As has become evident in my exploration of other types of anxiety disorders, Obsessive-Compulsive Disorder (OCD) is probably not what you think it is.
a serious condition that can cause people considerable anxiety, fear and severe disruption to their ability to function normally in day to day life. It is not keeping things tidy, washing hands frequently or checking things a few times.
OCD, as its name implies, has two dimensions..
..firstly, there is the obsessive thoughts: these are intrusive, persistent and uncontrollable and comprise images, worries, fears, doubts and impulses. Sometimes the intrusive thoughts are particularly distressing, containing violence or sex, and therefore can give rise to feelings of shame which can inhibit someone from seeking help until the condition has descended into severe symptoms.
Although the sufferer of OCD recognises that their thoughts are irrational there exists a powerful compulsion to obtain relief from them by performing compulsive behaviours. These behaviours are believed to prevent harm to a loved one or to the person themself. Thus the compulsion to repeat either physical behaviours or mental thought rituals is an attempt to gain relief from the tormenting obsessional thoughts. Relief is usually short-lived however and the compulsion cycle is inevitably reactivated into an ever deepening, worsening spiral of OCD. The image below, borrowed from Mind illustrates the perpetuating nature of the illness.
The diagnostic symptoms of OCD are ..
- obsessions and compulsions which consume excessive amounts of time
- Obsessive thoughts are typically about violence or harm, sex or blasphemy
- Compulsions are repeated activities that have to be done in order to alleviate the anxiety of the obsessive thoughts
- The obsessions and the compulsions cause anguish and distress, including fear, shame and loneliness
- these debilitating symptoms interfere with the ability of day to day functioning at home, school or work and affects the ability to form and maintain relationships
OCD affects men and women equally and usually manifests in adolescence for men and in the early 20s for women. OCD is known to have a close association with depression and symptoms can appear or worsen during depression.
What causes OCD..
.. is not clear and no one theory is conclusive.
The French have a phrase for OCD ‘La folie de doute’ - the doubting disease. It is the inability to tolerate doubt and uncertainty that often drives OCD. However, why this is the case has a number of potential answers:
- Dysfunctional beliefs:
Believing you have more responsibility for the outcome of events than you actually do
- Personal experience:
Painful childhood experiences, abuse or other trauma causing obsessions and compulsions as a means to deal with the resulting intrusive anxiety. Or it is learned behaviour from parents who have similar anxieties and use these behaviours as compensation strategies.
- Biological factors:
It has been proposed that a lack of the brain chemical serotonin may account for OCD although this has been disputed. Similarly theories of genetic pre-disposition have not yet been conclusive.
Treatment for OCD..
.. can be highly effective. Cognitive Behavioural Therapy (CBT) is the main form of treatment in the UK:
- Looking at alternative ways of thinking (cognitive)
- Challenging beliefs through actions (behavioural)
- Making connections between the thoughts, feelings and behaviours.
- Exposure Response Prevention is a particularly effective CBT technique for treating OCD
Treatment can also involve medication with antidepressents, tranquilisers or beta-blockers.
If you think you may be suffering from OCD..
.. your first step is to visit your GP, to discuss your symptoms as honestly as you can. In the UK the NICE (National Institute for Clinical Excellence) guidelines for treating OCD involves CBT; a combination of CBT and medication; or referral to a specialist OCD treatment service for the most severe cases.