Obsessive compulsive disorder, often referred to as OCD, is a mental health condition which affects approximately 1% of people in the UK. Categorised as an anxiety disorder, OCD is comprised of unwanted and upsetting thoughts, images, or urges (obsessions) that are extremely difficult to control. Those who live with OCD then attempt to reduce the anxiety these obsessions cause them by engaging in repetitive physical and/or mental behaviours (compulsions).
Unfortunately, OCD is very misunderstood and many people living with the disorder feel unwarranted shame and embarrassment, often delaying seeking help until their day-to-day lives are seriously disrupted and their quality of life is impaired. OCD is more than the popular misconception of someone liking their environment tidy and orderly; it’s a serious mental health problem which requires compassionate, professional support.
What are the symptoms of OCD?
While OCD usually begins in the teen or young adult years, it can also develop in older adults. Symptoms often begin gradually which is why seeking help early is so important. Symptoms generally worsen when a person living with OCD is under significant stress. These symptoms can be mild, moderate, or so severe and time-consuming that it becomes totally disabling.
Although OCD typically includes both obsessions and compulsions, it is possible for people to experience symptoms of either obsession or compulsion.
What are obsessions?
Obsessions are recurrent unwanted or intrusive thoughts, images or impulses which can cause significant distress. These obsessive thoughts are repeated with the sufferer unable to banish them. They often follow themes, such as a fear of contamination or dirt, requiring objects to be in extreme order, being seriously ill, or unwanted and uncontrollable fears about hurting oneself or other people.
Examples of obsessional symptoms include:
- A fear of being contaminated by touching objects other people have touched
- Extreme worries about becoming sick from germs in public places
- A fear of self or others becoming seriously ill, injured or dying
- Recurrent doubts about having caused an accident
- Intense and uncontrollable distress when objects aren’t orderly or facing a certain way
- Avoidance of situations that can trigger obsessions, such as shaking hands, or eating out in public
- Distress about repeated and unwanted images.
What are compulsions?
These are the repetitive behaviours which an individual feels compelled to perform so that they may reduce distress or to prevent an event from happening. In an attempt to stop the obsessive thoughts, people may act in a compulsive manner. These are repetitive behaviours which are meant to reduce the anxiety caused by the obsessions, or to prevent something bad from happening. However, engaging in the compulsions brings only temporary relief from the anxiety. It becomes a vicious circle and one that is extremely difficult to stop. Individuals will often try to resist from engaging in the behaviours as they believe them to be irrational and silly. However, the compulsion to undertake the activity in the belief that it will in some way alleviate the issue outweighs these thoughts and the cycle of repetitive behaviour continues.
Compulsions are by their very nature excessive, and as with obsessions, follow typical themes, including:
- Repetitive handwashing until skin becomes raw
- Uncontrollable checking of things such as locks and light switches
- Counting in certain patterns
- Silently repeating a word, phrase or mantra
- Arranging objects so that they face precisely the same way
- Constantly seeking reassurance from friends and family.
What causes OCD?
It’s not yet fully understood what causes some people to develop the disorder, but it’s thought that genes may play a role, as might certain structural or chemical abnormalities in the brain. There is also a theory that suggests as compulsions are repeated and become habitual, they become associated with relief from anxiety.
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.
Are some people more at risk of developing OCD?
It appears that people with a family history of OCD may be at higher risk of developing the disorder, as might personal experience of trauma which could trigger intrusive thoughts and rituals designed to reduce the emotional distress associated with the event. People living with other mental health problems such as anxiety, depression, or tic disorders, or people who misuse substances may also be more vulnerable to OCD.
Research has also shown that children and adolescents with Sydenham’s chorea as a result of rheumatic fever are at higher risk of developing OCD. Early treatment with antibiotics may reduce the chances of future obsessive thinking.
However, it’s important to note that there is no way to predict if someone will develop OCD as it can affect people without suspected risk factors.
How is OCD treated?
OCD often requires specialised treatment which might include a combination of approaches. For some people, medication (often an antidepressant) can help in conjunction with psychological therapies such as cognitive behavioural therapy (CBT) or less commonly, exposure response prevention therapy (ERP). For others, medication may not be required. Your GP can advise you on the best course of action based on the longevity and severity of your symptoms.
Some people also find support groups helpful, while others experience relief from symptoms when they have sound stress management techniques in place, such as mindfulness and meditation.
Recovery from OCD is very possible but it requires time and the support of specialists.
As Donald says of his recovery from OCD:
“I was terrified to seek help – I really thought that my doctor would think I was ‘weird’ but I managed to brave it, and I’m so glad I did. My GP explained that there’s nothing weird about OCD – that it’s a health condition, just like a heart problem is a health condition.
My OCD started when I was about ten, and at 29, I finally realised that it was time that I benefited from help. Before I went to my GP, I spoke to OCD UK who were really helpful, and I also encouraged my mum and girlfriend to speak with them too. As a result, they both felt more confident about the condition, and how they could support me. I approached treatment with an open mind – I had nothing to lose.
“Five years on, I remain committed to practising good self-care on a daily basis to avoid a relapse. I get enough sleep, I’ve got loads of helpful stress management techniques in my toolbox, and I don’t allow myself to get to the point where I’m so stressed that I can’t see the wood for the trees. My therapist did tell me that I might have recurrences of my OCD if I let myself become exhausted or overwhelmed which is why I now share my feelings with my girlfriend, my mum, and close friends as soon as I become aware of them. So far so good! It just means that I need to be vigilant to stay OCD-free but the time and the effort keeps paying off. My message to people with OCD is that recovery is absolutely possible. You don’t need to suffer on your own – it’s a living hell when you’re in it, but with the right help and guidance, you can live your very best life. Don’t be afraid – you can do this!”
Self- help techniques
Gradual ritual reduction, also referred to as response prevention, can be an effective self-help technique to start to help you take back control . Each week, set a goal to reduce your compulsions by disrupting the pattern of your rituals to take away their power. Give them a time limit. Gradually reduce time off them when you feel compelled to perform them until you no longer feel the need to engage with them.
You can also use the 15-minute rule where you resist a compulsion for 15 minutes at first, and then another 15 minutes as time goes on and you get more comfortable with this tactic.. Use that waiting time to refocus on something else. Give yourself a penalty such as a fine each time you default.
You might also find it helpful to speak with OCD UK, a charity run by people with experience of the disorder. It offers people living with OCD and their family and friends the opportunity to talk about the emotional impact, and guidance on how to access a range of treatments both through the NHS and privately. Click here for their contact details and opening times.
You can also contact the retailTRUST helpline on 0808 801 0808 or by emailing [email protected] if you wanted to speak to someone in confidence