OCD

This page is information on OCD

What is obsessive-compulsive disorder?
How common is OCD?
What are the common signs of OCD?
Common obsessions
Common compulsions
Avoidance
Cultural differences
What causes OCD?
How do you treat OCD?

Understanding obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) is described as an anxiety disorder. An obsession is a repeated unwanted thought or urge; a compulsion is a repetitive activity that you feel you have to do. OCD can be unpleasant and frightening.

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What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) has two main parts: obsessions and compulsions.

Obsessions are unwelcome thoughts; idea or urges that repeatedly appear in your mind; for example, thinking that you have been contaminated by dirt and germs, or worrying that you haven’t turned off the oven. These obsessions are often frightening or seem so horrible that you can’t share them with others. The obsession interrupts thoughts that you would rather have, and makes you feel very anxious. Often it will make you worry that you or other people are going to be harmed.

Compulsions are repetitive activities that you feel you have to do. This could be something like repeatedly checking a door to make sure it is locked or washing your hands. The aim of the compulsion is to ‘put right’ the distress caused by the obsessive thoughts and relieve the anxiety you are feeling. You will be unlikely to feel any pleasure from carrying out the compulsion but you might find yourself doing it again and again.

Most people with OCD experience both obsessions and compulsions, but some people experience only obsessive thoughts and some people have compulsions without knowing why.

If you have OCD, you know that the obsessional thoughts are your own. This makes it different to a psychotic disorder such as schizophrenia, where people feel that certain unwelcome thoughts and ideas come from outside themselves.

OCD is described as an anxiety disorder. Other anxiety disorders include phobias and panic disorder which can share symptoms with OCD such as recurrent intrusive thoughts and fear. OCD is also known to have a close association with depression, and some people find obsessions appear or get worse when they are depressed.

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How common is OCD?

Minor obsessions and compulsions are common. We all worry, occasionally, about whether we’ve left the gas on, or the locked the door, and we describe people as being obsessed with work or football. However, these are not normally unwanted thoughts and they do not interfere with daily life. Many people also carry out small, everyday rituals like not stepping on cracks. These rituals might help people feel safe, but are not normally considered problems.

If you are diagnosed with OCD, the problems are so severe that they have stopped you from being able to live your life the way that you want to.

You may understand that the way you are behaving is irrational, and feel ashamed and alone because of it. This shame often stops people from asking for help, and can lead to a delay in diagnosis and treatment. Many people try to cope alone until the symptoms are so severe they can’t hide them anymore.

You may not realise how common such problems are. It is thought that 1 to 2 per cent of the population have OCD that is severe enough to disrupt their normal life, and it can affect people of all ages and from all backgrounds; however, the onset of OCD symptoms is normally in early adulthood, with most cases emerging before the age of 25.

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What are the common signs of OCD?

Although everyone will have their own unique experiences, there are several common obsessions and compulsions.

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Common obsessions

The three most common themes are unwanted thoughts about harm or aggression, unwanted sexual thoughts and unwanted blasphemous thoughts.

Some examples of obsessions include:

  • fearing contamination – e.g. from dirt and germs in a toilet
  • imagining doing harm – e.g. thinking that you are going to push someone in front of a train
  • intrusive sexual impulses – e.g. worrying that you will expose yourself at work
  • excessive doubts – e.g. thinking that you have cancer despite having no symptoms
  • ‘forbidden’ thoughts – e.g. thinking about abusing a child
  • a fear of failing to prevent harm – e.g. feeling that you are responsible for security at work.

 

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Common compulsions

The most common compulsions involve repeatedly washing or checking. Some examples might be:

  • repeating actions – e.g. touching every light switch in the house five times
  • ordering or arranging – e.g. keeping food organised by colour in the fridge
  • washing – e.g. always washing hands six times with soap and six times without soap after using the toilet
  • checking – e.g. reading through an email ten times before sending it to make sure it doesn’t have any mistakes in it
  • touching – e.g. only buying things in the supermarket that you have touched with both hands
  • praying – e.g. repeating a mantra again and again whenever you hear about an accident
  • focusing on a number – e.g. having to do everything three times, or buy three of every item when you are shopping.

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Avoidance

You might find that some objects or experiences make your obsessions or compulsions worse, and try to avoid them as a result. For example, if you fear contamination, you might avoid eating and drinking anywhere except in your own home. Avoiding things can have a major impact on your life.

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Cultural differences

OCD is found in different parts of the world and does not seem to be restricted to one culture. The core experiences of obsessions and compulsions are similar, but the content is likely to reflect concerns that are relevant to the local situation. For example, people who belong to a particular religion might find their obsessions come in the form of blasphemous thoughts.

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What causes OCD?

There are different theories about why OCD develops, but none of these theories have been found to fully explain every person’s experience.

One theory suggests that OCD develops because of ‘dysfunctional’ beliefs and interpretations. If you experience OCD, you might have exaggerated beliefs about your responsibility for situations and find that your reaction is out of proportion; for example, many people might think about wanting to kill someone but attach no meaning to this and forget about it. However, if you interpret this as something that might happen, and develop a compulsion to try and counteract it, an OCD ‘cycle’ could begin.

Some psychological theories suggest that OCD is caused by personal experience. It is thought that if you have had a painful childhood experience or suffered trauma or abuse you might ‘learn’ to use obsessions and compulsions to cope with anxiety. It could also be that one or both of your parents may have had similar anxiety and shown similar kinds of behaviour, (such as obsessional washing) and you were affected by this. However, this theory does not explain why people who cannot point to any painful experiences might experience OCD.

Biological explanations have suggested that lack of a brain chemical, serotonin, has a role in OCD; although experts disagree about what that role is. It’s unclear whether changes in the levels of this chemical are a cause or effect of the problem, but some medication is based on adjusting these levels. Studies have also looked at genetic factors and how different parts of the brain might be involved, but have found nothing conclusive. Biological theories do not provide any explanation for why one person might develop a contamination obsession while another develops a doubting obsession.

 

How do youtreat OCD?

OCD is best treated behaviourally. Through thought process, challenging those thoughts and the beliefs that come with them.

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