Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is an anxiety disorder that usually begins in late childhood and affects 2-3% of people. People with OCD have reoccurring and persistent obsessions in the form of thoughts, images or impulses, that affect their everyday life in negative ways. People with OCD also perform certain compulsions, which involve specific rituals that can occupy a lot of time and be very distressing for the person. People with OCD are usually aware of how irrational and excessive their obsessions and compulsions are, however even with this understanding they are unable to control these behaviours.

Symptoms of OCD 

Obsessions

Obsessions are usually exaggerated versions of concerns and worries that can occur normally in many people. Common obsessions include:
  • Fear of contamination from germs, dirt, poisons etc.
  • Fear of harm from illness, accidents or death that may occur to oneself or to others.
  • Intrusive thoughts about violence
  • Excessive concern with symmetry, exactness and orderliness
  • Excessive concerns about religious issues or morality
  • Needing to know and remember things
  • Hoarding and collecting things.
Obsessions may be constantly on a person’s mind. They may also be triggered by certain situations. Obsessions can change in nature and severity and do not respond to logic. The anxiety leads to vigilance for possible threats, and a need for control. Obsessions can produce feelings ranging from annoyance and discomfort to acute distress and panic.

Compulsions

Compulsions can be behavioural (actions) or mental (thoughts). Compulsions are repetitive actions that are often carried out in a special pattern or according to specific rules. Compulsions are usually performed to try and prevent an obsessive fear from happening, to reduce the anxiety, or to make things feel ‘just right’. Common compulsions include:
  • Excessive hand washing, showering and tooth brushing
  • Excessive cleaning and washing of house, household items, food, car and other areas
  • Excessive checking of locks, electrical and gas appliances, and other things associated with safety
  • Repeating routine activities and actions such as reading, writing, walking, picking up something or opening a door
  • Applying rigid rules and patterns to the placement of objects, furniture, books, clothes and other items
  • Touching, tapping or moving in a particular way or a certain number of times
  • Hoarding – a need to save or inability to throw out excessive collections of various items such as newspapers, food or clothes
  • Need to constantly ask questions or confess to seek reassurance
  • Mentally repeating words or numbers a certain number of times, or concentrating on ‘good’ or ‘safe’ numbers
  • Replacing a ‘bad thought’ with a ‘good thought’.
Usually compulsions become like rituals; they follow specific rules and patterns, and involve constant repetitions. Compulsions give an illusory sense of short-term relief to anxiety. However, they actually reinforce anxiety and make the obsessions seem more real, so that the anxiety soon returns.

OCD can have a profound effect on a person’s life  

Compulsions and obsessions may take up many hours of a person’s day and can interfere with family and social relationships. They can also have a negative effect on education and employment. As OCD becomes more severe, ‘avoidance’ may become an increasing problem. The person may avoid anything that might trigger their obsessive fears. OCD can make it difficult for people to perform everyday activities like eating, drinking, shopping or reading. Some people may become housebound. OCD is often compounded by depression and other anxiety disorders, including social anxiety, panic disorder and separation anxiety. People with OCD are often acutely embarrassed about their symptoms and will put great effort into hiding them. Before the disorder is identified and treated, families may become deeply involved in the sufferer’s rituals, which can cause distress and disruption to family members.

Cognitive behaviour therapy

Cognitive behaviour therapy aims to change patterns of thinking, beliefs and behaviours that may trigger anxiety and obsessive compulsive symptoms. This therapy uses education to promote control over symptoms. The education includes information that helps to expose myths about the causes of OCD. Part of the therapy involves gradually exposing the person to situations that trigger their obsessions and, at the same time, helping them to reduce their compulsions and avoidance behaviours. This process is gradual and usually begins with less feared situations. The exposure tasks and prevention of compulsions are repeated daily and consistently until anxiety decreases. Over time, this allows the person to rebuild trust in their capacity to manage and function, even with anxiety. Cognitive behavioural therapy should be undertaken with a skilled, specialist mental health professional. Over-use of alcohol, drugs and some medications may interfere with the success of this type of treatment.