OCD
WHAT IS OCD
Obsessive-compulsive disorder (OCD) has two main parts: obsessions and compulsions.
- Obsessions are unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind. They can make you feel very anxious (although some people describe it as 'mental discomfort' rather than anxiety).
- Compulsions are repetitive activities that you do to reduce the anxiety caused by the obsession. It could be something like repeatedly checking a door is locked, repeating a specific phrase in your head or checking how your body feels.
You might find that sometimes your obsessions and compulsions are manageable, and at other times they may make your day-to-day life really difficult. They may be more severe when you are stressed about other things, like life changes, health, money, work or relationships.
What's it like to live with OCD?
Although many people experience minor obsessions (such as worrying about leaving the gas on, or if the door is locked) and compulsions (such as avoiding the cracks in the pavement), these don’t significantly interfere with daily life, or are short-lived.
If you experience OCD, it's likely that your obsessions and compulsions will have a big impact on how you live your life:
- Disruption to your day-to-day life. Repeating compulsions can take up a lot of time, and you might avoid certain situations that trigger your OCD. This can mean that you're not able to go to work, see family and friends, eat out or even go outside. Obsessive thoughts can make it hard to concentrate and leave you feeling exhausted.
- Impact on your relationships. You may feel that you have to hide your OCD from people close to you – or your doubts and anxieties about a relationship may make it too difficult to continue.
- Feeling ashamed or lonely. You may feel ashamed of your obsessive thoughts, or worry that they can't be treated. You might want to hide this part of you from other people, and find it hard to be around people or to go outside. This can make you feel isolated and lonely.
- Feeling anxious. You may find that your obsessions and compulsions are making you feel anxious and stressed. For example, some people feel that they become slaves to their compulsions and have to carry them out so frequently that they have little control over them. You can read more about anxiety here.
SYMPTOMS OF OCD
What are obsessions?
Obsessions are persistent thoughts, pictures, urges or doubts that appear in your mind again and again. They interrupt your thoughts against your control, and can be really frightening, graphic and disturbing. They may make you feel anxious, disgusted or uncomfortable.
You might feel you can't share them with others or that there is something wrong with you that you have to hide. You might feel upset that you are capable of having such thoughts.
Types and examples of obsessions
Fear of causing or failing to prevent harm
- Worrying you've already harmed someone by not being careful enough. For example, that you have knocked someone over in your car.
- Worrying you're going to harm someone because you will lose control. For example, that you will push someone in front of a train or stab them.
Intrusive thoughts, images and impulses
- Violent intrusive thoughts or images of yourself doing something violent or abusive. These thoughts might make you worry that you are a dangerous person.
Religious or blasphemous thoughts that are against your religious beliefs
- Relationship intrusive thoughts often appear as doubts about whether a relationship is right or whether you or your partner's feelings are strong enough. They might lead you to end your relationship to get rid of the doubt and anxiety.
- Sexual intrusive thoughts or images. These could be related to children, family members or to sexually aggressive behaviour. You might worry that you could be a paedophile or a rapist, or that you are sexually attracted to someone in your family.
Fear of contamination
- Contamination (for example by dirt, germs or faeces). You might worry that you have been contaminated and that you - or other people - are spreading the contamination. You might worry that you have or might get a disease.
- Mental contamination. You might experience feelings of dirtiness that are triggered by a person who has harmed you in some way. These feelings may also be triggered by your own thoughts, images or memories.
Fears and worries related to order or symmetry
- You might have a fear that something bad will happen if everything isn't 'right' - for example if things are not clean, in order or symmetrical.
You might experience more than one type of obsession. They are often linked together. For example you might experience a fear of contamination and a fear of doing someone harm by accidentally making them ill.
What are compulsions?
Compulsions are repetitive activities that you feel you have to do. The aim of a compulsion is to try and deal with the distress caused by obsessive thoughts.
You might have to continue doing the compulsion until the anxiety goes away and things feel right again. You might know that it doesn't make sense to carry out a compulsion - but it can still feel too scary not to.
Repeating compulsions is often very time-consuming and the relief they give you doesn't usually last very long.
Compulsions can:
- be physical actions
- be mental rituals (people who only have mental compulsions sometimes refer to their OCD as Pure O)
- involve a number (for example, you might feel you have to complete a compulsion a specific number of times without interruption).
Types and examples of compulsions
Rituals
- washing your hands, body or things around you a lot
- touching things in a particular order or at a certain time
- arranging objects in a particular way
Checking
- checking doors and windows to make sure they are locked
- checking your body or clothes for contamination
- checking your body to see how it responds to intrusive thoughts
- checking your memory to make sure an intrusive thought didn't actually happen
- checking your route to work to make sure you didn't cause an accident
Correcting thoughts
- repeating a word, name or phrase in your head or out loud
- counting to a certain number
- replacing an intrusive thought with a different image
Reassurance
- repeatedly asking other people to tell you that everything is alright.
What is 'Pure O'?
Pure O stands for 'purely obsessional'. People sometimes use this phrase to describe a type of OCD where they experience distressing intrusive thoughts but there are no external signs of compulsions (for example checking or washing). The name is slightly misleading as it suggests that there are no compulsions at all.
If you have Pure O you will still experience mental compulsions but you might not be aware of them. Because they are not as obvious as physical compulsions, it can sometimes be difficult to define exactly what these compulsions are.
Here are some examples of internal compulsions:
- Checking how you feel - for example, you might check to see if you are still in love with your partner.
- Checking bodily sensations - for example, you might check to see if you were aroused by an intrusive thought.
- Checking how you feel about a thought - for example, you might check whether you are still upset by the thought.
- Repeating phrases or numbers in your head.
- Checking if you still have a thought - for example, first thing in the morning.
Avoidance
You might find that some activities, objects or experiences make your obsessions or compulsions worse. For example if you are worried that you might stab someone then you might avoid the kitchen because you know there are knives there.
Sometimes it might feel easier to avoid situations that mean you have to do a compulsion. For example if you have to do a long and time-consuming ritual every time you leave the house, you might just decide it's easier to stay indoors. But avoiding things can have a major impact on your life.
CAUSES OF OCD
There are different theories about why OCD develops. None of these theories can fully explain every person’s experience, but researchers suggest that these are likely to be involved in causing OCD:
- Personal experience
- Personality
- Biological factors
Even though we don't fully understand what causes OCD, it can still be successfully treated.
Personal experience
Some theories suggest that OCD is caused by personal experience. For example:
- If you've had a painful childhood experience, or suffered trauma, abuse or bullying, you might learn to use obsessions and compulsions to cope with anxiety.
- If your parents had similar anxieties and showed similar kinds of compulsive behaviour, you may have learned OCD behaviours as a coping technique.
- Ongoing anxiety or stress, or being part of a stressful event like a car accident or starting a new job, could trigger OCD or make it worse.
- Pregnancy or giving birth can sometimes trigger perinatal OCD.
Personality
Some research suggests that people with certain personality traits may be more likely to have OCD. For example, if you are a neat, meticulous, methodical person with high standards, you may be more likely to develop OCD.
Biological factors
Some biological theories suggest that a lack of the brain chemical serotonin may have a role in OCD. However, it's unclear this is the cause or is an effect of the condition.
Studies have also looked at genetic factors and how different parts of the brain might be involved in causing OCD, but have found nothing conclusive.
SELFCARE FOR OCD
There are a number of things you can do to help you through the OCD and these could include:
- CBT
- Being open with a family member or friend who you trust
- Connect with support networks and other individuals who are going through similar experiences.
- Try a relaxation technique
- Try mindfulness.
- Manage your stress
- Get enough sleep
- Think about your diet
- Try to do some physical activity
TREATMENTS FOR OCD
How can I access treatment?
The first step to getting treatment for OCD is to visit your GP. Your GP will ask about your symptoms and discuss different treatment options.
The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – suggests that treatment for OCD should include talking treatments and medication.
The combination of treatments you are offered depends on how severe your OCD is, and what treatments have worked or not in the past. If you feel a treatment isn’t working for you, it’s a good idea to discuss this with your GP, as there may be other alternatives available.
What talking therapies might I be offered?
You may be offered the following talking therapies for OCD, either on their own, or along with medication
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour.
Exposure and response prevention (ERP)
Exposure and response prevention (ERP) is specifically designed for OCD. It encourages you to confront your obsessions and resist the urge to carry out compulsions.
During ERP, your therapist will support you to deliberately put yourself in a situation that would usually make you feel anxious. Instead of performing your usual compulsion, you will be encouraged to try and tolerate the anxiety.
ERP helps you to see that the uncomfortable feelings will eventually go away even if you don't perform a compulsion.
This type of therapy can be challenging and may make you feel more anxious at first. It’s a good idea to talk to a health care professional before you start about what it involves, and whether you are in a good place to start it.
Cognitive therapy
Cognitive therapy focuses on identifying and changing negative feelings about yourself, to help you change unhelpful responses and behaviours.
What medication might I be offered?
You may be offered the following medications for OCD, either on their own or alongside talking therapy:
- Selective serotonin reuptake inhibitors (SSRIs) – a type of antidepressant that has also been shown to be effective in treating OCD.
- Clomipramine – a tricyclic antidepressant, which you may be offered if an SSRI doesn’t work.
Different people find different medications helpful. You can talk to your doctor about your options – you might find you need to try out a few different types of medication before you find one that works for you.
Might I be offered social care support?
Depending on how your OCD impacts your life, you may be eligible for social care. Social care services support people who struggle to manage day-to-day activities.
Specialist OCD services
If your OCD is very severe and the above treatment options have not helped, you may be referred to a specialist OCD service. Unfortunately, not all areas have specialist services and you might have to travel outside your local area.
