Christina sparkles with enthusiasm for life. She is 27, working in a new job in a graphic design firm, which she loves. She loves her team. She loves the creativity that permeates the office, and she loves sparking and sharing ideas with those around her. She uses the word “love” a lot.
But all is not well because not everyone on the team is as enthusiastic as she is, and she suspects some resent her and gossip about her. She is terrified of being excluded because it has happened to her before — being cut out of friendship groups. Gravely she tells me that she has had periods of severe depression — and long periods of therapy — since the age of nine. That was when children she thought were friends were horrid to her at school. She became a people pleaser, as she termed it, desperate for acceptance, and yet the same thing happened again when she was 15 and girls in her friendship group rejected her, seemingly overnight.
This must have been truly awful. We know that being ostracised from groups can be a devastating experience, particularly for adolescents. Researchers at the University of British Columbia found that in adolescence (a time when opinions within peer groups become more influential than those of family) the most toxic challenge to sense of status is being ostracised or rejected by a group that one thought accepted them.
This kind of rejection is three times as likely to lead to depression as other highly negative life events, and can have lasting effects, if not addressed.1 Seemingly, the long bouts of therapy that Christina had undergone had not successfully addressed it.
“I’ve worked hard to get where I am and to be a nice person,” she sobs. “I don’t want people not to like me.”
I observe that suspicions are not facts, and that not everyone likes everyone, often because of their own experiences or conditioning; what counts are the close friends and colleagues who genuinely value and respect her.
She turns mournful eyes towards me: “You don’t understand. I have existential OCD.”
Existential OCD is now a thing — designated a subtype of OCD in which sufferers are plagued by distressing intrusive thoughts about the meaning of life, fear of non-existence, fear that none of us really exists, fear that nothing matters, etc, and spend hours ruminating and desperately searching for answers. It’s a highly disabling manifestation of the condition. As uncertainty of any kind is a major driver of anxiety, the existential variety will definitely top all others, because no such certainty is likely to be forthcoming in this lifetime.
But my instinct was that the roots of Christina’s distress were much more down to earth. Quite clearly, she did not spend hours wracked with such thoughts, as she was an effective, enthusiastic member of her team, who had high expectations of herself and the company, and enjoyed a busy social life outside of work.
So I asked her to explain. She sighed. “It’s worry about meaninglessness – I’ve got friends, money, a career, a fun social life, but it could all vanish. Yesterday, for instance, I had a panic attack about the point of it all.”
“What happened yesterday?”
“I had a lovely Sunday planned with two of the people at work — it was my idea and I was really pleased that we were going to drive to a beauty spot none of us had ever visited and then go for a meal in a highly recommended pub restaurant nearby. And then the one who was driving us had to cancel last minute and immediately I was sucked into the pointlessness of it all and spent the rest of the day agitating about it. Whatever you try to do, nothing matters in the end.”
Sidestepping the catastrophising, I said, “You must have been really disappointed that something you were so looking forward to had to be postponed.”
She looked at me cautiously. I said it again.
“It was a disappointment. It is normal to feel sad for a while about a disappointment, Christina. Especially when friendship and your place in a friendship group matters to you so much. It’s all right to allow that disappointment, you know. To just allow it to be there while finding something else to do with your unexpected free time.”
Breaking out of her negative trance, she smiled and reminded herself that she does try to find the positives in situations and make the best of things. At our next session, we will use the rewind technique to neutralise the high emotion around past rejection and build on her ability to put things into proper perspective.