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What is Obsessive Compulsive Disorder? We all have certain routines that we perform in our daily lives. When obsessive compulsive disorder (OCD) develops these routines become excessive, typically being repeated more often and for a longer period of time than necessary. Often routines develop that would not usually be necessary at all, but typically, despite knowing this, you still feel compelled to repeat them until you can feel comfortable. At any given time OCD is thought to affect around 2.5% of the population although recent findings have indicated that this figure may be even higher. OCD can develop in both children and adults alike with the symptoms the same in both cases. There are two main components to OCD- obsessions and compulsions (compulsions are also known as rituals).
What are Obsessions? Obsessions are unwanted thoughts, images or worries that continually run through a person’s mind. Common obsessional themes include worries about contamination, thoughts about harming or killing a loved one, repeated doubts (continuing thoughts that something has not been done properly, even though you know that it has - eg turning off the stove) fear of losing something important and/or a persistent need to have things arranged or conducted in a particular order.
What are Compulsions? Compulsions are behaviours or mental actions that are performed repeatedly in order to reduce the anxiety caused by an obsession. Common compulsions include repetitive behaviours such hand washing, ordering, checking, requesting/demanding reassurance or repetitive mental acts such praying, counting, repeating words or lucky numbers phrases etc silently.
Strong avoidance behaviours are also typically engaged in when you have OCD, such as avoiding coming into contact with places or objects you feel are contaminated (eg door handles, the floor, toilets, people perceived as unclean etc). This avoidance can spread to the rest of the family with OCD sufferers in many cases expecting their family also to engage in behaviours such as showering so as to avoid contaminating the OCD sufferers environment.
It is important to recognise that avoidance of contamination is a normal behaviour to a point, and to be diagnosed with OCD your behaviours must cause noticeable distress above that expected from an average individual. They would also be time consuming (typically taking more than 1hr per day), and significantly interfere with your daily routine or functioning. Similarly, researchers have demonstrated that around 90% of people have intrusive thoughts that are similar to those experienced by people with OCD. Having these thoughts is a normal part of life and doesn't mean that there is something wrong with your brain. It is only when the thoughts become frequent and you have trouble dismissing them without the use of some form of ritual physical or mental behaviour, that a diagnosis of OCD may apply.
How Did I get OCD? Almost everybody has behaviours from time to time that may be considered obsessive. When you get a new car you may wash it excessively, you may avoid walking under ladders, breaking mirrors or sometimes have avoided stepping on cracks. Many people always use the same numbers on lottery tickets and get anxious if they miss placing them one week. It is also normal for many of us to like things in our homes to be tidy and clean. OCD is seen by specialists in the field to develop from these same normal desires having become extreme as a result of the obsessive thoughts triggering higher than normal levels of physical and emotional anxiety. This involves activation of the sympathetic and autonomic nervous systems as part of the 'fight or flight response' . This can occur for a variety of reasons including the experience of a traumatic event such as contamination resulting in severe food poisoning. There is also some evidence that some of us may inherently hold a higher than average likelihood for the development of OCD due to a genetic predisposition, although it is unlikely that there is an OCD gene as such. Even if one possesses a higher than average predisposition to develop OCD it does not always develop. Research has shown that this is due to the large role that learning and the environment plays in OCD onset and subsequently in successfully eliminating it.
What Can I do to Get Rid of OCD? OCD symptoms, until successfully treated, will tend to increase and decrease over time. Typically, the more you indulge your compulsive rituals the more your obsessions will grow. In order to have the greatest likelihood of eliminating OCD permanently the most strongly evidenced treatment is a behavioural therapy known as exposure and response prevention (ERP). ERP involves a process whereby you work with a psychologist who specialises in treating OCD to thoroughly map your obsessions and compulsions and take methodical steps to overcome them. Simplistically, the process involves exposure to the feared situation and prevention of the compulsive behaviour. While this approach can be challenging, if designed properly, it should not at any point be too uncomfortable and significant progress can typically be made over a relatively short period of time. Prior to engaging in ERP work the psychologist will typically also provide you with knowledge and techniques to assist in reducing anxiety during the ERP work.
A more recent approach to treating OCD which has been promising even stronger results than ERP alone, involves using a therapy known as (CBT). This approach is similar to ERP with addition of cognitive or thought techniques that assist in eliminating the underlying thoughts and beliefs that produce the need to engage in OCD behaviours.
What about Medication? Studies involving the use of selective serotonin re-uptake inhibitors have indicated that these medications alone do often at least partly reduce the symptoms of OCD for most sufferers, but the amount of benefit is typically less than that obtained from ERP. Adding medication to ERP or CBT treatment typically produces little if any additional benefit. Most OCD specialist psychologists recommend that medication is useful initially only if you are too anxious to be able to engage in CBT or ERP work, however is not indicated if you are able to successfully begin CBT or ERP work without it. Most specialists agree that while SSRI's and other medications may be useful in reducing anxiety symptoms (and subsequently the thoughts they induce) initially they do not provide a cure for OCD. Moreover they do not teach the skills needed to overcome OCD completely. It is important to remember also that effective ERP and CBT can be conducted whether you are on medication or not, typically leading to significantly improved long term outcomes. In any case, at all times before considering any medication changes you should consult your doctor.
Remember: Evidence based best practice OCD therapy can now, in many cases, achieve an almost complete elimination of OCD behaviours in between 8 to 20 weekly consultations, without the need for medication. Moreover, in almost all cases a significant and lasting improvement can be obtained. If you would like to hear more click on 'contact us' below or in the left column and we will respond to your questions. Alternatively click on the 'Enquire About or Book a Consultation' button in the right column to arrange to talk directly to one of our psychologists or to arrange an appointment.
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