OCD Obsessive Compulsive Disorder
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OCD is an anxiety disorder, and can be viewed as a rather complex form of avoidance that sufferers use in an attempt to deal with their fears. The obsessions are a consistent, often terrible or disturbing worry. The compulsions are an activity used in an attempt to neutralise the anxious thoughts. Although used as an attempted solution to the worry, as is often the case in anxiety disorders, such solutions often turn into the problem in itself.
Once thought uncommon, a recent review found that OCD is the fourth most prevalent psychological disorder, with an estimated 1 in 50 of all adults experiencing symptoms within any given year. The World Health Organisation ranks OCD as one of top ten most debilitating disorders (physical or psychological) in terms of reduced quality of life and income loss. Perhaps unsurprisingly based on distress levels, at least 20% of sufferers also suffer from depression. Fortunately, there are well established Cognitive Behavioural Therapy (CBT) protocols for managing OCD. Obsessions are intrusive thoughts or images that are resistant to attempts to put them out of our mind. Some of the most commonly observed obsessive OCD phenomena include fears about: contamination, harm coming to others, sexual orientation or religious themes. Other common themes involve perfectionism, over inflated responsibility, chronic doubt or a need for certainty. Sometimes people report having compulsions without any obsessionally or intrusive thoughts. However the relevant problematic thoughts can usually be accessed when the client is encouraged to risk halting their compulsive behaviours. Compulsions are rituals that are utilised in the misapprehension that such behaviours will enable the sufferer to feel 'just right' and therefore be able to carry on daily lives. Common OCD compulsions include washing, cleaning, sorting, checking, ordering/arranging, hoarding, repeating, counting or a similar mental activity. Unfortunately, such behaviours can be incredibly damaging, not least in terms of time spent in their enactment. These behaviours can sometimes cause real physical damage, whilst also causing OCD sufferers to feel alienated and embarrassed. |
OCD can also involve covert obsessions and compulsions which whilst not obvious can be equally debilitating. For example, mental activities such as repeating, checking, and counting.
OCD responds very well to cognitive behavioural therapy (CBT) and there are well-established protocols that can be followed. At the London OCD Clinic treatment includes learning to challenge unhelpful beliefs, which in turn emboldens sufferers to begin gradually challenging their unhelpful behaviours. Often treatment involves learning to overcome one's sense of over-inflated responsibility, cope with issues around certainty and control, whilst also learning that feared catastrophes do not, in fact, come to pass. OCD can also respond well to SSRI’s (the standard medication for depression that is also effective with anxiety disorders such as OCD). Sometimes it is recommended that sufferers approach their GP to discuss this option. A surprising number of people do not realise their negative experiences are actually OCD. Others avoid seeking treatment as they may fear ‘upsetting the apple cart’. However through applying CBT sufferers lives can be remarkably improved, making treatment highly recommended. Cognitive Behavioural Therapy (CBT) is viewed as the psychological treatment of choice for OCD by the National Institute of Clinical Excellence (NICE) and the Royal College of Psychiatrists. |
Prof Paul Salkovskis explains CBT for OCD |
OCD-UK outline CBT treatment for OCD |
