It is thought that about 1–2% of the population in the UK may have OCD and it can affect people of any age, from young children to older adults.
What is obsessive-compulsive disorder (OCD)?
OCD is name given to a condition in which a person has obsessions and /or compulsions, but usually both. Most people with OCD tend to follow a set pattern of thought and behaviour;
Obsession – a thought, image or impulse that keeps coming into a person’s mind and is difficult to get rid of. These fears or concerns can be irrational, constant and overwhelming. The obsession provokes a feeling of intense anxiety and distress.
Compulsion – a feeling a person has that they must repeat physical or mental acts. Usually people do this in response to an obsessive thought with the intention or reducing anxiety or distress.
The compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the pattern or cycle to begin again.
There are lots of different obsessions that can affect someone with OCD, a few examples are:
- Being afraid of contamination by dirt or germs
- Seeing disturbing pictures in your mind
- Fear of hurting yourself or someone else
- Worrying that your home is not safe, such as an electrical appliance left on
- Wanting to have things in a particular order or arrangement
There are lots of different compulsions that can affect someone with OCD (sometimes called ‘rituals’), a few examples are:
- Excessive washing and cleaning
- Checking things repeatedly (for example, that a door is locked at least three times before you leave the house)
- Keeping objects that other people might throw away (called ‘hoarding’)
- Repeating words or numbers in a pattern
How OCD may affect you?
Almost everyone has a disturbing thought or checks more than once they have locked the door. With OCD, the thoughts and feelings of discomfort can take over.
People with OCD may:
- Realise that their thoughts and actions are irrational or excessive, but they will not be able to help themselves from thinking the obsessive thoughts and carrying out compulsions
- Spend much of their day carrying out various compulsions and be unable to get out of the house or manage normal activities
- Appear to be coping with day-to-day life while still suffering a huge amount of distress from obsessive thoughts
- Carry out their rituals and compulsions in secret or make excuses about why they are doing something
- Not realise that repeated thoughts, such as a fear of harming other people, are common symptoms of OCD and do not mean that they will carry out these thoughts
There are many things we can do to reduce the impact of your OCD to a more manageable level. We may use a combination of the following to help you in recovery:
To help you develop an awareness and insight into your condition.
The most appropriate medication to meet your needs will be discussed with you.
Psychological therapies are used to help develop effective coping strategies and solving skills. Relevant treatment options will be discussed with you.
I first experienced obsessive, intrusive thoughts as a university student. In the beginning they manifested themselves only occasionally, for example, once when I was a passenger in a car I had a fear of suddenly yanking the steering wheel in the direction of oncoming traffic. While these thoughts were not pleasant they generally only occurred in ‘fleeting’ moments – for example, after I had completed the car journey the thoughts vanished, and so they didn’t have a particularly major impact on my life.
However on one occasion when I was doing the washing up I suddenly felt an urge to stab my housemate with a knife I had been cleaning at the time. This time the thought affected me considerably – I thought that I had to be evil to hold such thoughts about harming my friends. These thoughts quickly evolved – whereas previously I only held them while I was around knives, they started to involve other forms of violent acts both to myself and other people. There was no way I could escape these thoughts; I could avoid holding heavy objects or knives, but I still thought that if I wanted to I could hit someone with my fists or spit on them. The thoughts became a constant and ever-present factor in my life.
On no occasion did I want to act on these thoughts; they were just based around a ‘what if’ situation. I imagined that all it would take would be for one small loss of control to make my worst nightmares come true. I wasn’t able to enjoy a holiday with my dad because of these fears – from shouting out something inappropriate on the plane, to randomly assaulting someone in the street – these thoughts became almost constant.
I went to my GP and told her about my concerns, and was given an appointment with a psychiatrist who gave me the diagnosis of “OCD with primarily obsessional features”. This is a form of OCD known as “Pure O” which has fewer observable ‘compulsions’ than “classic” OCD. For example, while traditional OCD may involve compulsive activities like hand-washing, counting and checking, pure OCD compulsions and rituals are less common and are mostly mental in nature, for example, they may involve excessive rumination and avoidance of certain situations.
While I was prescribed some antidepressants, self-help guidebooks on OCD were the most helpful to me. These books explained that to have such intrusive thoughts is not the mark of an ‘evil’ person. The revulsion one experiences to such thoughts is a sign that they are a caring and moral person – after all, a ‘serial killer’ would not find such thoughts of harming others to be distressing. The typical person who is distressed by intrusive thoughts would not act on these thoughts because it would be completely contrary to his or her character.
Challenging obsessions, compulsions, and other intrusive thoughts is best done through Cognitive Behavioural Therapy (CBT). In the case of Pure ‘O’ OCD, this can be done through repeated exposure to the intrusive thoughts or scenario in a method called “Imaginal Exposure”. For example, if somebody had a fear, say, of causing violence to a loved one, then in this method they would write a story graphically describing them committing their worst fear with the worst possible outcome. They would then read or listen to a recording of this scenario many times each day. While this may seem counterintuitive, it has been shown that to face your fears head on rather than try to avoid them completely will, over time, reduce the ‘shock factor’ of any intrusive thoughts much in the same way that watching a horror film again and again will gradually reduce the fear it produces in us.
While this form of therapy has not ‘cured’ my intrusive thoughts, I now find them much easier to manage on a day to day basis. My fears have once again been relegated to a position of being annoying, fleeting moments rather than something that interferes with my life wherever I go.