Have you ever thought that you have obsessive compulsive disorder? A debilitating and distressing mental illness that can be all-consuming in its effects, its seriousness can sometimes be trivialised by its all too common use to describe someone who just likes to keep things clean or has perfectionist tendencies. A much more common mental health issue than most people think, does it arise solely out of a need to keep things in order or does the reason run deeper?
A condition that comes in many different forms and levels of severity from excessive cleaning to intrusive thoughts, we asked Dr David Veale , consultant psychiatrist at the Priory Hospital North London and The Maudsley Hospital for his advice when it comes to effective treatments and the triggers behind compulsive behaviours. As isolating as it is misunderstood, the good news is that it can be cured. So if you are a sufferer, rest assured that it can be defeated with the correct diagnosis and advice.
GTG: What is OCD?
DV: Obsessive compulsive disorder (OCD) is a condition consisting of obsessions or compulsions, or, more commonly, both. Obsessions are recurrent thoughts, images or urges that you may regard, at least initially, as intrusive and senseless. But you find them distressing and feel anxious or guilty. You cannot distract yourself from them or ignore them. Compulsions are actions which sufferers repeat purposefully to avoid or reduce discomfort. They are also called rituals. Although mainly voluntary, you feel driven to perform them.
GTG: Are there different types?
DV: Yes; contamination, order, unacceptable thoughts, and causing harm.
GTG: What are the most common OCD symptoms?
DV: Obsessions vary. The most common one is that objects or other people are “contaminated”. This might be from germs, dirt, disease, or radiation. Sufferers usually feel compelled to decontaminate themselves by excessive hand-washing or cleaning.
The next most common obsession is fear of causing accident, injury, or misfortune. You may believe that you left the doors or windows unlocked, or left the gas taps on. You feel compelled to check them repeatedly.
Obsessions can also be concerned with violence, murder, blasphemy or sex. Some sufferers find it difficult to put their obsession into words, but whatever it is, they usually avoid a wide range of situations or activities in order to prevent discomfort and the risk of causing harm.
The most common compulsions are:
* Checking to prevent a feared danger such as gas taps left on
* Excessive cleaning or hand-washing
* Repeated seeking of reassurance that a feared event will not in fact happen
* Counting or repeated touching of objects to prevent a feared disaster
* Arranging or ordering of objects or activities in a particular way leading to slowness
* Repeated questioning of or confessing to others
GTG: What causes OCD?
DV: Psychological explanations emphasise the way a sufferer has learned to avoid certain situations and carry out compulsions that perpetuate the condition. Individuals typically have an over-inflated sense of responsibility, that is, they overestimate the degree to which they believe they can influence or prevent bad events from happening. This is often combined with a tendency to catastrophise and demand certainty or a guarantee that a bad event will not happen.
Biological explanations emphasise that some families have a genetic predisposition to anxiety which may make it more likely that another member of the family will inherit OCD. Certain stresses or life events may precipitate the onset. Once the disorder has developed, the brain tries too hard to regulate the system. Changes in serotonin function may occur in the brain, which are probably consequences rather than a cause of the disorder.
GTG: Are there certain personality types that are more prone to suffering from OCD than others?
DV: Not really.
GTG: What is the most common misconception about OCD?
DV: That it’s just about excessive cleaning when there are several other types.
GTG: What can cause OCD to get worse?
DV: Stress or a life event like pregnancy.
GTG: If you find yourself acting compulsively, are there any things that we can do to lessen the attack?
DV: Use the principle of cognitive behaviour therapy and test out your fears.
GTG: What are the best forms of OCD treatment from mild cases to the more severe? What is involved in cognitive behavioural therapy?
DV: CBT is based on a psychological understanding of your OCD and what keeps the problem going.
The therapist may try to help you change the excessive degree of responsibility and magical thinking you feel, your demand for guarantees about the risks of exposure and the criteria you use for termination of a compulsion. When ready to test out which theory best fits the facts, people with OCD may confront whatever they fear (a process called “exposure” or a “behavioural experiment”) without performing a ritual (“response prevention”). This means learning to give up control, to resist the compulsion and to tolerate repeatedly the discomfort that occurs.
Facing up to the fear gets easier and it gradually becomes easier to cope with the anxiety. You begin by confronting easier situations and then gradually work up to more difficult ones. The side-effects are the anxiety and distress in the short-term, but these tend to gradually decrease. Of those that do adhere to the programme, about 75% are helped significantly. The risk of relapse after treatment is about 25% when you may require additional treatment. There is no evidence that psychodynamic or analytical therapy or hypnotherapy is of any benefit in OCD.
GTG: Can OCD be cured?
DV: Yes, most people can make significant improvement with cognitive behaviour therapy and/ or selective serotonin reuptake inhibitors (SSRI) medication.
GTG: If you feel that you’re suffering from OCD, what would be your advice?
DV: See your GP and get a referral to a therapist. Try also reading Overcoming Obsessive Compulsive Disorder by myself and Rob Willson, £10.99.
Find out more about OCD here .