March 2016
Living with Obsessive Compulsive Disorder

Living with Obsessive Compulsive Disorder

What is Obsessive Compulsive Disorder (OCD)?

According to the American Psychiatry Association, OCD is a form of anxiety disorder. People experience recurring, unwanted thoughts, ideas or sensations (obsessions) which make them feel the need to do something repetitively (compulsions).

 

How common is it?

It is common for people to have thoughts or desires to repeat certain behaviours however they are manageable and do not affect daily life. Common expressions in society are to say that a friend or a family member is “obsessed” with something or “compulsive”. These terms are used to describe when someone does something over and over. It isn’t a problem and can be beneficial to individuals to have a routine to add structure or order to a person’s life. Sometimes the words are used to describe people who gamble, drink alcohol, shop, use street drugs – or even exercise too much. However, these behaviours can be pleasurable. The compulsions in OCD never give pleasure – they are always felt as an unpleasant demand or burden (RCPsy).

 

OCD is when thoughts or actions become persistent and routines are so fixed that if the person was not to complete the task or follow through, they would experience significant distress. About 1 in every 50 people has OCD at some point in their lives, men and women equally (RCPsy). Many children can have mild compulsions, organising their toys precisely for example however this tends to fade as they get older (RCPsy). Adult OCD often begins in childhood or early adulthood, the average age of symptoms start at 19 years old (APA). Symptoms can come and go however people do not tend to seek help until they have had OCD for many years.

 

The symptoms of Obsessive Compulsive Disorder

OCD has three parts:

  • the thoughts that make you anxious (obsessions)

  • the anxiety you feel

  • the things you do to reduce your anxiety (compulsions) (APA)

 

Obsessions

These are recurrent and continuous thoughts, impulses or images that cause distressing emotions. It is common for people to recognise that the obsessions are in their minds and is excessive and yet they cannot be erased by logic or reason (APA). People attempt to ignore or supress these obsessions or perhaps adopt a counter action or thought. Obsessions could include concerns of contamination or harm, requirement for precise or forbidden sexual or religious thoughts.

 

Anxiety

There are many emotions an individual can experience including feeling tense, anxious, guilty, disgust, fearful or depressed. Feelings of relief can be felt once the compulsive action/ ritual have been completed. This however is a temporary feeling.

 

Compulsions

These are repetitive behaviours or actions that a person feels driven to complete in response to the obsession. Behaviours could be aimed at preventing or reducing distress or a feared situation (APA). In a severe case, constant repetition could fill a whole day and therefore take over a person’s life. Compulsions could include;

  • Ordering and arranging. Making sure particular items are positioned correctly or household items are arranged in a symmetric order.

  • Cleaning. A fear of germs, dirt or chemicals will contaminate them. To address this, many hours could be spent washing their body or their surroundings.

  • Checking on things. By over checking, a ritual can develop. This is to reduce fear of harm. Examples include checking the gas is turn off at the stove, locking the door or ensuring your journey route is safe.

  • Repeating. This could include repeating a certain behaviour, repeating a phrase or a name. The person is aware that the repetitions will not guard them against injury but fear that if the repetitions are not completed, they will be harmed (APA).

  • Mental compulsions. This is to reduce anxiety or prevent a dreaded future event; a person may pray silently or say a special phrase repeatedly. It is felt that this is preventing bad things from happening.

  • Avoidance. Avoiding something that may be a reminder of a worrying thought. You avoid touching certain objects, going to particular places, taking risks or accepting responsibility.

  • Hoarding. Keeping hold of old worn items as nothing can be thrown away.

  • Reassurance - you repeatedly ask others to tell you that everything is alright.

 

Associated factors

Other conditions which share some of the same characteristics of OCD mainly occur in family members of someone with OCD. Examples are;

  • body dysmorphic disorder (distress caused by imagined ugliness). Hours are spent in front of mirror checking and may stop going outside in public, ashamed of a particular body shape or look.

  • hypochondriasis (fear of suffering from a physical illness),

  • trichotillomania (hair or eyebrow pulling)

  • some eating disorders such as binge eating disorder

  • neurologically based disorders such as Tourette’s syndrome (APA)

  • children and adults with some forms of autism can appear to have OCD because they like things to be uniform and may like to do the same activity over and over (RCPsy).

 

The causes of OCD

There are many potential causes of OCD. These include:

  • Genetic inheritance: OCD can sometimes be inherited and can run in the family.

  • Stressful events (in about 1 of 3 cases)

  • Life changes such as puberty, birth of child, a new job

  • Brain changes. This is still uncertain but if OCD symptoms have been present for a long time, there could be an imbalance of serotonin which develops in the brain

  • Personality. If you are a perfectionist who has high standards you are more likely to develop OCD.

  • Ways of thinking. Many people have distressing thoughts time to time however are quickly dismissed. Some people are disturbed that they even let these thoughts enter their minds and therefore pay more attention to them (RCPsy).

 

A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function (APA).

 

How can OCD be treated?

Cognitive Behavioural Therapy (CBT)

CBT helps to change the way you think. Exposure and response prevention (ERP) is a type of CBT, using exposure as a means to stop compulsive behaviours and anxieties from strengthening each other. We know that if you stay in a stressful situation long enough, you gradually become used to it and your anxiety goes away. So, you gradually face the situation you fear (exposure) but stop yourself from doing your usual compulsive rituals, checking or cleaning (response prevention), and wait for your anxiety to go away (RCPsy). During treatment, the person is exposed to the situation and the compulsive behaviour is provoked. Through provoking the behaviour, the person learns to decrease and finally stop the compulsion entirely. This is a useful technique for where compulsions can be easily re-created. For people who experience mental compulsions where they fear a future event, therapy relies on imagining exposure to the anxiety producing situation. CBT can help reduce OCD however the treatment is only effective if the person adhere to the procedures.

There are two main ways of trying ERP:

  • Self-help book/DVD

You also have occasional contact with a professional for advice and support, but less often. This approach may be suitable if your OCD is mild, and you have the confidence to try out ways of helping yourself.

Direct regular contact with a professional, on your own or in a group.

This can be face-to-face, over the phone or by video link. This usually happens every week or two weeks to start with, and can last for between 45 and 60 minutes at a time. Up to ten hours of contact is recommended to start with, but you may need more (RCPsy).

About 3 out of 4 people who complete ERP are helped significantly. Of those who get better, about 1 in 4 will develop symptoms in the future, and will need extra treatment (RCPsy).

 

Cognitive therapy is another form of therapy aimed at helping to stop fighting the obsessive thoughts. Most meetings with a therapist take place at your local GP practice, a clinic or sometimes a hospital. You might be able to have CT over the phone, or in your own home if you can't leave your house (RCPsy).

 

Medication

Anti-depressant medications called selective serotonin reuptake inhibitors (SSRIs) are known to be effective in the treatment of OCD (APA). They reduce obsessions and compulsions.

SSRIs can be used alone, or with CBT, for moderate to severe OCD. Higher doses often work better for OCD (RCPsy). Other psychotropic medications can be used if there are no results with SSRI. Noticeable benefit usually takes six to twelve weeks to occur (APA). About 6 out of 10 people improve with medication. On average, their symptoms reduce by half. Anti-obsessional medication does help to prevent OCD coming back for as long as it is taken, even after several years. Unfortunately, about 1 in 2 of those who stop medication will get symptoms again in the months after stopping it. This is much less likely to happen if the medication is combined with CBT (RCPsy).

 

Following appropriate treatment, people with OCD can have an improved quality of life, attending school, employment and maintain healthy relationships and social activities. It is important to live a healthy balanced lifestyle, to keep stress levels to a minimal. It is recommended to become familiar to the warning signs and what to do if OCD returns. Effective coping mechanisms that help reduce anxiety such as relaxation techniques such as meditation, yoga, visualization, and massage.

 

Ways people live OCD

People adopt ways to try and manage their OCD however can make matters worse. Some people attempt to supress unpleasant thoughts however they seem to return the more they try to push the thought out of their mind. Some people count or imagine a picture to help correct or generate a safe thought. Replacing a disturbing thought with another thought is done (RCPsy). Rituals of checking, avoiding or seeking reassurance can make you feel less anxious in the short term. It may be believed that by performing the ritual, a bad event may have been prevented.

 

Ways to stay well

  • Tell yourself you are not going mad

  • Face the troubling thought directly. This will help to take control of the situation. Study what it is, what it looks like, how it makes you feel. You need to do this frequently, for half an hour every day until the anxiety reduces (RCPsy)

  • Resist the compulsive behaviour, not the obsessional thought

  • Avoid substance misuse to control your anxiety

  • If your thoughts involve worries about your faith or religion, then it can sometimes be helpful to speak to a religious leader to help you work out if this is an OCD problem (RCPsy)

 

Tips for family and friends

  • Research OCD and obtain a better understanding of what the person is experiencing

  • Be supportive

  • Encourage the person to read about OCD and talk about their experiences

  • Signpost them to see a professional.

  • Help with exposure treatments by reacting differently to their compulsions

  • Support and help tackle fearful situations;

  • Say 'no' to taking part in rituals or checking;

  • Do not reassure them that things are alright.

  • Don't worry that someone with an obsessional fear of being violent will actually do it. This is very rare.

  • Ask if you can go with them to see their GP, psychiatrist or other professional (RCPsy).

 

‘WPA Public Education Initiative’

Dr. Avdesh Sharma, International Lead, WPA; Consultant Psychiatrist, India
Dr. Sujatha Sharma, Consultant Psychologist, India
Stefanie Radford, Senior Project Manager, United Kingdom
Rajeev Verma, Administrator, India
Pragya Mehra, Media Specialist, India
Jatin Kumar, Media Editor, India

Supported by Unrestricted Educational Grant by SUN Pharma SUN LOGO

>> Please click here the pdf version of this document

  

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