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What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an illness that traps people in seemingly endless cycles of repetitive thoughts that will not leave their minds (obsessions) and in feelings that they must repeat certain actions over and over again (compulsions). These obsessions that intrude into the person’s every day thinking may be frightening, disgusting, painful, or even trivial. To relieve their anxiety, some individuals with OCD feel they need to do something. These feelings that they must repeat certain actions or rituals are their compulsions - the things they feel they have to do to avoid some dreaded event or to prevent or undo some harm to themselves or others, as suggested by their obsessions. In most cases, the obsessions cause extreme anxiety. A common exa mple is recurring obsessive thoughts about germs and dirt, with a compulsion to wash your hands repeatedly to "clean off the germs". However, there are many other examples. Treatment often works well to reduce the symptoms and distress of OCD greatly.

What are obsessions?

Obsessions are unpleasant thoughts, images, or urges that keep coming into your mind. Obsessions are not simply worries about your life problems. Common obsessions include:

  • Fears about contamination with dirt, germs, viruses (eg HIV or other infections).

  • Worries about doors being unlocked, fires left on, causing harm to someone, etc.

  • Intrusive thoughts or images of swearing, sex, someone harmed, etc.

  • Fear of making a mistake or behaving poorly.

  • A need for exactness in how you arrange things.

Obsessions can be about all sorts of things. Obsessive thoughts can make you feel anxious or disgusted. You normally try to ignore or suppress obsessive thoughts.

What are compulsions?

Compulsions are thoughts or actions that you feel you must do or repeat. Usually the compulsive act is in response to an obsession. A compulsion is a way of trying to deal with the distress or anxiety caused by an obsession.

For example, you may wash your hands every few minutes in response to an obsessional fear about germs. Another example is you may keep on checking that doors are locked in response to the obsession about doors being unlocked. Other compulsions include repeated cleaning, counting, touching, saying words silently, arranging and organising - but there are many others.

How does OCD affect your life?

The obsessions that you have with OCD can make you feel really anxious and distressed. The compulsions that you have may help to relieve this distress temporarily but obsessions soon return and the cycle begins again.

The severity of OCD can range from mildly inconvenient, to causing severe distress. They know that the obsessions and compulsions are excessive or unreasonable. However, they find it difficult or impossible to resist them.

OCD affects people in different ways. People with OCD do not want to have obsessive thoughts, nor do they want to engage in time-consuming rituals. Most people with this disorder realise how senseless it all is. Recognising the bizarre nature of their obsessions and compulsions, many conceal their condition from others. Eventually people with OCD may be discovered, or their obsessions and compulsions become so time- consuming that they can no longer function at home, on the job, or without developing conflicts with others.

Many people with OCD do not tell their doctor or anyone else about their symptoms. They fear that other people might think they are crazy. Some people with OCD may feel ashamed of their symptoms, especially if they contain ideas of harming others, or have a sexual element. As a result, many people with OCD also become depressed. If you are concerned that you may be depressed (for example if you have been feeling very down and you no longer take pleasure in the things that you used to enjoy) you should see your doctor.

What causes obsessive-compulsive disorder?

It is thought that between 1 to 3 in 100 adults have OCD. Anyone at any age can develop OCD but it usually first develops between the ages of 18 and 30. About 2 in 100 children are also thought to have OCD.

child depression
OCD is usually a chronic (persistent) condition.

How is obsessive-compulsive disorder diagnosed?

If you are concerned that you may have OCD, you should see your doctor and explain your concerns. Questions that can act as a 'screen' for possible OCD:

  • Do you wash or clean a lot?

  • Do you check & re-check things a lot?

  • Is there any thought that keeps bothering you that you would like to get rid of, but cannot?

  • Are you concerned about putting things in a special order, or do you get very upset by disorderly arrangement or a mess?

  • Do these problems trouble you to a level of making you anxious?

However a more detailed assessment is then needed before OCD can be diagnosed. This is carried out by your psychiatrist. The assessment will look at any obsessional thoughts and compulsions that you have and how they affect you and your daily life before any treatment is offered.

What is the treatment for obsessive-compulsive disorder?

About 60% of the people with OCD can be helped with medication. It allows many people to lead normal lives. People can also be taught to reduce their anxiety from their obsessions.

OCD is not only distressing to the persons affected, it is also hard on the people who live with them. Family members react to living with a person with OCD in a number of ways:

  • They may demand that the person stop ritualising.

  • They may give continual reassurance.

  • They may even participate in the rituals themselves, to pacify the individual and to avoid arguments.

Note: These may seem like the best tactics, but they do not improve OCD.

Treatment for OCD

The usual treatment for OCD is:

  • Cognitive behaviour therapy (CBT).

  • Medication, usually with an SSRI antidepressant medicine.

  • A combination of CBT plus an SSRI antidepressant medicine.

CBT is a type of specialist 'talking' treatment (psychotherapy). It is probably the most effective treatment for OCD.

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy (CBT) is a mixture of Cognitive therapy is based on the idea that certain ways of thinking can trigger, or 'fuel', certain mental health problems such as OCD and Behaviour therapy aims to change behaviours which are harmful or not helpful. For example, compulsions in OCD.This is the most common treatment for OCD. Therapy is usually weekly sessions of about 50-60 minutes each, for several weeks.

SSRI Antidepressants

Although they are often used to treat depression, SSRI antidepressant medicines can also reduce the symptoms of OCD, even if you are not depressed. It is important to note that:

  • Antidepressants do not work straight away. It takes 2-4 weeks before their effect builds up and start to work. They may take up to 12 weeks to work fully. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give them time to work.

  • These antidepressants are not tranquillisers, and are not addictive.

  • The doses needed to treat OCD are variable.

  • If it works, it is usual to take an SSRI antidepressant for at least a year to treat OCD.

  • Most people who take an SSRI have either minor, or no side-effects.

Possible side-effects vary between different preparations:

  • The most common ones include: diarrhoea, feeling sick, vomiting, and headaches.

  • Some people develop a feeling of restlessness or anxiety. It is worth continuing with treatment if side-effects are mild at first. Minor side-effects wear off after a week or so.

Response to treatment of OCD

Symptoms can improve by up to 70% if you take an SSRI. So, although symptoms may not go completely, they usually greatly improve so the obsessions and compulsions are much less of a problem. This can make a big difference to your quality of life.

Reasons why medication may not work so well in some people include:

  • The dose is not high enough and needs to be increased.

  • Medication was not taken for long enough - it may take up to 12 weeks to work.

  • Side-effects became a problem and so you may stop the medication. Tell a doctor if side-effects are troublesome.

If OCD is not treated, obsessive thoughts and compulsions may not improve and may get worse in some people. However, with treatment many people's symptoms can be brought under control and some people may be completely cured.

If you have OCD, there is a risk that it can return even after successful treatment and recovery. If your symptoms do come back, be sure to see your psychiatrist for further treatment.