And I want to talk about that later, about how you help others that maybe can't. 

Francesca: Yeah, sure. 

Andrew: Just first, can we take our listeners through what is and what isn't OCD?

Francesca: You know, with anxiety disorders, I think it's, you know, whether we're talking about OCD or generalised anxiety or social anxiety, I think what's really important to understand, as health practitioners, is that, you know, there's a difference between normal, everyday, you know, worries, concerns, anxieties and even, you know, intrusive thoughts. There's a difference between that and when it becomes something that's actually hampering your ability to function, and it's affecting your quality of life and your, you know, your professional functioning and your social functioning, and how you show up in your relationships. 

So, I mean, gosh, we could spend a long time talking about what exactly OCD is. So, I'll try to sort of put it into a nutshell, as it were. So, it is an anxiety disorder, and there are many anxiety disorders. And obsessive-compulsive disorder is characterised by persistent, that's quite a key word, persistent, intrusive, unwanted thoughts which create a level of anxiety for the person experiencing them which drives that person to typically carry out some form of mental or physical ritual to quell that anxiety. 

And unfortunately, carrying out that ritual, this is the compulsion, to quell the anxiety, it's only the temporary. So the intrusive thoughts always come back, and the anxiety ramps up again, and so you end up caught in this vicious cycle of obsessive thoughts and compulsions to try and quell the anxiety. But they always come back. You...

And in some ways, a psychologist will say that you're actually feeding the OCD by carrying out those compulsions. There's a saying with psychologists...

Andrew: Because it works. Right.

Francesca: Well, because you're not changing, I guess, your neural pathways. You're not changing your cognitive, you know, reasoning or functioning around these persistent, intrusive thoughts and fears. 

Andrew: Yeah. Yeah. 

Francesca: And I guess what's really important to understand for...you know, whether you're a health practitioner, or whether you're supporting, you know, someone you love, you know, who's affected by OCD. Whether you're a teacher who's trying to help a student, whatever the situation is, it's really important to understand that for the person affected by obsessive-compulsive disorder, the thoughts are very real, the anxiety is very real, the fear is very real. So it's not something that they can just let go of, or stop thinking about, or snap out of. Because trust me, if we could, we would. 

Andrew: But it's far more than being just a neat freak, correct? It's far more than just a place for everything, and everything in its place.

Francesca: Absolutely. Yeah. So there's actually what we call OCD themes. And unfortunately, the idea of the person with OCD liking everything clean and neat has somehow become one of the most well-known themes, OCD themes in popular culture. 

And so we have memes all over the internet and social media, you know, like there's that common one when you have a party, you know, invite someone with OCD over because they'll be sure to start cleaning, you know? There's a lot of really offensive, misinformed jokes like that, that situate online.

Andrew: Right, yep. 

Francesca: And that actually cause, you know, quite a lot of emotional distress and a feeling of being unseen and, you know, a feeling of not receiving compassion for people who are actually affected by OCD. 

And so one thing that I usually do when I talk to people about OCD, to help increase understanding, is I tell them, you know, there's so many different themes, and yes, for some people, you know, their OCD does take the form of intrusive, you know, scary thoughts around perhaps, you know, infection, germs, disease, lack of cleanliness, contamination. And that can be psychological contamination as well, you know? Sometimes, a person affected by OCD might not actually be able to tell you what it is that makes something feel dirty. But there's a certain, you know, place or a certain object that to them just feels unclean, and therefore scary. And then, of course, the compulsion results to try and get rid of that feeling.

So it's not necessarily about thinking they're going to get AIDS or they're going to catch a disease. It could just be just an intangible feeling that something's unclean. 

Andrew: Yeah. 

Francesca: So that is a real OCD thing. It's a fairly common one, but it's not the only one. And I know from conversations and support groups that I'm in that it causes a huge amount of frustration among people affected by OCD, that everybody thinks it's about being clean and neat. 

So, I'll just quickly talk about some of the other OCD themes. So, this won't be comprehensive, but there is harm OCD, that's a very common one. So harm OCD is where the sufferer, typically, will have intrusive thoughts that harm is going to come to people who they love. Or that they themselves are going to cause harm to other people. 

So, a classic example of this could be hit and run harm OCD. And this could be where the sufferer has persistent, possibly violent, graphic, disturbing mental images, thinking that, you know, when I drive to the supermarket, I'm sure I hit someone, I ran someone over. And so what could happen in that OCD theme, is that the person suffering from OCD will spend an hour driving, you know, retracing their route, driving around, looking for the body of this person that their brain is telling them, yeah, that you hit someone.

Andrew: Oh, wow. That's not just a checking behaviour. Like, is that more of a psychotic behaviour? Is that more of a psychosis?

Francesca: Yeah like, there's definitely an element of delusion there.

Andrew: Delusion, yeah.

Francesca: And I suppose...I guess I'm quite familiar with all the OCD themes, and over the years I've spoken to so many people with OCD, so I'm kind of used to it all by now. 

But I suppose, yeah, I give you these examples because I want to really help illustrate for people who are wanting to learn more about OCD just how invasive this illnesses is. You know, how it literally takes over your mind. 

Andrew: Yeah. 

Francesca: And it's the things that are happening in your brain are very irrational. And the thing is, and this is perhaps one of the cruellest aspects of the disease, OCD sufferers know at some deep level that it's irrational. You know, we know deep down that it's...deep down, we know, you know, I didn't run somebody over in my car. 

Deep down, we know my family's not going to die if I don't carry out this complex ritual. But it's the anxiety that colours everything.

Andrew: Yeah. 

Francesca: And makes it impossible to just sort of push that thought away. So yeah, it's... My own naturopath described OCD as a condition that makes you a slave to what you think and feel. And to date, that is the best description that I've ever heard of OCD. 

So yeah, so you have people...I mean, other examples of harm OCD, a true-life story, a little girl in the UK, she was convinced that her mother would die if she didn't harm herself. So, to keep mum alive, she had to cut herself, for example.

Andrew: She had to harm. Aw, gosh.

Francesca: Yeah, now, you can imagine how heartbreaking that was for the parents. 

Other OCD things, there is...and I think this is a really important one to talk about because it would be great to get a lot more understanding around this. There's POCD, which stands for paedophilia OCD. So this is where the person affected has persistent, intrusive thoughts that I'm a paedophile, if I pick up my child and hug them, what if I have a sexual response? What if I go to the playground and I'm watching the children, and oh, my God, one of the kids would kick the soccer ball over here, what if I hand, you know, the ball back to that child... And they might start having, like, you know, graphic unwanted mental images of things that they don't actually want to do. You know, the thing to realise with OCD is the person who has fear of being a paedophile is not a paedophile. The person who has fears of harming others doesn't have a harming bone in their body. This is the really cruel thing about OCD, is it sort of causes you to doubt yourself.

Andrew: Yeah. 

Francesca: I think...so if we go back to the 1800s and further back, it was actually called the doubting disease. So it's like a really savage self-doubt. And so, yeah, so the OCD sufferer creates these mental and physical rituals to quell these anxieties. And, you know, the rituals could be...it could be cleaning, it could be that you have to mentally recite certain words, or counting things, or you know, carry out certain, you know, physical, sort of ritual activities. You know, some people might think that they have to count in a certain way and it will stop your family from dying. 

Andrew: Wow. 

Francesca: Then, typically what happens if you're interrupted in any way while you're performing a ritual, then you have to go back to the beginning and start all over again. It has to be perfect. It has to feel right. 

And so, you know, people can end up spending hours, literally hours of their daily life on these rituals, trying to make the anxiety go away, trying to stop their families from dying, trying to, you know, quell these fears that they're a paedophile. And it's...yeah. So it really takes over people's lives. 

And with the knowledge that I have now, and the hindsight that I have, to me, it seems like it almost an illness of self-hatred. Because people with OCD are incredibly hard on themselves, and there's a lot of hyper-responsibility going on. 

Andrew: Yeah. 

Francesca: You know, we're responsible for everything.

Andrew: Yeah.

Francesca: I remember the first time I actually sat in a psychologist's office and spoke with him about it, you know, I remember I sort of quite innocently said to him, "Is it true that," you know, "us people with OCD, we're quite hyper-responsible," and without missing a beat, he said, "Very."

Andrew: Worst thing from age 10 to 14, in your formative teenage years, that must have been so hard on you.

Francesca: Oh, it was hell. Like, hell is the word I use to describe it. Because it was. And I actually felt like I was living in hell, at the time. 

Andrew: Yeah. 

Francesca: And, you know, and I was hiding it from everybody around me, and this is the other really sad thing about OCD that I think is, again, really important for health practitioners, you know, in all disciplines and, you know, friends, family, teachers, and you know, loved ones of people who have OCD. It's crucial to understand that people affected by OCD, we carry a huge amount of shame. Because, you know, if you're walking around thinking, oh, other people are contaminating me, or oh, my God, I might be a paedophile, or oh, my God, I think that if I'm around knives, I'm going to pick one up and stab somebody. It's not easy to tell someone that you're having those thoughts. Because, you know, they're going to think you're crazy. 

Andrew: Yeah, that’s right. 

Francesca: Or at least, this is probably what we tell ourselves, people are going to think I'm crazy, I'm going to get locked up. I mean, there have been real-life cases where someone affected by paedophilia OCD has disclosed this to an employer, or in a job interview, you know, doing the right thing, being honest, you know, maybe letting their employer know that they're getting treatment, and have then been, you know, fired from their job. And then had to go and, you know, fight from a human rights perspective. And I'm happy to say that the one case that I know of, the woman actually won her case. I'm very happy to say that. But I'm sure there's others who haven't, and I'm sure there's others who didn't have the strength to fight, and...yeah.

So, there's a lot of shame that goes with this illness. And that, I think, is one of the biggest barriers. Because we know from...I think it's the World Health Organisation data that the typical OCD sufferer waits 10 years before they seek help. 

Andrew: Yeah, yeah. 

Francesca: And I waited...I mean, I lived with OCD for 15 years before I told another person I had it. And I lived with it for 19 years before I decided it was time to get help. 

So, I'm in my late 30s now, and yeah, pretty much from sort of age 10 to 30, my life was kind of dominated by...it wasn't kind of dominated, it was dominated. By this anxiety disorder, OCD. And I think when you've kind of lived in shame in silence for so long...I suppose I've now kind of gone the opposite way, and I don't shut up about OCD.

 Andrew: Yeah, but I've got to say, I'm so glad that you saw that light because you're now offering hope to others. So, I just want to go on, we've spoken a little bit about what it is, and I will ask for some resources at the end because I think it's critically important that practitioners read up about this. They need to upskill.

Francesca: Yes, yes. Yeah, I agree. I agree. And I think it's not covered by a lot of colleges, or it's maybe only touched on very briefly. 

I suppose...well, yeah, maybe something that I'd like to touch on here is we...because I think this is important to understand, especially for a shared care approach, and getting the best for clients. There is some evidence that there is often a role, that childhood trauma often plays a role in the development of OCD, and these mental health problems, in general. 

Andrew: Yes. 

Francesca: So, you know, if you think about it, if you're in your formative years as a toddler, an infant, teenager, and for whatever reason, you know, there's abuse or neglect happening, you're not going to be feeling safe. You're, you know, going to be experiencing probably some pretty painful emotions. 

And there's a brilliant psychotherapist, Pete Walker, he...I can't remember if he's Canadian or American. I think he's Canadian. He's passed away, but he wrote a beautiful book on how to recover from complex trauma. And it's not specifically about OCD, but in that book, he does talk about OCD a little bit. 

And he puts forward the theory that when people become sort of driven by their thoughts, and driven by doing, which I think are two characteristics of anxiety, that you're doing and doing and thinking and thinking. And not relaxing. It's a way of running away from emotions. Because for some people, maybe there is a history of painful unaddressed emotion, and so, becoming fixated on thinking and mental ritual, and doing, and physical rituals, and worrying and planning, and then worrying about planning, and…

Andrew: Yeah. 

Francesca: It's a way to run away from your feelings, whether you realise that or not at the time. And you know, I certainly look back on parts of my life, and that rings very true for me.

And so, yeah, and so to tie that back into this whole concept of safety...yeah, ultimately I think people with OCD, they don't feel safe in themselves, they don't feel safe in the world. They perhaps, they probably don't feel safe with other people and are kind of manifesting in all these different ways. And again, I think as I mentioned earlier, I think there's a real lack of self-love going on as well. 

Andrew: Yeah. 

Francesca: So yeah, all this, you know, there is a role for childhood trauma. And I'm not saying that's the case, everyone who has OCD, that all these things we're talking about here, you know, are good reasons why you might refer to, why you probably should refer to a psychotherapist and have a shared cared approach. 

And also, in terms of treatments that we know work for OCD, the gold standard for probably the last 30 years has been ERP exposure and response prevention therapy, which is delivered by psychologists. Although, I have a theory that the way forward for OCD treatments, and treatment of probably other mental illnesses as well, would be for the nutritionist and naturopath and the psychotherapist, the psychologist/therapist to get together and combine herbal medicine, nutritional medicine, stress reduction, self-compassion tools, with the therapy and with the ERP therapy that the psychologists can deliver. And I think honestly, if we could do that, and if we could make that the gold standard for OCD support, I think we would see a greater reduction in symptoms, you know, a greater reduction of relapse. I think we would just see greater rates of successful rounds, and people getting their lives back.

Andrew: Yeah. 

Francesca: Because it's...you know, it's not just cognitive stuff that's going on. And the psychologists are brilliant at working with that. But there's biochemical stuff going on, there's social and emotional stuff going on, there's a lot of stress response stuff going on. 

And you know if someone gets to the point like I did, where they're housebound with OCD, and they're kind of hysterical, I think that's where you need to go in first with the nutritional medicine and the herbal medicine and get that person off the ceiling before they can actually get into a psychologists office. 

And this is my theory, you know, look after the nervous system, look after the endocrine system, get rid of all the other horrible stuff that might be going on with their physical health, whether it's, you know, migraines, or PMS, or insomnia, or you know, whatever it may be. The classic things that we see in anxiety is often things like headaches and insomnia, digestive problems. You know, reduce all that, and just get the person...just help them calm down a little bit. Get them feeling better, get them sleeping better, get them feeling a bit safer and happier. And you know, get them adding some more good stuff into their life, and then they're going to be able to get into the psychotherapist's office, and then start the ERP therapy and the cognitive behavioural therapy. And then they're going to have a wonderful mental health toolbox.

 Andrew: It's really interesting you mention the nutritional status. And I don't know if she's concentrated specifically on OCD, I'm going to say not, I think she has done work on generalised anxiety disorder. And this is the work, of course, of Professor Julia Rucklidge, at Massey University

Francesca: Yes, I'm a big fan. I actually have one of her papers open now. Julia published a case study in 2009, which did not get as much attention as it should have. So yeah, 2009, Julia published successful treatment of OCD with a micronutrient formula, following partial response to cognitive behavioural therapy. This was in the Journal of Anxiety Disorders, 2009. And yeah, I'm just looking at the abstract of that. And yeah, essentially what happened was she had an 18-year-old male who had cognitive behavioural therapy for a year and sort of, yeah, shifted from having severe symptoms of OCD to moderate symptoms. But after the therapy stopped, things deteriorated for him. His OCD became severe again, he became very depressed. And then he entered a trial where he was taking the micronutrient formula, and he took that micronutrient formula for eight weeks.

Andrew: Wow, that's quick.

Francesca: And to quote from the abstract, "Mood was stabilized, anxiety reduced, obsessions were in remission. The micronutrient treatment was being discontinued for eight weeks, during which time his obsessions and anxiety worsened, and his mood dropped. Reintroduction of the formula again improved the symptoms. This case illustrates the importance of considering the effects micronutrients have on mental illness." 

And actually, when I first came across...I think I came across that study around 2011, and I actually wrote to Julia Rucklidge and just told her about my own experience of how, you know, nutritional and herbal medicine gave me my life back. 

Andrew: Yeah.

Francesca: Yeah, yeah. And I think I was kind of hoping she would study me, but of course, she couldn't because it was all sort of, you know, retrospective at that point. But, yeah.

 Andrew: How do you best approach somebody that might present in your clinic, and you go “Hang on, what's going on here?” Because sometimes they might not come in saying, "Hello. I have OCD, and I'm here to see you." It might be something less obvious. 

Francesca: Yeah. Well, now I'm trying to think...I think about the things I've had people say to me, and if I think about how I would have, you know, talked to someone, back when I was a teenager, and if I'd had the opportunity. 

So it could be, you know, either gender, any age. I don't think we're, you know, looking at a particular demographic here. But if they do have OCD, you can probably assume they've had it for a while, because we know, as I said earlier, people seem to suffer for ten years before they first seek help. 

So, I, as a practitioner, I would advise being very mindful of, for example, if your client comes in and is kind of making vague statements about anxiety, unwanted thoughts, delusions, thoughts that upset them, mental images that upset them, anything like that. And you might even hear a person just use the word obsessive. So they might not say, "I have obsessive-compulsive disorder," but I actually, I had a case study client when I was still at college, and I remember in his initial consultation, he used the phrase, "I have quite an obsessive personality," about five times in the space of 25 minutes. And I said to him, "Do you have OCD?" And he said, "Yeah, good guess."

Andrew: Ah, right.

Francesca: Yeah, yeah. So I think sometimes people might be trying to tell you something…

Andrew: Yeah. 

Francesca: But... You know, again, think about the fact that a lot of these people probably do have a weight of shame hanging around their necks. So yeah, if you hearing anything, like oh, I'm anxious, or I have anxiety, you know, which is pretty vague and we do hear that a lot these days, you know, I would maybe ask questions like tell me how that is you, and you know, make it easier for them. So maybe questions and phrases like are you having unwanted thoughts? Are you having distressing, you know, pictures in your head? And possibly even questions like are you having thoughts that upset you because they're so opposite to who you actually are, you know? Or are you having fears or worries about your loved ones? 

So, those could be some good questions to ask. And then there is actually a tool, and I don't know if...I think it was probably developed for psychotherapists, but it's probably a useful one to be aware of. There's a scale, a Yale-Brown Obsessive Compulsive scale, and it's known as the Y-BOC, or Y-BOC. Yeah. And that's useful for determining the presence and the severity and the type of symptoms in OCD. And if you google Y-BOC, so it was Y-BOC, you'll find that and you'll be able to download it online. 

So again, perhaps more useful for a psychotherapist who's about to commence CBT or ERP therapy. But you know, if you're a natural health practitioner, it could help you, as a practitioner, and your clients get clearer on what's going on. And you know, and it's probably going to be a huge relief, you know, for someone who's living with OCD if as the practitioner you can actually sit there and say, okay, so... I mean, I think most people with OCD know they have it. Not always, but a lot of the time. And if you can sort of, you know, bring that up in a compassionate and accepting way, and you know, just as we would be so comfortable with, you know, someone coming into our clinic room with a gluten intolerance, or psoriasis, or infertility, you know?

Andrew: Yeah. 

Francesca: Why should OCD be any different? So if you can just let them know hey, you know, this is a health condition, yes, it's serious. I'm glad that you've come, and I can help you. 

Andrew: Yeah. 

Francesca: And maybe, you know, if you're interested in working in this area, have a read on OCD themes, you know, have a read on paedophilia OCD, magical thinking, harm OCD, existential OCD, relationship OCD, symmetry, religious scrupulosity, you know, these are all types of OCD themes. And then, you know, then you'll have that familiarity. And just, you know, if you do a bit of reading on that, it really does help to illustrate that the symptoms of OCD are really quite varied, you know, as varied as the people who have it.

Andrew: When you spoke earlier about referring to a psychotherapist, how do you choose a good one? How do you choose somebody that's competent?

Francesca: Well, I mean, aside from the obvious things, like qualifications 

Andrew: Qualifications, yeah. 

Francesca: And registration, I think the main thing to look for is you want someone who specifically says, you know, in their website, in their flyers, in their brochures that they work with anxiety disorders. And you want them to specifically mention OCD. 

Andrew: Right. 

Francesca: And even better, if they're talking about the ERP therapy. Now, when I've looked around, because I've been trying to build up...I've been working at building up a network of psychologists I can refer to, those are the things I look for, you know? And then, you know, how much experience do you have supporting people with OCD? You know, do you use ERP and CBT, or do you use a combination of both, or one or the other? And, yeah, yeah, I guess and maybe just asking, you know, how long have you been working with people with OCD?

Andrew: Yeah. What about things like red flags? And indeed, I've got to ask the question, we covered it a little bit, but is there any specific questioning techniques, or any other techniques that you might employ to find out what it isn't? Like, they haven't got OCD, how would you discern OCD from other anxiety disorders? And indeed, as I said before, the red flags, what do you need to be careful of?

Francesca: Probably the compulsions are, you know, a classic feature of OCD. So, you know, there is generalised anxiety, where people will worry about everything all the time and have a lot of anxious predictions. But I guess what's quite unique to OCD is the intrusiveness of the thoughts and the fact that you often can have graphic mental images, and then the associated compulsion. 

So I guess, asking the person, you know, do you feel like you have to do something to make it right, or to make those thoughts go away…

Andrew: Yeah. 

Francesca: Would be a good tool. And if I think back to my own experience with my naturopath, I mean, gosh, she...yeah, she had me fill out about three questionnaires before my first consultation. And yeah, I mean, she asked me a lot of questions like, yeah, "Do you need to feel like, yeah, you had to do something to make things feel okay again?" You know, "Do you find that you spend a lot of time checking things, or cleaning your environment, or you know, a lot of time on your own personal washing? Do certain, you know, people, or places feel dirty to you? Do you feel like you need to say your prayers over and over and over to get them right? Do you worry that you might have hurt someone? Do you worry that someone might hurt your family? Yeah, questions like that.

Andrew: Yeah. 

Francesca: But then my...so yeah, just thinking back to my own naturopath, she also asked me a lot of questions, I would say, related to nervous health. So, she gave me a big checklist, and I remember going through it and thinking, damn, how does this person know so much about me? 

It was a huge checklist of questions, and it was things like do you find it difficult to be in crowds? Do you feel that you startled excessively, you know, if someone surprises you, or says your name, or if there's a loud noise? Oh, gosh, I should probably...I will have that questionnaire probably somewhere buried on a memory stick. I should probably go back and look at it. But, yeah…

Andrew: Well, maybe we can put these up on the FX Medicine website. Is that okay?

Francesca: Yeah, yeah. And also questions around sleep as well, I think is a big one.

 Andrew: Yeah, of course. Where can practitioners get more resources, both complementary, I guess, in nature, or indeed orthodox in nature, so that they can understand this form of anxiety disorder?

Francesca: Okay, so I will send you a bunch of links, Andrew.

Andrew: Oh, please. 

Francesca: Because I've, for about ten years now...or probably for actually about seven, eight years, I've been collecting a bunch of research articles on OCD. So I do have a nice little collection of articles on serum mineral profiles in OCD, oxidant status in OCD. 

Probably a big thing now...I know this doesn't really answer your question exactly, but a really important thing to know is that for the last probably 15 years, if not slightly longer, there's been a lot of research done where they've used diffusion tensor imaging to look at the white matter?

Andrew; Yeah. 

Francesca: In the brains of people affected by OCD, and in, you know, compared with white matter in the brains of people not affected by OCD. So, when we're talking about white matter, we're talking about nerve fibres and myelin sheaths. 

And what's been found is that people...consistently, across many studies, what's being found is that the amount of white matter is reduced, or is abnormal, there are white matter deficits in the brains of people who have OCD. Meaning that there are, as one researcher put it, there’s less strong connections and nerve fibres. 

And the reason this is so fascinating to me is because my own naturopath had a theory about the link between problems with myelin and OCD. So we do...now, I don't know if we know this for certain, I think it’s speculative, but there is some evidence for it. It would appear that omega-3s support white matter integrity. I know from my own experience, and experiences of clients and people that I was in a support group with back in the day, when I was early in my recovery, we all felt a lot better taking omega-3. And to some of us, that was a lot of omega-3. 

Andrew: So, what sort of dose? What sort of dose are you talking about?

Francesca: Okay, I'm going to be completely honest here. Now, I'm normally pretty careful who I say this to because I don't want the general public to rush out and do this unsupervised because they would not be safe. But for me, I was taking both flaxseed oil and fish oil for a number of years. And at one point I was taking 10 grams of fish oil a day and I was generally taking two tablespoons of flaxseed oil a day, separated. So, that's just off the top of my...

Andrew: That's high.

Francesca: That is very high, yeah. 

Andrew: That’s high. 

Francesca: I mean, I wasn't always taking ten grams of fish oil a day, it was probably more around five, six grams a day, but now and then I would give myself a boost. And in the months leading up to when I hit that point where some of my major OCD fears just weren't there anymore, I had boosted up to ten grams a day. 

Now, I was doing this under the supervision of a qualified naturopath.

Andrew: Yeah. 

Francesca: And I was looking after my liver. I'd done a lot of liver work because that's a lot of hard work for the liver. But I can tell you that, yeah, I certainly was eating a lot more protein, a lot more B12, B6, a lot more saturated fat. And yeah, long term, I also took magnesium long term. What else was I doing back then? Herbs for my liver, nervines...I mean, I took nervines for years.

Andrew: Yeah. Absolutely.

Francesca: And to be honest, I'd quite happily take nervines for the rest of my life. I think nervine is the best thing ever. 

And I waited quite a while before I took B complex... And I didn't really understand it at the time. My naturopath had explained to me, but I didn't understand it at the time, with the level of understanding I had. But she warned me to be careful with B complex, and that when I did start taking it, that I had to go very slowly, and that if I, you know, noticed that any symptoms got worse, I had to stop taking it. 

And yeah, so it was probably a solid year of really improving my diet and looking after my liver, and really, you know, getting more essential fatty acids, and more minerals before I'd even, you know, moved into taking B complex as well. 

And actually, something that frustrated me was when I began studying, and I talked to a couple of my tutors, I actually had a couple of tutors say to me, you know, point blank, "That is ridiculous, you shouldn't be taking that many supplements," you know, da, da, da, da, and, "You shouldn't be taking them long term." And fortunately, I had the confidence, and I felt well enough at that point to just know this has helped me, and...you know, because sometimes when you're younger, you do take on board everything everybody else says. But...

Andrew: So, of course.

Francesca: I do wonder if, you know, for people affected by not just OCD, but mental health conditions, there is a role for mega-dosing. Because historically, if we look at the work of Abram Hoffer and Carl Pfeiffer who were medical doctors who pioneered, you know, nutrient therapy for mental illness, they were quite keen on mega-dosing. I think that's where the term mega-dosing comes from. 

Andrew: Yeah. 

Francesca: High dose niacin for schizophrenia, for example. High doses of B12. So...yeah. So, certainly, and we know that, you know, there's some research that shows mineral deficiencies in the serum of people with OCD, compared with the control group...

Andrew: That's very interesting. So that sort of goes along...thank God we've got the brilliant work of Julia to rely on here, for actually an intervention-type study, or studies, using these micronutrients. And, you know, I guess there's a dose ranging there, the Abram Hoffer, Carl Pfeiffer sort of approach. I'm just so glad that you've been able to hook into their foundation, if you like, and use it for your own benefit, and now be in a place where you can help others in the same sort of predicament.

Francesca: Yeah, yeah. Well, I mean, and hey, there's probably still a lot that I don't know. I mean, I look over the research and, you know, I believe there's a role for alterations in the glutamatergic, dopaminergic, serotonergic pathways. 

Andrew: Yeah. 

Francesca: You know, there probably could be something going on...yeah, this could all be related to genetic variants. But I think as practitioners, yeah, the main thing to understand is, you know, just see that person as a person who has an illness, first and foremost. And help lift some of that shame, and let them know you can help them. And then of course, you know, as holistic practitioners, we look at diet and lifestyle first. Because even if there are problems going on at genetic level, you know, cleaning up diet and lifestyle first is going to have positive impact on all of that. 

I mean, I've never had any genetic testing done myself. I finally reached the point where I'm curious and I'm thinking about doing it. I think there probably is something going on for me, at a genetic level, and there's enough research to suggest that genetics do play a role in the pathophysiology of OCD. 

But you know, for me those diet and lifestyle changes, and the herbal medicine...you know, I'm a nutritionist, but I have to give a big shout out to herbal medicine because that all really helped me. And...

Andrew: You'll be back at college.

Francesca: Yeah, I know I will be, eventually. I'll be upgrading to become a naturopath. But you know, those things helped me, and I can't stress enough the stress reduction, and you know, filling up your life with good stuff. 

Because at the point where I hit rock bottom for that second time, I had some pretty toxic people in my life. 

Andrew: Yeah. 

Francesca: I had some pretty stressful stuff going on, and on a day-to-day basis. You know, I wasn't filling up my day with things that brought me joy. And so part of my OCD recovery was I bought a piano. I got a pet cat...or actually, she got me, she showed up on my doorstep. I'm still convinced that that cat was a gift from the universe. You know, I distanced myself from toxic people.

Andrew: Yeah. 

Francesca: I stopped putting up with certain things, I started putting myself first more, and I started laughing more. I started watching more stupid comedy, silly films. And you know, so I think there's a huge role for all of that, in almost supporting a person affected by probably any form of illness, just especially one where there's been a history of sort of...yeah, sort of self-doubt and lack of self-kindness. 

Andrew: Yeah. 

Francesca: You know, support that system, and fall in love with themselves, and finding their talents and their gifts, and the things that light them up inside. And I truly believe that all that is just as important as the pathology and the nutritional therapy. And you know, in some ways, maybe it's more important..

Andrew: Yeah. 

Francesca: Than the technical stuff that goes on in the lab.

Andrew: Yeah, yeah. Francesca Eldridge, thank you so much for joining us on FX Medicine today, and for taking us through... Obviously, it's something that has filled you with passion because of your own experiences. But now you have both the credentials and, obviously, the compassion to help your fellow patients, not just with this, but in other anxiety disorders as well. 

So, thanks so much for joining us on FX Medicine today. 

Francesca: Hey, thank you so much for having me. And, yeah, it's been an absolute pleasure. Thank you. 

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook


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