Obsessive Compulsive Disorder: What is it?

The term ‘OCD’, an abbreviation for Obsessive Compulsive Disorder, has slipped into modern cultural usage almost as a joke.   For example, it’s used as a ‘humorous’ excuse as to why someone might be late leaving the house.   This way of talking about the condition has become acceptable perhaps because sufferers of OCD are not really understood to be ‘suffering’, rather OCD is viewed almost as an extreme personality quirk.   The disorder does not come with physical symptoms, and individuals with the condition are not considered a danger to themselves or others.  However, the problem with this humour is that it makes it increasingly difficult for a sufferer of the condition to admit what is happening to them, for fear of laughter and shame.

What most people don’t understand is that OCD can seriously impair the quality of someone’s life.   Sufferers may have trouble leaving their homes, and may not have been able to take a holiday in a very long time, if at all.   They could have difficulty in sustaining intimate relationships and friendships, and often have to take jobs well beneath what they are capable of doing.   All of these factors can lead in turn to low self-esteem, feelings of hopelessness and depression.   Sufferers can also have suicidal feelings.   In extreme cases, such as that of Samantha Hancox in 2011, who had a phobia of germs, the condition can lead to death.

What is OCD?

Obsessive Compulsive Disorder is an anxiety disorder.   The ‘Obsessive’ part of OCD is so termed because of the recurrent and persistent thoughts that cause the sufferer distress and from which there is little relief.   These thoughts can be incongruent and alien to the individual experiencing them, and can be that something fearful will happen, such as the death of someone close, or a beloved pet, or they can have ‘shocking’ thoughts about killing family members, or themselves.

The ‘Compulsive’ part of OCD is so termed, because these fearful/shocking thoughts then lead to compulsive actions which a sufferer has an overwhelming urge to perform again and again, to make sure whatever it is they fear can never occur.   These actions or rituals can involve counting, checking, washing, cleaning, (there can be an overwhelming fear of germs and contamination) touching objects (such as a window) a number of times, or saying certain phrases.   An individual may feel, for example, that they need to remove all plugs before leaving the house and/or turn off light switches and check all appliances are off.   They may then return back to the house many times to check once again that this has been done.

With OCD there can also be an increased desire for perfectionism in things.   A sufferer may, for example feel compelled to be top of the class and get ‘distinctions’ in all subjects they take on.   This may seem like no bad thing to most people.   However, this is not just a wish but a compulsion over which an individual has no control, and all other areas of life can suffer as a result.   This is not done for enjoyment or achievement, but because of the fear of terrible things that could happen if they don’t.   The pressure and stress they therefore put themselves under, and that also affects those they are close to, is enormous.

Unfortunately sufferers of OCD can often go undiagnosed because of the aforementioned embarrassment, shame and guilt associated with this condition.   

What causes OCD?   

Causes will differ obviously with each individual, however, often the condition begins after a stressful event in early adulthood such as work difficulties, pregnancy, or during a period of depression.   However, the roots themselves can lie deeper than this, and the event in adulthood may be a re-triggering of a deeper trauma/worry/anxiety originating from childhood.

What treatments are there?

Current treatment for OCD includes Cognitive Behavioural Therapy, of which there are two types, Exposure and Response Prevention (ERP) and Cognitive Therapy (CT).   The former exposes the person to the anxiety/fear which they obsess about and stops them from being able to carry out the compulsive ritual which keeps the obsession going.   Many individuals do find improvement from receiving this therapy.   However, it does not suit all sufferers and some have returning symptoms. 

Cognitive Therapy, which attempts to identify and change the client’s irrational and uncontrollable thoughts, has been used alongside ERP to assist in the treatment.    

Medication, such as clomipramine (an anti-depressant) has also been used to treat OCD.   However, symptoms often return once off the medication.

How counselling can help with OCD

Whilst traditional psychoanalysis has not proved successful at treating OCD, there is evidence to suggest that the use of supportive therapy such as counselling, can be of benefit to individuals.   Counselling can help the client with any trust issues they have, as well as give them a space in which to voice their unspoken fears and ‘shocking’ thoughts.   It can also help correct these ‘irrational’ fears and thoughts in a safe nonjudgemental environment, and together counsellor and client can explore safely to see if something deeper is going on; whether anything has been left unresolved emotionally from some point in the client’s life, perhaps a traumatic circumstance which underlies the condition itself.

Overall, counselling as a treatment for OCD can help alleviate a sufferer’s anxieties and support them in taking steps into leading a more fulfilling life.