What is OCD?

Obsessive compulsive disorder (OCD) is a type of anxiety disorder that is complex and heterogeneous in nature, meaning that it can present differently in different individuals. It is characterised by recurring obsessions and compulsions that consume a lot of time and have a negative impact on the individual's functioning, causing significant psychological distress.

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What are obsessions and compulsions?

Obsessions

Obsessions are unwanted and intrusive thoughts, images, urges and doubts that repeatedly occur in an individual's mind. They can cause significant distress, anxiety and guilt and are unreasonable and excessive, as noted by Veale (2002). Obsessions are a common symptom of OCD, and they can be classified into various categories.

The most common ones are related to:

  • fear of making a mistake that could lead to harmful accidents for oneself or others
  • fear of harming oneself or others through contamination (such as diseases, germs, body fluids, etc.)
  • intrusive thoughts related to sex, violence, blasphemy, and aggression
  • the need for symmetry and order
  • hoarding

According to McKay et al. (2004) and Veale and Wilson (2009), these are the most common obsessions experienced by people with OCD.

Compulsions

OCD sufferers often feel distressed by their intrusive thoughts and seek to reduce or avoid this discomfort by performing repetitive behaviours or mental rituals, which are known as compulsions. The compulsions provide temporary relief by cancelling out or neutralising the feelings caused by their obsessions. However, these compulsions are time-consuming and unreasonable, and they can have a negative impact on a person's ability to function properly.


Prevalence, onset and causes

Obsessive compulsive disorder is a common mental health condition and has been recognised as a leading cause of disability by the World Health Organization (1996). People with OCD generally suffer from a reduced quality of life (Jacoby et al., 2014). It affects around 2% of both children and adults worldwide. Moreover, it is estimated that three out of every 100 adults will experience OCD at some point in their lives, but this doesn't necessarily mean that they will experience the full range of symptoms associated with the disorder.

Obsessive compulsive disorder can occur at any age, but it usually begins during childhood or early adulthood (Veale & Wilson, 2009). On average, adults with OCD develop symptoms between the ages of 22 and 36, with women tending to experience symptoms earlier than men (Ruscio et al., 2008). However, men are more likely to be affected by OCD during childhood and adolescence.

Studies suggest that there are various reasons why someone may develop obsessive compulsive disorder. According to Alsobrook et al. (1994), biological, genetic, psychological, and external factors can all play a significant role in the development of this disorder. OCD may also develop after a stressful life period, a major crisis, or a traumatic event in childhood, such as abuse or the sudden death of a relative.

Additionally, certain personality traits, such as an inflated sense of responsibility, perfectionism, or intolerance of uncertainty, may increase the likelihood of developing OCD, as noted by the Institute for Quality and Efficiency in Health Care (IQWiG) in 2006.


Treatment for OCD

Cognitive behavioural therapy (CBT) is considered the first-line treatment for OCD according to NICE (2006).

One of the most widely used and accepted CBT models for the treatment of OCD is Salkovski’s cognitive-behavioral approach (1985). The central concept of Salkovski’s CBT theory for OCD suggests that intrusions become obsessions when the individual attributes a particular threatening appraisal to them, which is linked to their excessive sense of responsibility and personal values. These obsessions can cause awful feelings for the sufferers, who then proceed with specific compulsions to remove, neutralise, or cancel them in order to feel better.

According to Clark (2004), research shows that compulsions can incrementally increase the power of intrusive thoughts. In addition, they prevent patients from challenging and disconfirming their distorted and inaccurate beliefs, Taylor, Abramowitz, Mccay, (2009). Thus, a vicious cycle of anxiety is maintained because the urge of the compulsions is never distinct. Veale, (2007).

Salkovskis's (1985) model of OCD focuses on challenging the negative appraisals given to intrusive thoughts using behavioural experiments, which incorporate exposure and response prevention (EX/RP), one of the most effective and excessively researched for its efficacy treatment-intervention for OCD, March, Frances, Carpenter, & Kahn, (1997).


References

  • Abramowitz, J. (2018). Getting over OCD Getting Over OCD. A 10-Step Workbook for Taking Back Your Life. 2nd ed. The Guilford Press. 
  • Abramowitz, J., Taylor, S. and McKay, D., 2009. Obsessive-compulsive disorder. The Lancet, 374(9688), pp.491-499. 
  • Association, A. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®). Washington, D.C.: American Psychiatric Publishing. 
  • Alsobrook, J. and Paul’s, D. (1994). Genetics of anxiety disorders. Current Opinion in Psychiatry, 7(2), pp.137-139. 
  • Clark, D. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford Press. 
  • Jacoby, R., Leonard, R., Riemann, B. and Abramowitz, J. (2014). Predictors of quality of life and functional impairment in Obsessive–Compulsive Disorder. Comprehensive Psychiatry, 55(5), pp.1195-1202. 
  • InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Obsessive-compulsive disorder: Treatment options for obsessive compulsive disorder. 
  • McKay, D., Abramowitz, J. S., Calamari, J., Kyrios, M., Sookman, D., Taylor, S., & Wilhelm, S. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms. Clinical Psychology Review, 24, 283-313. 
  • Morrison, N. and Westbrook, D., 2003. Managing Obsessive-Compulsive Disorder. Oxford: Oxford University Press. 
  • March JS, Frances A, Kahn DA, Carpenter D. The Expert Consensus Guideline series: Treatment of obsessive-compulsive disorder. J Clin Psychiatry. 1997. 
  • National Institute for Health and Clinical Excellence (NICE). Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. NICE Clinical Guidelines; Volume 31. Rushden: The British Psychological Society and The Royal College of Psychiatrists; 2006. 
  • Ruscio, A., Stein, D., Chiu, W. and Kessler, R., 2008. The epidemiology of obsessivecompulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), pp.53-63. 
  • Salkovskis, P. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), pp.571-583. 
  • Veale, D. (2007). Cognitive–behavioural therapy for obsessive–compulsive disorder. Advances in Psychiatric Treatment, 13(6), pp.438-446. 
  • Veale, D. and Willson, R. (2009). Overcoming obsessive compulsive disorder. Robinson. 
  • World Health Organization. (1996). The World health report: 1996: fighting disease, fostering development / report of the Director-General. World Health Organization. Case Report 2 

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Written by Dimitrios Kouklakis, Integrative Counsellor | CBT Therapist PGDip, BABCP, BABCP
London EC4N & WC1A

Dimitrios has a great passion for working with people to improve their quality of life through good mental health. From an early age, he had a keen interest in learning more about mental health, which led him to pursue his studies in the art of psychotherapy in the UK and complete thousands of clinical hours in the field.

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