Obsessive-Compulsive Disorder (OCD) can take over your life. Intrusive and distressing thoughts that feel beyond your control, coupled with the need to perform certain behaviours, leads to being stuck in a vicious cycle that can be difficult to break free from.
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition characterised by obsessional thinking or compulsive behaviour or both. In adults, the prevalence of OCD in the general population is thought to be 1–3% and around 0.25% in children and adolescents aged between 5 and 15 years old (NICE, 2018). People who experience OCD can have varying insight into their symptoms.
What are obsessions and compulsions?
Obsessions are repetitive intrusive thoughts, urges or mental images that cause anxiety.
Compulsions are repetitive behaviours or actions that are time consuming.
A person experiencing OCD will typically have an obsessional thought (which could be in the form of an image), which leads to anxiety. In order to reduce or get rid of this anxiety, the person will engage in a compulsion which brings temporary relief. However, the nature of OCD is such that more obsession thoughts/images show up, leading to being trapped in the OCD cycle:
People with OCD can also feel low in mood or depressed. One study found that up to one third of people with OCD also feel depressed (Overbeek et al, 2002).
What are the different types of OCD?
OCD symptoms can vary widely in people. Some may engage in different compulsions and rituals, whereas others may only experience obsessional thoughts or ‘pure O’ OCD. There are many different types of OCD that carry a certain theme, and they can often overlap. For example, you may have fears of contamination and therefore clean excessively, but also need things to be symmetrical like food cans in kitchen cupboards.
Fears around being dirty or contaminated in some way and therefore coming to harm, or someone else coming to harm. For example, touching dirty surfaces leading to excessive hand washing. Some people can experience mental contamination; a fear that their mind has been contaminated in some way, for example, by thinking certain thoughts.
Symmetry and orderliness
The need for things to be ‘just right’, or in their right place/in order or symmetrical. The associated compulsions may be having to put objects 'right' which can be very time consuming.
Doubt and Harm
Feeling overly concerned about the consequences of your actions, and a fear that your actions will in some way harm others or yourself, even for things that are outside your control. These sorts of fears often lead to excessive checking. For example, when driving you may doubt whether you have inadvertently hit someone, even though you know logically that you didn’t. You may check for damage on your car, or play back the dash cam.
You may experience intrusive thoughts that are felt to be unacceptable or taboo such as physically harming someone or being abusive towards others. This can also include having sexual intrusive thoughts about others including children. These types of intrusive thoughts can be particularly distressing.
OCD that occurs during the pregnancy or the post-natal period is referred to as perinatal OCD. A person may have experienced OCD before before getting pregnant, and it is common for there to be an exacerbation of symptoms either in pregnancy or once the baby is born. For others, perinatal OCD may occur without any previous history of experiencing OCD symptoms. It is normal to experience intrusive anxious thoughts about bringing a child into the world and looking after a baby, but in perinatal OCD the thoughts and associated compulsions interfere with daily life.
Fears and doubts about a relationship such as ‘is this person right for me?’, ‘am I happy in this relationship?’, or, ‘has my partner cheated?’. These kinds of obsessions may lead you to check your partner’s phone, or continually seek reassurance that they still love you.
Psychological treatments for OCD
The psychological treatments for OCD are varied but the generally accepted ‘gold standard’ treatment is cognitive behaviour therapy (CBT) including exposure and response prevention (ERP) (NICE, 2005).
Cognitive behaviour therapy for OCD involves psychoeducation for OCD, identifying the different obsessions, associated compulsions, avoidance strategies and reassurance seeking that person engages in. Once the client and therapist have a good ‘map’ of all the different aspects of a person’s OCD experience, they will work together to develop a list of feared situations/places/things if the person did not engage in the compulsions, or an ‘exposure hierarchy’. Each item is rated for anxiety level. It is this that serves the basis for the ERP, with the client moving up the list from least anxiety provoking to most anxiety provoking. Crucially, the client will learn gradually that when they expose themselves to the feared situation and at the same time prevent the response (i.e., the compulsion), their anxiety will reduce over time. The treatment will also involve identifying the specific obsessive-compulsive beliefs that tend to maintain the person’s symptoms.
Studies show that these types of beliefs tend to have themes of: inflated responsibility, over-importance of thoughts, importance of controlling one’s thoughts, overestimation of threat, intolerance of uncertainty and perfectionism (Myers et al, 2008). Cognitive behaviour therapy seeks to challenge and modify such beliefs so they have less power in maintaining a person’s symptoms.
How can I get help for OCD?
At Harley Clinical Psychology we understand how difficult it can be to reach out. All of our Psychologists are experienced in helping people with OCD break free from obsessional thinking and compulsive behaviour. In addition, our Director, Dr Liz White, has carried out doctoral research into OCD and has a special interest in the area.
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How can I get help for OCD?
Studies show that there can be many barriers to seeking help when you experience OCD. People who experience OCD can feel a lot of stigma and often fear the reaction that health care professionals might have (Robinson et al, 2017), especially when the obsessions involve thoughts of harm to others.
For this reason, some people may go years without seeking help.
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: treatment. Clinical guideline [CG31].
Overbeek T, Schruers K, Vermetten E, Griez E. Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. J Clin Psychiatry. 2002 Dec; 63 (12):1106-12.