By Annie Makoff MembersWorking with Obsessive Compulsive Disorder20 Jul 2023 OCD is widely misunderstood. Here’s how two people are working with the condition, and what employers can do. Freelance practice accountant and bookkeeper Natalie Micu AATQB works with clients across several industries: manufacturing, online retail, software and engineering as well as the wellbeing sector. But there’s something slightly different in how Natalie works. She relates to clients on a deeply personal level, sharing some of her own circumstances while clients share theirs. It serves two purposes: building and maintaining client relationships is crucial for business success, but also, it’s a way for Natalie to ensure she works with people who understand and accept her. Natalie, who speaks six languages and is highly skilled in QuickBooks, Sage, fraud analysis and forensic accounting, has Obsessive Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) which developed following 20 years of domestic abuse. Her memories, she says, are still with her, sometimes returning as flashbacks. And some things still trigger her. “I did eventually leave the abusive relationship, but the experience has affected my life in huge ways,” says Natalie. “If someone raises their voice, regardless of the situation, I have a ‘fight, flight or freeze’ response. I become extremely agitated, upset, nervous and very tearful.” PTSD can develop following distressing or life-threatening events such as war, sexual assault and, as in Natalie’s case, domestic abuse. Symptoms can include intense flashbacks and intrusive memories, severe emotional distress or avoidance of certain activities or places that may trigger a memory. It’s possible that Natalie’s OCD developed as an unconscious coping technique – a way to bring order, control and stability into her world. For example, Natalie says she always needs to know where certain things are. When she worked in an office environment, she’d have a box of things she’d take to and from the office and would become ‘extremely anxious’ if she couldn’t find them. She also needs to arrange things such as files or books and arrange them in a certain order and she likes things to be clean and tidy.A lot of people think ‘that’s irrational’ and they’re absolutely right, but rationality goes out the window with OCD. Nick ElstonNick Elston, Inspirational Speaker of Lived Experience and Mental Coach, developed OCD and Generalised Anxiety Disorder (GAD) after witnessing a family accident in his childhood. He explains “OCD behaviours try to help you control the uncontrollable. For me, that meant checking gas or light switches three times. Even at the age of seven, I feared I would bring harm to my family if I didn’t do these things. You’re fuelled by compulsive, intrusive thoughts. A lot of people think ‘that’s irrational’ and they’re absolutely right, but rationality goes out the window with OCD.” In Natalie’s case, she’s sometimes struggled in job interviews if there is a shelf with files or documents – she has to stop herself from trying to organise them. And when she’s away on holiday, Natalie has to inspect, check and clean every inch of the accommodation until she experiences relief from her compulsive thoughts. Yet this relief only lasts so long. If Nick asks for emotional reassurance from someone or checks a gas appliance a certain number of times, twenty minutes later, he’ll need to repeat the behaviour.So what exactly is OCD and how does it manifest?OCD is characterised by obsessive thoughts and compulsive behaviours which can be extremely distressing. There may be repeated, unwanted thoughts or images which can lead to a ‘compulsion’ to act to experience temporary relief. Someone with a fear of illness or disease for example, may need to clean constantly, or constantly check on loved ones and experience extreme anxiety if loved ones leave the house. Nick believes that OCD as a pathological diagnosis just isn’t generally understood to the depth it should be, even though it’s a term many are familiar with. There are many light-hearted television programmes such as Channel 4’s Obsessive Compulsive Cleaners, but this just trivialises it. “You might hear people say ‘I’m a little bit OCD’. Well no, you’re not OCD. It’s a very painful, frustrating and debilitating condition.” This lack of understanding can cause problems in the workplace. Natalie herself has struggled – and having both PTSD and OCD has made it impossible to continue in an office environment. It’s why she took the decision to become freelance. “One of my employers was very impatient and unsympathetic,” Natalie recalls. “Whenever I was in an emotional state he’d get very frustrated and ask me, ‘do you actually want to work here?’ What I needed was support and to be understood.” The need for validation and the space to be herself is essential for Natalie’s mental health. It’s why her primary focus is on working with clients who understand and who have similar experiences. The relationships she builds with clients early on ensures they’re both a match, emotionally and professionally. In this way, she doesn’t just provide skilled accountancy work and advisory services, but she offers emotional support, too. “Many of my clients have their own mental health difficulties whether it’s ADHD, autism or OCD and I support them in what they’re going through,” she says. “I don’t want anyone to go through what I went through, so I make sure I’m a shoulder to cry on. My clients are like family – we’ve built very strong relationships and have bonded. To me, that’s just as important as providing accountancy services.”Providing support With OCD affecting 12 in every 1,000 people according to OCD-UK charity and 1 in 10 people experiencing PTSD at some point in their lives according to PTSD UK, what should employers do to support their employees to ensure they’re continuing to thrive in their roles? For Nick, utilising lived experience to foster understanding and awareness is absolutely key. “If there’s someone with lived experience willing to share their experiences with their peer group, that’s always going to be powerful. Lived experience is the perfect vehicle to drive engagement to solutions.” Clear communication and psychological safety where employees can speak privately to their line manager is also important, Nick adds. “It needs to be easy for people to speak confidentially if they need to. You can actually be high performing and highly functioning but still struggling and no one will know otherwise.” From a practical point of view, Nick recommends that line managers communicate clearly about tasks and objectives. “Some people with OCD like me need clarity. I need specific instructions or I just lose focus completely or, conversely, I get bogged down in too much detail.” Working flexibly can help too, particularly if the office environment creates anxiety. Then there’s the importance of talking therapies which can be extremely beneficial for some people. For Nick though, enabling people to form community groups and share experiences can be an immensely valuable tool. “OCD manifests in many different ways,” he explains. “We need to have those human-to-human conversations to understand this in psychologically safe spaces. I always say that the deeper we share, the stronger the sense of community.” ResourcesCharities that advocate for OCD supportOCD ActionOCD-UKTraining workshopsOCD-UK’s workshopsMind’s workshopsReasonable adjustmentsAn overviewFor employersFor employeesSelf-helpThings you can do Annie Makoff is a freelance journalist and editor.