(OCD) Obsessive Compulsive Disorder 

What is it?

We all have habits of some description, such as having to double check the front door is locked or making sure the TV is unplugged from the wall before going to bed.

For people who have obsessive-compulsive disorder (OCD), these habits ‘take over’ and begin to seriously impact on their quality of life. Their recurrent obsessions and /or compulsions are severe enough to cause considerable distress and interfere with the person’s functioning at work and at home with their family, and in social activities.

Obsessions are unwanted, intrusive thoughts, ideas, urges, impulses or worries that run through the person’s mind over and over again. Often the ideas do not make any sense, or are unpleasant or counter to the person’s values or beliefs. They are accompanied by fear, guilt, worry, sadness or anxiety. Common obsessions include:

  • repeated impulses to kill someone you love (even though that is the last thing you’d want to do in reality);
  • worries about dirt, germs, contamination and infection;
  • recurrent thoughts that something has not been done properly, even though you know it has;
  • fear about losing something important;
  • fear about being responsible for keeping someone safe / preventing harm;
  • ideas that certain things must be in a certain place.

Compulsions or rituals

Compulsions or rituals are repeated behaviours or mental actions that are used to reduce anxiety or discomfort caused by an obsession. The purpose or intention behind a ritual is to ‘undo’ or ‘neutralise’ the obsession. Most people recognise that these rituals are excessive but still feel compelled to do them in a particular way, according to their own rules, like checking the car alarm six times.

Common rituals are: hand washing, showering, cleaning, touching certain objects, repeating an action to undo a thought or image, placing things in a particular order, collecting items, repeating certain phrases, exchanging a ‘good’ thought for a ‘bad’ one. Compulsions may occur only now and then, or they may take up many hours every day.

OCD is often a long-term condition that fluctuates over time. The person with OCD may go to great lengths to hide the problem so that the disorder goes unnoticed, even by family members. However, when the symptoms start to impact on different aspects of a person life, sometimes becoming their major life activity, OCD becomes difficult to conceal.

How does OCD begin?

Lots of people have intrusive thoughts that are similar to those experienced by people with OCD, such as thoughts of doing something violent or verbally blasting someone or being extremely rude.

However, people who don’t go on to develop OCD seem to understand that while their intrusive thoughts are unexpected or odd, they don’t really warrant attention and are easy to dismiss.

In contrast, people who go on to develop OCD appear to respond to these intrusive thoughts as if they represent real threats and have to be taken seriously.

They try and stifle the thoughts. This usually has the opposite effect - the thoughts appear more often. In addition, people who are afraid of their intrusive thoughts or images start to avoid situations and /or objects that might trigger the thoughts (for instance, the kitchen area where there are sharp knives, provoking thoughts of stabbing someone).

This often does not work, so the individual tries to undo them using behavioural or mental rituals. Unfortunately, avoiding situations and compulsions prevent the individual from experiencing their thoughts fully and getting used to them so that they no longer cause discomfort or distress.

In this way obsessions and compulsions can become an increasingly deep-rooted pattern, and the person never learns that, by tolerating the obsessions without avoiding situations or engaging in rituals, their fears will reduce over time.

Treatment of OCD

Many people can benefit from treatment using Cognitive Behavioural Therapy (CBT) and/or medication.

Essentially there are two approaches within CBT for OCD.

1) The behavioural approach aims to disconnect obsessive thoughts, images and impulses from the fear and distress usually associated with them. This is achieved by:

  • gradual exposure to a list of feared situations (planned carefully in advance with your therapist); and
  • prevention of rituals and avoidance behaviours.

2) The cognitive approach helps people to examine their interpretations and beliefs, and to develop alternative ways of thinking about intrusive thoughts and images that are far less threatening. Basic elements are:

  • Identification of irrational thoughts and beliefs
  • Questions examining the logic for the interpretations (‘how have you arrived at this conclusion?’)
  • Techniques, such as conducting your own behavioural experiment to test out ideas relating to obsessions or estimating areas of responsibility for a feared event, that can help challenge thoughts or beliefs (‘provide a reality check’).

Self-help and finding out more...

In this short video from NHS Choices, someone who has experienced OCD talks about how Obsessive Compulsive Disorder has affected her, how she has dealt with it, and the support available to people with OCD. You might also find the following self-help guide to OCD helpful in learning more about your own situation.

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