What is OCD?

Obsessive-compulsive disorder (OCD) is an anxiety disorder. It has two main parts: obsessions and compulsions. Obsessions are unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind.

Most people with OCD fall into one of the following categories:

• Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
• Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
• Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
• Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colours, or arrangements.
• Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.

Symptoms:

Obsessive-compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

This pattern has four main steps:

1. Obsession – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind.
2. Anxiety – the obsession provokes a feeling of intense anxiety or distress.
3. Compulsion – repetitive behaviours or mental acts that you feel driven to perform as a result of the anxiety and distress caused by the obsession.
4. Temporary relief – the compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

Some common obsessions that affect people with OCD include:

• fear of deliberately harming yourself or others – for example, fear you may attack someone else, such as your children
• fear of harming yourself or others by mistake – for example, fear you may set the house on fire by leaving the cooker on
• fear of contamination by disease, infection or an unpleasant substance
  a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way

Common types of compulsive behaviour in people with OCD include:

• cleaning and hand washing
• checking – such as checking doors are locked or that the gas is off
• counting
• ordering and arranging
• hoarding
• asking for reassurance
• repeating words in their head
• thinking “neutralising” thoughts to counter the obsessive thoughts
• avoiding places and situations that could trigger obsessive thoughts

Causes:

The causes of OCD are not fully understood There are several theories about the causes of OCD, including:

• Compulsions are learned behaviours, which become repetitive and habitual when they are associated with relief from anxiety.
• OCD is due to genetic and hereditary factors.
• Chemical, structural and functional abnormalities in the brain are the cause.
• Distorted beliefs reinforce and maintain symptoms associated with OCD.

It is possible that several factors interact to trigger the development of OCD. The underlying causes may be further influenced by stressful life events, hormonal changes and personality traits.

Treatment:

The two main treatments are:

psychological therapy – usually a type of therapy that helps you face your fears and obsessive thoughts without “putting them right” with compulsions

medication – usually a type of antidepressant medication that can help by altering the balance of chemicals in your brain.

Cognitive Behavioural Therapy:

Therapy for OCD is usually a type called cognitive behavioural therapy (CBT) with exposure and response prevention (ERP).

This involves:

• working with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions
• encouraging you to face your fear and let the obsessive thoughts occur without neutralising them with compulsive behaviours – you start with situations that cause you the least anxiety first, before moving onto more difficult thoughts

Medication:

You may need medication if psychological therapy doesn’t help treat your OCD, or if your OCD is fairly severe.

The main medications prescribed are selective serotonin reuptake inhibitors (SSRIs). These can help improve OCD symptoms by increasing the levels of a chemical called serotonin in your brain.

You may need to take the medication for 12 weeks before you notice any effect.
Most people require treatment for at least a year. You may be able to stop if you have few or no troublesome symptoms after this time, although some people need to take medication for many years. Your symptoms may continue to improve for up to two years of treatment.

Don’t stop taking SSRIs without speaking to your doctor first, as this can cause unpleasant side effects. When treatment is stopped, it will be done gradually to reduce the chance of this happening. Your dose may need to be increased again if your symptoms return.

Self-help tips for people living with OCD:

There are many ways that you can help yourself in addition to seeking therapy. Some suggestions are:

• Refocus your attention (like doing some exercise or playing a computer game). Being able to delay the urge to perform a compulsive behaviour is a positive step.
• Write down obsessive thoughts or worries. This can help identify how repetitive your obsessions are.
• Anticipate urges to help ease them. For instance, if you compulsively check that the doors are locked, try and lock the door with extra attention the first time. When the urge to check arises later, it will be easier to re-label that urge as ‘just an obsessive thought’.
• Set aside time for a daily worry period. Instead of trying to suppress obsessions or compulsions, set aside a period for obsessing, leaving the rest of the day free of obsessions and compulsions. When thoughts or urges appear in your head during the day, write them down and postpone them to your worry period – save them for later and continue to go about your day.
• Take care of yourself. Although stress doesn’t cause OCD, it can trigger the onset of obsessive and compulsive behaviour or make it worse. Try to practice relaxation (such as mindfulness meditation or deep breathing) techniques for at least 30 minutes a day.

If you or someone you know experiences OCD, we’d be interested to hear about your experiences in the comments. If you would like affordable counselling from us, to help you work through your OCD you can receive it here.