Obsessive compulsive disorder (OCD)
Obsessive compulsive disorder (OCD) is a condition where people have obsessional thoughts followed by compulsive urges. These obsessions can be intense, and typically the only way a person can relieve these intrusive thoughts is to repeat an action until they are quelled.
This anxiety-related illness affects around 1.2% of the UK’s population, and approximately 740,000 people are thought to suffer with OCD at any one time. Research suggests 50% of sufferers endure severe OCD symptoms, while 25% only experience mild symptoms.
A common perception of OCD is that sufferers feel compelled to excessively wash their hands or constantly check that doors and windows are locked. In reality, OCD is a far more complex illness and can make day-to-day living very difficult for the sufferer and those close to them. One of the biggest challenges for family and friends is understanding the illness, but it can also take a toll on relationships. It is possible, however, for people with OCD to learn ways to better manage the condition.
On this page the illness will be explored in more depth, including OCD symptoms, what obsessions and compulsions are, and effective treatment options.
Obsessive compulsive disorder isn’t a one-size-fits-all illness; it affects every individual differently. There are however consistent patterns of behaviour and thoughts that are caused by OCD. These are outlined below to help you understand the core symptoms and to help you determine whether or not you (or someone close to you) may have the condition.
The four key behaviours that contribute to OCD are:
- Obsession – An intrusive, persistent and uncontrollable thought that enters your mind.
- Anxiety – You start feeling stressed and anxious due to the obsession.
- Compulsion – You find a compulsive need to exercise repetitive acts or behaviours because of the stress or anxiety that the obsession has caused.
- Temporary relief – A 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, you are advised to visit your doctor for a formal diagnosis.
If you have OCD, your obsessions will most likely fall under one or more of the following categories:
- uncontrollable and persistent thoughts
These obsessions can be intrusive and at times disturbing, and as a result can affect your day-to-day 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.
On the other hand, you are not likely to act on your troubling thoughts. The compulsions are employed to relieve and prevent the thoughts from ever happening. For example, if you think that you might harm close member of your family, you will demonstrate compulsive behaviour to stop it from occurring.
If you have OCD, you might worry about:
- Catching an illness, especially ones publicised in the media.
- Causing sexual or physical harm to yourself or others.
- The contamination of something (an object, a person etc.).
- Arranging everything in a particular order, be it symmetrical or otherwise.
- Having violent thoughts.
- Causing a road accident whilst driving.
- A bad thing happening unless you check something repetitively.
You may be aware that these 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. In most cases the feeling of discomfort that these thoughts create is anxiety, but it can also create general unease and tension.
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 formalities, 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 tend to only wash their hands if they see they are dirty or after using the bathroom. But if you are experiencing OCD symptoms, you may wash your hands if they ‘feel’ dirty, and feel compelled to keep on washing them until they ‘feel’ clean. You might do this to stop the spread of a disease that you are frightened of getting, even though you most likely have an extremely low risk of getting it.
Here are some examples of OCD compulsions:
- The avoidance of people, places or situations to avoid an intrusive thought.
- Cleaning to excess (clothes, objects, the house).
- Thought patterns or mental exercises that neutralise an obsessive thought.
- After a word is spoken, instantly saying another word to counteract a negative repercussion.
- The avoidance of sharp objects, such as a knife, to prevent hurting others.
- Checking of locks, light switches, radiators etc. to try to prevent the dangers associated with them i.e. getting burgled, electrical fires or pipes freezing.
These compulsions are categorised as covert (a mental act) or overt (observable by others). A covert compulsion includes 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.
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, frustration and embarrassment for the sufferer.
If you are worried your child may have OCD, going to your doctor to receive a formal diagnosis is the first step. There are lots of professionals available who specialise in counselling children and are able to help them discuss and manage their symptoms in an easy to understand manner.
Types of OCD
Most cases of obsessive compulsive disorder fall under four main categories, even though there are many strains which 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 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 of the individual's social life or career.
A compulsive hoarder might:
- buy lots of useless items
- develop an emotional attachment to these things
- have a limited social life due to the clutter
- endanger their health by living in unsanitary living conditions
- put family, neighbours and pets at risk of harm.
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, banisters 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 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.
OCD symptoms can occur in all areas of life, and often sufferers will notice them affecting their relationships. Known as relationship OCD or ROCD, this form of the condition sees intrusive thoughts and compulsions focusing on your relationship.
Most people will experience relationship doubts from time to time, but those with relationship OCD will experience more than most. Typical symptoms of relationship OCD include:
- Constant analysis of your feelings for your partner.
- Constant need for reassurance/approval from your partner.
- Doubting that your partner is being faithful, with no evidence to the contrary.
- Doubts that you may be unfaithful.
- Polarised thinking and an intolerance of uncertainty within the relationship.
This kind of thinking, like most OCD thinking, is incredibly exhausting and can lead to break-ups. If you are aware that you suffer from OCD and are experiencing intrusive thoughts about your relationship, be sure to mention this to your OCD specialist or counsellor. Both yourself and your partner may also benefit from couples counselling - this will allow both of you to discuss how you feel and how you can manage the symptoms.
Causes of OCD
The overall cause of this anxiety disorder is unknown, but there are multiple related factors that might increase the chances of obsessive compulsive disorder developing.
Stress – Stressful situations and traumatic life events can cause OCD. Approximately one in three cases are caused by stress.
Genes – In some cases OCD is 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 kind 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 the full anxiety disorder and should seek help.
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 medical condition, and counselling in particular has proven useful for helping sufferers to take back some control over their OCD symptoms. Cognitive behavioural therapy (CBT) is often deemed the most helpful form of therapy in this circumstance.
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.
The therapy 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. This is the key to recovering from OCD.
There are two types of CBT for OCD – cognitive therapy and exposure response therapy.
Cognitive therapy (CT)
Cognitive therapy is a psychological therapy that tries to change your response to your thoughts, rather than trying to get rid of them. This can be helpful if you have worrying, intrusive thoughts, but do not perform any actions or rituals to neutralise them.
Exposure and response prevention (ERP)
Exposure and response prevention is a way to 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.
Even if you are not depressed, antidepressants can help moderate obsessions and compulsions. According to research, over half of people with OCD improve after taking medication. Unfortunately, if you stop taking medication, there is around a 50% chance of OCD symptoms returning. However, if you combine medication with CBT for OCD, it is much less likely to return.
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) have 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:
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