Around three quarters of a million people are thought to be living with severe, life impacting and debilitating Obsessive-Compulsive Disorder (OCD) here in the UK.
Obsessive-Compulsive Disorder (or more routinely referred to as OCD) is a serious anxiety-related condition where a person experiences frequent intrusive and unwelcome obsessional thoughts, commonly referred to as obsessions.
Obsessions are very distressing and result in a person carrying out repetitive behaviours or rituals in order to prevent a perceived harm and/or worry that preceding obsessions have focused their attention on. Such behaviours include avoidance of people, places or objects and constant reassurance seeking, sometimes the rituals will be internal mental counting, checking of body parts, or blinking, all of these are compulsions.
People with OCD experience unwanted obsessions which take the form of persistent and uncontrollable thoughts, although obsessions can sometimes be persistent images, impulses, worries, fears or doubts or a combination of all these. They’re always intrusive, unwanted, disturbing and most importantly significantly interfere with the sufferers ability to function on a day-to-day basis as they are incredibly difficult to ignore.
People with OCD usually realise that their obsessional thoughts are irrational, but at the same time feels so very real and they believe the only way to relieve the anxiety caused by them is to perform compulsive behaviours (which includes avoidance and seeking reassurance). These compulsive behaviours are carried out to prevent perceived harm happening to themselves or, more often than not to a loved one, even when there is no correlation between their thoughts and compulsive behaviour.
In 2005 The National Institute for Health and Clinical Excellence (NICE) published their guidelines for the treatment of OCD and BDD, within their findings they published this table to illustrate the types of obsessive fears that people with OCD have reported.
|Contamination from dirt, germs, viruses (e.g. HIV), bodily fluids or faeces, chemicals, sticky substances, dangerous materials (e.g. asbestos)||37.80%|
|Fear of harm (e.g. door locks are not safe)||23.60%|
|Excessive concern with order or symmetry||10.00%|
|Obsessions with the body or physical symptoms||7.20%|
|Religious, sacrilegious or blasphemous thoughts||5.90%|
|Sexual thoughts (e.g. being a paedophile or a homosexual)||5.50%|
|Urge to hoard useless or worn out possessions||4.80%|
|Thoughts of violence or aggression (e.g. stabbing one’s baby)||4.30%|
The table above is perhaps a good example of the types of obsessive fears that people with OCD will experience. However, in different parts of the world where different beliefs are more prevalent these percentages may changes. For example, countries where religion is a prominent part of everyday life, obsessions around religious thoughts may become more common.
Occasionally some people affected by OCD will report no obvious obsessive fear, just compulsions. In these rare cases, either the individual does not have OCD (OCD needs to include both obsessions and compulsions for a diagnosis) or most likely they did have an obsessive fear/worry originally, but it has been forgotten over time. Now, their obsession is that feeling of discomfort – All obsessional thoughts (regardless of content) usually produce a sense of discomfort, or a ‘feeling’ of unease. Some people describe it to be an increase or trigger of anxiety, but for others it is simply that ‘feeling’ of general unease, tension and/or discomfort.
Often a person living with OCD will feel a heightened sense of responsibility to perform the neutralising behaviour simply because they feel doing so will prevent harm coming to themselves or loved ones. Equally, sometimes the person with OCD will have an overwhelming urge to obtain that ‘just right’ feeling with no other reason than to feel comfortable.
A compulsion can either be overt (i.e. observable by others), such as checking that a door is locked or covert (an unobservant mental act), such as repeating a specific phrase in the mind.
Overt compulsions typically include checking, washing, hoarding or symmetry of certain motor actions. Another key compulsive behaviour, particularly where the sufferer lives with another person is the need to seek constant reassurance. Initially, like any compulsion, when reassurance is received the sufferer will feel an initial sense of relief, but the doubts and uncertainty caused by OCD will return, and the need to seek further reassurance follows.
Any relief that any of the compulsive behaviours provide is only temporary and short lived, they simply reinforce the original obsession and need to carry out the compulsion, creating a gradual worsening cycle of OCD symptoms.
Treatment for Obsessive Compulsive Disorder
Cognitive Behavioural Therapy
CBT makes use of two evidence-based behaviour techniques, Cognitive Therapy (C) that looks at how we think, and Behaviour Therapy (B) which looks at how this affects what we do. In treatment we consider other ways of thinking (C), and how this would affect the way we behave (B).
CBT is used successfully as a treatment for many psychological problems, including OCD and other anxiety problems such as panic, post-traumatic stress disorder and social phobia. It also figures in the treatment of eating disorders, addictions and psychosis. In many cases, CBT alone is highly effective in treating OCD, but for some a combination of CBT and medication is a more effective treatment package, especially if there is co-morbidity like depression. Medication can be helpful in reducing anxiety enough for a person to start, and eventually succeed, in therapy.
Exposure Response Prevention (ERP)
ERP is a therapy that encourages you to face your fears and let obsessive thoughts occur without ‘putting them right’ or ‘neutralising’ them with compulsions.
By using what we call ‘behavioural experiments’ in CBT, a person with OCD finds out what happens when they don’t check or perform their rituals. Rather than just riding out their anxiety in the feared situation (as in ERP). CBT tests out the sufferer’s belief that they could ultimately be responsible for harm if they do not check or perform their rituals (cognitive).
The therapist will always acknowledge that there is a risk that something bad could happen if the sufferer doesn’t do their compulsions, but explains that it is the compulsions themselves that magnify their perception of risk, which we talked about in the understanding OCD page. The one guarantee is that with continued checking, washing, ruminating, OCD will always remain a problem.
The importance of facing fears
Being asked to face your fears is perhaps one of the bravest aspects of treatment, and is where the approach of the therapist is most valuable, helping a person understand the cognitive reasons behind an exercise and being there to help encourage and motivate them to face the challenges it involves. If the therapist actually participates in the exercises too, this helps build up trust and confidence in what they are asking the person with OCD to do.
Generally, people find that exposure exercises are not as difficult as they thought they would be, and their anxiety and fears fade away much quicker than they ever imagined. This helps boost their confidence and makes tackling more difficult challenges much easier.
OCD doesn’t have to be a burden, there are ways to deal with it and minimise its impact on daily life.