Obsessive compulsive disorder (OCD)
Obsessive compulsive disorder (OCD) involves intrusive and obsessional thoughts, often followed by compulsive urges. These obsessions can be overwhelming, and the only way a person can relieve these intrusive thoughts is to repeat an action until they are quelled.
Here, we’ll explore the condition in more depth, including common OCD symptoms, what obsessions and compulsions are, and effective treatment options.
There are several misleading stereotypes surrounding this condition, including the idea that sufferers are very neat and tidy. In reality, OCD is a far more complex illness and can make day-to-day living very difficult for the affected person and those close to them. One of the biggest challenges for family and friends is understanding OCD.
Obsessive compulsive disorder isn’t a one-size-fits-all condition; it affects every individual differently. There are, however, patterns of behaviour and thoughts that are caused by the condition. These are outlined below to help you understand the core symptoms.
The four key behaviours that contribute OCD
1. Obsession – an intrusive, persistent and uncontrollable thought that enters your mind.
2. Anxiety – you start feeling stressed and anxious due to the obsession.
3. Compulsion – you find a compulsive need to exercise repetitive acts or behaviours because of the stress or anxiety that the obsession has caused.
4. Temporary relief – temporary relief from the stress or anxiety is gained from the compulsive behaviour. This cycle repeats when the obsession returns, usually soon after.
If you relate to these symptoms and are worried you may be suffering from OCD, a visit to your doctor is recommended for a formal diagnosis.
If you have OCD, your obsessions will most likely revolve around fears, worries, impulses or even images. These obsessions can be intrusive and at times disturbing and, as a result, can affect everyday life depending on their severity. Even when you begin to understand that the obsessions are involuntary, it can be difficult to figure out why you have them.
OCD is an anxiety-based condition and often the intrusive thoughts are rooted in a deep-seated fear. For example, if you have intrusive thoughts that you’re going to harm someone, it is likely because it is the thing you are most scared of happening (and, therefore, will very unlikely do).
The compulsions are employed as a coping mechanism to relieve and ‘prevent’ the thoughts from ever happening. For example, if you think that you might harm a close member of your family, you will demonstrate compulsive behaviour (which your OCD convinces you will stop it from occurring). It is not the behaviour or action stopping you from acting, but the idea of not carrying it out is very difficult for those with OCD, ‘just in case’.
You may be aware that your worries and fears are irrational, but you will be unable to control them. Additionally, the more you try to fight them, the more prominent they become.
With OCD, there’s always a thought in the back of your mind. I know that nothing bad will happen if I don’t do my rituals, but I have to do them - just in case.
- Read Calli’s story.
A compulsion is a natural response to the feeling of anxiety or discomfort that derives from an obsessive thought, impulse or fear. Examples include a repetitive set of mental actions (such as counting, checking a feeling/sensation or repeating a phrase), physical behaviours or actions.
Compulsive behaviours are very structured - most commonly set to a routine in an attempt to prevent the apparent danger from taking place. You might feel a responsibility to carry out certain actions to repress the threat, as you feel that it will harm yourself or a loved one. Sadly, the relief gained from this is only temporary. The cycle will then repeat.
For example, people who do not suffer from OCD may switch off a light and think nothing more of it. Someone with OCD symptoms surrounding checking may feel the need to switch the light on and off a certain number of times as their OCD has convinced them this will ensure the house doesn't catch fire.
These compulsions are categorised as covert (a mental act) or overt (observable by others). A covert compulsion may be mental counting to neutralise a disturbing and unwelcome image. An overt compulsion is physical, for example, washing, or checking things repeatedly to quell the obsession.
What is 'Pure O'?
The term 'pure O' means 'purely obsessional' and is sometimes used by those who experience intrusive thoughts but don't show external compulsions. Some may think this means there are no compulsions. But, the truth is, the compulsions are often mental (such as checking physical sensations) and, therefore, are more difficult to notice.
The term can be misleading and, as pure O is not a term used in the medical community, it can be unhelpful. Learn more about the term and its impact at OCD UK.
What is relationship OCD?
Relationship OCD (or ROCD) is a type of OCD that centres around relationships. It often involves lots of questioning about the relationship, affecting self-esteem and the relationship itself. Read more about relationship OCD and how to get support in the article, Relationship OCD by counsellor Tracy Foster, Dip.Couns, Dip.CBT Registered (MBACP).
OCD in children
While every case is unique, many people who have OCD say their symptoms began in childhood. Children with OCD may worry that things aren't in the 'right order'; they may be concerned about losing possessions or have a compulsion to collect things.
When asked why they carry out certain rituals, they may have a tough time explaining why, saying something along the lines of 'just because'. OCD in children can cause low self-esteem and frustration.
It all started when I was 11 years old. I began picking up small rituals that I felt compelled to do for no real reason. I was stepping on drains a certain number of times, touching certain objects twice and avoiding many situations in case I couldn't complete my compulsions.
- Read Aimi’s story.
If you are worried your child may have OCD, going to your doctor to receive a formal diagnosis is the first step. There are many professionals available who specialise in counselling children and are able to help them discuss and manage their symptoms in an easy to understand way.
Types of OCD
Most cases of obsessive compulsive disorder fall under four main categories, even though there are many strains that fall under a number of sub-categories. The four main areas are checking, hoarding, contamination and intrusive thoughts/ruminations.
The types of things that people with obsessive compulsive disorder may feel the need to check in order to prevent damage include:
- water taps (fear of flood damage to the house and contents)
- lights (fear of causing an electrical fire)
- car, door and window locks (fear of car/household items getting stolen)
- appliances (fear of the house burning down)
- gas appliances/canisters (fear of explosions)
- wallet, purse or handbag (fear of losing money, personal documents or bank cards)
- re-reading emails, postcards, letters (fear of mistakes or writing something offensive)
The amount of checking that is needed to ‘neutralise’ the obsession ranges from repeating it a few times to hundreds of times, which can take hours. This repetitive checking can seriously affect an individual’s career and personal relationships.
Hoarding refers to the compulsion to accumulate items. It is considered to be a compulsive disorder symptom when the hoarding of items interrupts day-to-day life. For example, cluttering up the bedroom so there is nowhere to sleep or if the gathering of objects has a detrimental effect on the individual's social life or career.
This is the obsessive fear that something needs to be cleaned or washed out of fear of contamination, and it can arise in a number of different situations that may make an OCD sufferer feel uncomfortable:
- wearing clothes (shaking them to remove bugs, dead skin, etc.)
- being in a crowd (fear of catching a disease from other people)
- using toilets (fear of contracting germs and illnesses from other people)
- shaking hands (fear of catching an illness from other people)
- touching door handles, bannisters, etc. (fear of contracting germs and illness from other people)
In the case of obsessive compulsive disorder, ruminations refer to a prolonged phase of thinking about a theme or a question that can often have a religious or philosophical context. An example could be the fixation on what happens after death. Sufferers might visualise heaven, hell, purgatory and what other philosophers and religious leaders have said on the subject.
These are obsessional, prolonged thoughts that are often troubling in nature. Intrusive thoughts can include sexual or violent harm to loved ones. However, people with OCD are usually the least likely to act on them as they find them so repugnant in nature.
Other common intrusive thoughts include those surrounding relationships, sex and religion.
What is POCD?
POCD (pedophilic obsessive compulsive disorder) is a specific fear of being a paedophile. Those with POCD worry that their intrusive thoughts may lead them to do something, even if they are convinced they never would. Understandably, this fear can be consuming and may lead to shame and fear of reaching out for support. As counsellor Carina Palmer explains, this is all a part of OCD.
It's important to realise that no matter how real all of this feels, it's part of the OCD pattern. OCD takes you to the very worst place for you. Whatever you find most abhorrent in the world is where it wants you to go.
Causes of OCD
The overall cause of this anxiety disorder is unknown, but there are several related factors that might increase the chances of obsessive compulsive disorder developing.
Stress – stressful situations and traumatic life events can trigger OCD.
Genes – in some cases, OCD is thought to be inherited; passed down from one generation to the next.
Life-changing scenarios – OCD tendencies can occur when increased responsibility gets too much. A birth of a child, a death of a loved one or a new job are the kinds of scenarios that change one’s life enough to develop obsessive compulsive disorder symptoms.
Personality – for meticulously organised people who are already methodically cataloguing their life possessions, symptoms of OCD might go unnoticed. These symptoms can get out of hand - if it goes too far, they can develop a full anxiety disorder.
Biological changes – small changes to the balance of neurotransmitters in the brain such as serotonin might play a role in triggering OCD. This is one of the reasons why medication is thought to help sufferers better manage their condition.
Ways of thinking – depending on the individual’s moral outlook on life, thoughts like ‘what would happen if I stepped in front of that train?’ or ‘I might harm my partner’ are usually quickly dismissed. But, if someone has an extremely high sense of responsibility and morality, they might feel that it’s their fault these involuntary thoughts come into their head, which makes the thoughts more likely to return.
Obsessive compulsive disorder is a treatable condition and counselling, in particular, is advised for helping sufferers to take back some control over their OCD symptoms. Cognitive behavioural therapy (CBT) in particular is recommended.
CBT for OCD
Cognitive behavioural therapy is a talking therapy that aims to help overcome problems by recognising and changing the way an individual thinks and behaves. CBT looks to teach the person that it isn’t the thoughts that are the major problem; it’s what the individual makes of those thoughts and how they act on them.
Exposure and response prevention (ERP)
Exposure and response prevention is a type of CBT that can help stop anxieties and behaviours from getting stronger. The longer you are exposed to your fear, or stressful situation, over time you become used to the setting and the need to perform compulsive actions is naturally neutralised.
Antidepressants can help relieve anxiety and support those with OCD. Speaking to your doctor about this is advised. Following the advice of your counsellor/doctor and discovering what works for you is key. Know that support is available and that you can manage your condition and live a fulfilling, happy life.
Over the years, having treatment and pushing myself has helped more than anything. Knowing that you are more than a label changes things.
- Read Stacey’s story.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat someone with OCD. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- There are a number of treatments for adults with OCD that are helpful, including psychological therapies and medication.
- The main psychological treatment for OCD is cognitive behavioural therapy (CBT) including exposure and response prevention (ERP).
- Most psychological treatment for OCD consists of CBT with ERP, but if you do not feel comfortable starting ERP, or it has not helped you, then your healthcare professional may offer you cognitive therapy that has been adapted for people with OCD.
- Research has shown that medication used for treating depression (called 'antidepressants') can also help people with OCD.
- There are different types of antidepressants, but ones called selective serotonin re-uptake inhibitors (or SSRIs for short) often work best for people with OCD.
Read the full NICE guidelines.