Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder, commonly termed OCD, is the title given to the condition in which the person develops intrusive thoughts, images or impulses (e.g. obsessions), usually alongside associated compulsive behaviours. OCD is a treatable disorder that can affect both males and females of all ages. It is the fourth most common mental health disorder, and is diagnosed as often as diabetes or asthma. Often, individual sufferers may be in denial, or too embarrassed about admitting their obsessions and seeking the help they require.
An obsession develops when a thought, image or impulse repeatedly comes to mind, often disrupting other thoughts and mental focus. These thoughts tend to be distressing in nature, and can lead to an anxiety response. An individual with OCD usually feels an overwhelming need to reduce their anxiety resulting from these obsessions, and therefore engages in compensatory compulsive mental acts or behaviour(s).
A compulsion is a behaviour that a person feels compelled to act upon to engage in, in order to reduce or relieve the distress their obsessive thoughts are causing them. Often people with OCD believe that the consequences for not acting on their thoughts will result in negative outcome(s), which is usually disproportionate to reality; we call this “Magical Thinking”.
There are a number of suggestive viewpoints as to the cause of OCD, with many ascribing to the idea that the causes of OCD are multifaceted. Although strong evidence exists that there is a genetic predisposition to developing OCD (i.e., family history of OCD places an individual at risk of developing it), psychological learned behaviours also play a significant role and must not be overlooked; these behaviours can be learned from watching and hearing others engage in OCD-driven behaviours and beliefs.
The development of OCD has also been suggested to be associated with a deficiency of certain neurotransmitters e.g. serotonin. Another hypotheses is that OCD involves a dysfunction in a neuronal loop running from the orbital frontal cortex (front part of the brain; responsible for decision making) to the cingulate gyrus (responsible for processing emotions and for behavior regulation), striatum (caudate nucleus and putamen; a critical component of the motor and rewards systems), globus pallidus (involved in the regulation of voluntary movement), thalamus (responsible for regulating the body's voluntary motor control, consciousness, and its sleep/wake cycle) and back to the frontal cortex. This dysfunction is argued to result in an increase in compulsive behaviours and anxiety in response to worry, which can explain the repetitive and seemingly senseless rituals indivudals with OCD engage in.
- Obsessive concern with germs, contaminants, or chemicals
- Obsessive concern around harming oneself or others with spreading germs, contaminants, or chemicals
- Fear of losing something (eg: objects, a person, information)
- Need to know or remember insignificant things (eg: licence plate numbers, advertising slogans, names of actors or dates they were born)
- Need for things to be exact, or symmetrical (eg: arranging clothes alphabetically; making the bed without creases; aligning items in the pantry straight; folding and re-folding washing)
- Unwanted sexual impulses or excessive thoughts about gender identity or sexuality (eg: worries that they might commit sexual violation when not meaning to; constant wondering about being homosexual even if he/she firmly believes to be heterosexual)
- Excessive superstitious or religious fears, or fears of demonic possession (eg: pentangles, “666”)
- Fear of being responsible for disaster (eg: causing flooding, pipes freezing, burglary, fires)
- Fear of harming oneself or others due to not being cautious enough, or acting impulsively (eg: not paying enough attention and hitting a pedestrian when driving; pushing someone in-front of ongoing traffic)
- Fear of public embarrassment or performing something inappropriate (eg: laughing at a funeral, shouting out insults, walking out of a shop with unpaid products)
- Fear of saying the wrong thing to others, or not performing something “good” or “moral” enough (eg: reviewing all the possible responses to say to someone else before responding; unsupported worries about dishonesty or cheating).
- Excessive or ritualistic washing or cleaning of self or objects (eg: cleaning the self, household items, or pets when already clean, prolonged scrubbing floors or vacuuming, washing hands repeatedly).
- Constant checking of locks, electrical appliances, brakes (eg: making sure the iron is turned off, the oven wasn’t left on, lights or taps are turned off)
- Having to repeat routine activities or boundary crossings in a certain way or number of times (eg: taking clothes on and off, getting in and out of car, adjusting seats, not stepping on cracks in footpath, entering a doorway)
- Re-reading or re-writing something to make sure it was correct
- Strict ritualistic daily activities (eg: having to do a set of activates upon waking up before anything else can be done, putting on clothes in a certain order, following an elaborate routine before bed, running through mental checklists a specific number of time, saying a special prayer)
- Straightening or arranging items (eg: tidying and re-adjusting objects in a room or items on a desk)
- Ritualistic eating behaviours for fear other than weight gain (eg: having to eat food in a certain order on plate, only eating meals with a particular knife/fork, some food and not others must be prepared in certain ways or on certain chopping boards/plates/bowls)
- Making sure things are even (eg: left side of body has to feel as balanced as right side, hair must be cut or styled evenly or symmetrical, tension of shoe laces)
- Saving or hoarding valueless items (eg: collecting large amounts of junk, not throwing away expired articles or newspapers)
- Desire to confess, ask or tell things to others (eg: framing the same question in various ways to ensure it was comprehensively understood, explain everything in detail so that nothing is left out)
- Mental rituals, other than checking or counting (eg: silently recalling non-sense words, or phrases to neutralise thoughts; mentally recalling past conversations)
- Ritualised avoidance (eg: planning to take specific route on map to avoid crossing bride or taking a longer route to somewhere because road is straighter/ cleaner/ tidier)
- Deliberate avoidance of coming into contact with feared objects, contaminants or circumstances related to obsessions (eg: not shaking hands for fear of receiving germs, wearing gloves,
- Only using certain tools or utensils in everyday activities (eg: can only eat meals with a particular knife and fork, only particular sets of clothes can be worn for certain days of the week, some food and not others can be used in certain bowls/plates/chopping boards)
- Mentally reassuring oneself that everything is ok
While it is normal and healthy for everyone to experience worries from time to time, problems develop when these worries become unmanageable, time consuming and begin negatively affecting the everyday tasks of individuals’. To observers, the symptoms of someone who is developing OCD may be more easily recognised when displayed in their physical behaviour. However, because some individuals’ obsessions and compulsions are struggled with internally/mentally, it can be difficult for an observer to detect the signs. However remember, compulsive behaviour causes distress, is time consuming and disrupts your day – a quirk does not!
The most successful psychological treatment for OCD is Cognitive Behavioural Therapy (CBT) and Exposure Response Prevention (ERP). CBT identifies, challenges, and helps sufferers’ overcome their dysfunctional thoughts, behaviours and overwhelming emotions, by changing their thought processes, allowing them to think and act differently in relevant situations. Recent reports on 12 studies regarding the outcome of CBT treatment in adults, illustrate an 83% success rate, with positive gains maintained over follow up (Storch, Mariaskin and Murphy, 2009).
ERP is when individuals’ are gradually and repeatedly exposed to their underlying anxieties or fears until they diminish or significantly reduce, with the support and guidance of a trained healthcare professional. This allows them to deal with their challenging thoughts as they learn other coping strategies to reduce their anxiety, instead of avoiding the situation, or engaging in their compulsive actions.
OCD Treatment often ranges between 12-16 sessions. Treatment duration depends on the individual and the severity of their OCD. Once treatment is completed, clients are recommended to continue to see a trained healthcare professional for “booster sessions” over the next 6- 12 months to prevent relapses.
If you are concerned that your loved one may demonstrate any of the OCD symptoms previously listed, or characteristics similar to these, it is important you offer your ongoing emotional support, while strongly encouraging them to seek an assessment and treatment from a trained healthcare professional. Reassure them that they are not alone and treatment is achievable. If possible, it is beneficial if both the individual and their family or carer work with the guidance of the treating healthcare professional(s) if the individual agrees. However, an individuals’ willingness or readiness to seek help may depend on the severity and lifecycle of their OCD. They may be reluctant to talk openly with others about their struggles, or deny there is a problem altogether.
It may also be useful for you to talk with a healthcare professional about how you are coping and dealing with the individual’s OCD. If you are aware of any way in which you may be unintentionally contributing to their obsessions, compulsions, or rituals, it is important to notify the treating healthcare professional(s), so that they can advise you on how to disengage in these while still supporting them. Caring for a friend or family member with OCD can be very distressing, tiring and demanding, and it is important that you too find the support you may need. Often people without OCD have trouble understanding why individuals with it cannot just “snap out of it”, which may result in unhelpful frustration or anger towards the individual. It is important to practise being mindful of your reactions and to be patient with the individual, remembering it is not their fault or their choice to engage in these behaviours.
What can we do?
At Anxiety House we have three clinicians who treat adult OCD (Dr Emily O’Leary and Dr Daphne Bryan). If you are concerned that you, a friend, or relative may be experiencing OCD, it is strongly recommended to seek advice from a healthcare professional immediately.
For more information, feel free to contact us on 3399 9480, or make an online enquiry via our website. Alternatively, please visit The OCD Clinic for additional information on Obsessive Compulsive Disorder and how we can support you or your loved ones.