Obsessive Compulsive Disorder

This month I’m exploring a problem I see a lot of in my clinical work – obsessive compulsive disorder (or OCD for short).  Despite the many Channel 4 documentaries on all things OCD, and the great work that various charities do to dispel the stigma around it, this still, in my opinion, remains one of the most misunderstood anxiety problems.

We can help understand OCD by looking at the definitions of obsessions and compulsions:

An obsession is a recurrent and persistent thought, impulse or urge which is unwanted and causes distress.

A compulsion is anything we might do to try to remove the obsession and/or the distress it causes us; or to prevent something we fear from happening.

In order for OCD to be diagnosed these obsessions and compulsions need to be causing a significant level of distress, and also to be interfering with our day-to-day functioning. This brings me to my usual point in these rambles: many mental health problems are on a continuum, and we should be careful how we use these terms. Just because you like your toiletries lined up in a particular way on the bathroom shelf doesn’t mean you have OCD!

OCD can affect people in lots of different ways, and to reflect this there are various types of OCD which you can be diagnosed with. (It’s also common for people to relate to more than one type.)

Contamination OCD: Obsessions centre on fears of germs and contamination.  This can lead to a whole range of life limiting compulsions, such as excessive hand washing, excessive housework, and avoiding touching anything considered to be contaminated, for example door handles, toilet seats and other people.

Checking OCD: Obsessions focus on fears of having accidentally done something wrong, and the potential for this to lead to embarrassment or serious harm to self or others. This can result in excessive checking of doors, taps, and windows, electrical appliances, written work and forms, tasks at work and ensuring we haven’t knocked anyone over whilst driving.

Rumination OCD: We all have slightly ‘odd’, negative thoughts that pop into our heads now and again, but people with rumination OCD find it particularly difficult to let go of these thoughts and tend to get into a ‘mental argument’ about them.  For example they may have a thought that leads them to fear that they are a paedophile or that they may harm a loved one, this thought will occupy their mind a lot and they may avoid situations which trigger this thought for them e.g. bathing their baby.

You may have seen elements of yourself in these descriptions – I know that I have the occasional fear of having touched something contaminated. I also check my back door is locked more than is necessary, and I also have occasional random odd thoughts from time to time. I, however, do not have OCD because I’m not doing any of these things excessively; they aren’t upsetting me and they aren’t impacting my day to day life.

OCD is a serious condition which can have a hugely debilitating impact on people’s lives. It’s like living with a bully inside your head, constantly shouting about your worst fears and insisting you engage in certain behaviours. Perhaps one of the saddest things about it is that there is an average delay of 12 years from onset of OCD to people seeking treatment. If you are concerned about OCD then get treatment now before it becomes more severe.  

Cognitive Behavioural Therapy (CBT) is the treatment recommended by NICE guidelines for OCD, and there have been lots of scientific studies which prove how effective it can be. Treatment begins by understanding what OCD is like for you, how it’s affecting your life and why you’re struggling to make changes on your own. We then use techniques called behavioural experiments and exposure and response prevention to help you to gradually face the things you fear without using any compulsions.  This can be hard work but it helps you to learn that your worst fear is very unlikely to come true and you don’t need to keep doing your compulsions.  One of the things I love about CBT is that it gives you insight into your problems and the tools for how to cope with it – tools which you can continue to use for the rest of your life.

I had the pleasure of meeting Paul Salkovskis at an OCD Workshop last year – Paul is a well-known expert on OCD and his book ‘Break Free from OCD’ is an excellent resource.  It’s something you may like to work through alone or with a therapist.

OCD Action is the UKs largest charity for OCD and you can find lots of useful information on their website.  They also have support groups throughout the country and a helpline and email support service.

OCD UK is a charity run ‘by suffers for sufferers’ they publish a quarterly magazine for members called ‘Compulsive Reading’.  

And, as always, Mind has great resources too.