OCD from an IFS perspective

The founder of IFS, Richard C. Schwartz, developed IFS while working with bulimic clients. In this article, I am going to show how the roots of IFS offer a hopeful and valuable new way of framing our understanding of OCD.

I have worked with OCD clients for years, and it is only since I started using IFS that I have noticed the biggest shifts. I am recently reading, again, the Richard Schwartz’s book “Internal Family Systems (second edition)” and I can see quite a few similarities between his journey in the treatment of bulimia, and the patterns I am encountering while working with OCD.

Aug 2024 Update - This article does not deal with OCD that is the result of neurodivergence and/or the result of PAN/PANDAS neuropsychiatric disorders affecting children.

What has got bulimia to do with OCD?

While it might not be that intuitive, bulimia, as well as other conditions that we call “eating disorders”, has got all the features of an OCD condition.

Bulimic people generally have obsessions with some aspects of their body and/or appearance, coupled with the compulsion to purge. Fred Penzel, one of the writers I have found most informative about OCD, includes eating disorders (as well as other conditions) under the OCD umbrella, and predicts that, with time, more and more mental health conditions will fall under the name of OCD.

No treatment for OCD exists, yet

Despite having reached out to various colleagues and having done some research on the treatments available for OCD, I have found lack of clarity and research over the help available to people affected by OCD.

Sometimes OCD gets so bad that, unfortunately, obsessions and compulsions become invasive to the point that the person can barely function. In these cases, OCD is treated with medications that lower the anxiety, but this is the realm of psychiatry and I am not qualified to give any advice on that. What I can see, though, is that there is nothing like “inpatient” treatment centres that exist for addiction problems, and the best someone can hope for is to have a diagnosis of OCD, access to medications (if they believe is it appropriate), attend OCD groups, and privately funded therapy.

The type of therapy offered by the NHS in the UK is a course of CBT, which can help clients understand what goes on in their mind and which can give strategies that include

• noticing the anxieties without acting on them

• some level of exposure to what triggers the anxieties so that the client can re-frame their thinking

• a structure with small and achievable targets to make sure life is not taken over by OCD symptoms

While the above is, arguably, a definitive solution to OCD, it is certainly a good starting point that people can easily try. The downside to the bullet points above is that there is no mention of the traumatic causes of OCD. The CBT model draws its strength from the fact that it teaches that our symptoms and unwanted behaviour come from some form of distorted cognition that we apply to an external stimulus. Where it falls short is in the exploration of the “inner world”, which is where IFS shines.

Looking inside, and not just outside

In IFS we use a technique called “insight” to help clients engage in an inner journey to get to know the many different parts that make up our experience. Here is what Richard C. Schwartz writes about “regular” protagonists inhabiting the mind of a bulimic client

When I pressed her [the bulimic client] to differentiate these voices [in her head], she found—to our mutual surprise—that she could easily identify several regulars who got into heated debates. One voice was highly critical of everything about her, but especially her appearance. A second defended her by blaming either her parents or the bulimia for her problems. A third felt sad, hopeless, and helpless. And, finally, there was a fourth who “took over” to make her binge.

Schwartz, Richard C.; Sweezy, Martha. Internal Family Systems Therapy, Second Edition (p. 12). Guilford Publications. Kindle Edition.

We can easily extend this idea to OCD. The name “obsessive-compulsive” lends itself to the idea that there are, at least, two regulars that contribute to the condition

• One part that obsesses about something (for example about something being contaminated, or about some possible illness)

• One part that, in order to lower the anxiety (as CBT teaches us), activates the compulsion of choice (washing hands, performing checking and rituals, etc.)

I would add more parts to this

• A part that wants to “fix” the OCD and wishes it never existed

• A part that fears that there is no end to the OCD

• A part that wants to carry on as if OCD did not exist

The more clients I work with, the more parts I get to know. Each internal system is different, and there is hope for each of them.

Naming the parts

What clients find useful is to start becoming familiar with the parts that, together, create their OCD experience. It can be extremely refreshing to think of OCD as the result of the interaction of parts, rather than an illness or a condition that is at the core of oneself.

Within 2 to 3 IFS sessions targeted at getting to know the parts that make up the OCD experience, it is possible to identify the main parts at play so that the client can become aware of when these parts are taking over. In IFS, when a part takes over our body, mind and behaviour, we say that we are “blended” with that part. It is necessary for healing and for any therapeutic gain that the client realises when they are blended with a part.

Naming the parts can be a first step to get to know your parts and, therefore, be able to interact with them. This leads to the next step

Finding out why parts do what they do

One of the most extraordinary discoveries of IFS is that, once we connect to a part of ourselves from a place of curiosity, parts start to open up and reveal the reasons why they do what they do.

It is our parts, according to IFS, that hold the knowledge and the information about what they do in our system. While other types of therapy might make very good guesses as to why we develop certain behaviours, I have found that our parts can tell us with great precision and clarity why they take on certain roles, and why they get so extreme. This is in line with the general principles of Coherence Therapy (founded by Ecker and Hulley in the 1990s), which states that symptoms “make sense” and are coherent with our psychological structure and development. Gestalt psychotherapy also has a similar take on symptoms and sees them as a form of “adjustment” used to regulate the interaction between the person and the environment.

In the case of OCD, we are dealing with some of the most extreme behaviours that parts can have, and these behaviours come from trauma. It is only our parts that can tell us the way to heal this trauma. Usually the trauma that caused the OCD is buried and exiled in the most remote corners of our psyche. It is only by making safe connections with the parts of us that hold this trauma that we can restore health and wellbeing.

Final thoughts

I hope this article gave you food for thought, but also touched your heart. Who suffers from OCD experiences a lot of pain for many years, and it is important, and possible, to find a way to heal from it.