A man with OCD carefully trims grass

What is Obsessive Compulsive Disorder?

Although previously thought to be a rare condition it has now been established that Obsessive Compulsive Disorder in its many forms and subtypes affects around 1% – 2% of the population. OCD (to use its common abbreviation) is classified as an anxiety disorder with, as the name suggests, two components: obsessions and compulsions.

Obsessions can take many forms including intrusive thoughts, images, doubts, worries, feelings and urges. These obsessions are firmly rooted in fear – resulting in the sufferer experiencing extreme levels of anxiety, discomfort and uncertainty. The compulsive element of this condition can take the shape of ‘rituals’ which the sufferer feels they must engage in order to bring temporary relief from the symptoms of anxiety generated by the unwanted obsessions. These compulsions can take the form of both physical and/or mental rituals. Physical compulsions can include activities such as excessive hand washing or constantly going back to check that a door is locked, while mental compulsions can include avoidance, guilt, rumination (excessive and repetitive thinking about a subject or issue), reassurance seeking and/or obsessive researching of the obsessive subject.

In modern times, OCD has been widely misrepresented in the media as a condition which makes people overly fastidious regarding cleanliness or being overly concerned with having things in the correct ‘order’. While both can be symptoms of OCD there is a world of difference between someone who likes to keep themselves clean and carries out appropriate hand washing and someone who has a clinical condition forcing them to repeatedly wash their hands until they bleed. It is also widely believed that to have OCD you must have some kind of physical compulsion – However, this is completely untrue, with many OCD sufferers displaying only symptoms around mental compulsions. This latter subset is often referred to as a ‘Pure OCD’ or just ‘Pure O’.  However, both the physical and mental types of compulsions are valid symptoms of OCD.

A second misconception is that people with OCD suffer from some form of personality flaw or that the unwanted intrusive thoughts and worries represent some legitimate aspect of their character or desires. Both of these are absolutely untrue and, in fact, the exact opposite is true.

What forms can Obsessive Compulsive Disorder take?

The umbrella term of OCD covers a huge range of subtypes but in all instances, the condition has its primary roots in fear and anxiety. All sufferers will have a typical ‘theme’ or subject around which they experience a great deal of anxiety or discomfort. These can be ‘triggered’ by real-world stressful situations or are the result of unwanted, intrusive thoughts which the sufferer feels compelled to constantly analyse, examine, avoid or find a solution to.  Principally, OCD obsessions will revolve around the four broad categories:

1) Fear of causing or of failing to prevent harm

Frequently called Harm OCD, sufferers will worry excessively that they have or will have harmed others. For example, they may worry that they have knocked someone down in their car without noticing or have extreme fears that they will ‘lose control’ and hurt others in some way. In the latter example, the sufferer may avoid using (or even being around) knives, scissors or other sharp objects

2) Fear of contamination

Contamination OCD revolves around the sufferer’s fear of germs, diseases or dirt. In this way, they fear that they or other people are somehow contaminated. In addition, they might develop extreme anxiety about contracting a disease or catching something contagious. This type of OCD is one where the compulsions can include excessive hand washing and stringent levels of cleanliness. 

3) Fear of disorder/Need for excessive symmetry

Order based OCD involves the fear that something bad will happen if things are not placed in a certain way. Normally this centres on symmetry but it can also include cleanliness and having items in a certain order. Sufferers will experience anxiety (sometimes just described as a feeling that something is wrong or mentally uncomfortable) and feel compelled to rearrange things to make it ‘right’ and avoid the feared consequences.

4) Intrusive thoughts, unwanted mental images and ‘urges’

In this category, sufferers of OCD experience intrusive (or unwanted) thoughts that run contrary to their own values and personalities. The use of the term ‘intrusive thoughts’ also includes upsetting mental pictures, images, feelings or apparent ‘impulses’ which rise, unbidden, into the sufferer’s mind causing them extreme distress and worry.  Examples of these themes include:

Violence

Imagining carrying out violent acts both against others and even their selves (self-harm). Sufferers will worry that they actually ‘want’ to do these things and that they are a danger to themselves or others (especially friends and loved ones).

Religious

Unwanted thoughts regarding religious beliefs, including blasphemous images and urges. Sometimes called ‘Scrupulosity’ this can be extremely upsetting for people of faith. Sufferers may even start to believe that their intrusive thoughts are the result of being tempted by the devil or being the subject of demonic possession. These only add to the sufferers already high anxiety levels.

Relationships

Here the subject of the unwanted thoughts and images revolves around loved ones, specifically doubts about whether they are ‘the one’ or the erroneous thought that their partner is cheating on them. In addition, sufferers may worry excessively about whether their feelings for a partner are ‘strong enough’. This can result in sufferers ending a perfectly good relationship in order to alleviate the fear and doubt, only to discover that the feelings do not go away or result in extreme guilt and unhappiness.

Sexual

This form of OCD centres on the topic of sex and sexuality. For example, a sufferer may suddenly start to worry about their sexual orientation – a heterosexual individual will start to worry that they are gay, while homosexual individuals start to experienced unfounded anxiety that they may be straight. Others may start to worry that they find children or members of their own family sexually attractive. Still others may fear that they are potential rapists.

OCD: The insidious, lying imp of the mind

In all the cases listed above, it is critical to understand that OCD fears are ‘ego-dystonic; – that is that they run contrary to a sufferer’s true beliefs, values and feelings. OCD is a cruel, spiteful disorder which makes gentle people fear that they are violent, loving partners to unrealistically doubt their love for others and tortures deeply religious people with thoughts and images contrary to their faith. In all cases of OCD the doubts, fears, questions and extreme anxiety are the solely the creation of OCD.

People stricken with Obsessive Compulsive Disorder can take heart in the knowledge that OCD attacks that which they personally love and value most. Very often people will worry that OCD has some deep and meaningful reason behind it. i.e. “These thoughts must mean that on some level I do want to hurt others/leave my wife/am a paedophile!” In fact, the very opposite is true. During therapy, OCD sufferers will come to understand that not only does everyone have intrusive thoughts that occasionally pop in their minds, but that the mere fact that these thoughts provoke anxiety, discomfort and fear in the sufferer proves that they do not want to act on them. For example, people who harbour a wish or desire to harm others would not react with fear or anxiety to such thoughts…they would encourage them! A paedophile does not avoid children for fear of harming them; they would actively seek out children to abuse.

This welcome revelation often leads sufferers to experience the very common secondary fear of “What if it’s not OCD and I really am a monster?!” This is where OCD shows how insidious and devious it can be as a mental illness. Faced with the fact that sufferers are only worrying about something they would never do, the OCD imp will try hard to persuade the individual that they really don’t have OCD…and so perpetuate the anxiety spiral.  To some extent, this secondary worry is a good indicator that the sufferer has OCD on the ropes and it is desperately casting around for something to prolong the sufferer’s fear and distress.

What causes Obsessive Compulsive Disorder?

As with many mental illnesses, there are several theories about the causes of OCD, however, researchers agree that it is a combination of three factors: biology/inherited genes, personal experiences and dysfunctional beliefs. Certain individuals may inherit genes or have a biochemical reason why they are more at risk of developing OCD but this is influenced by their personal history (upbringing, previous experiences, etc.) and exacerbated by learned negative thinking styles. Looking back sufferers can often identify periods in their lives when they have obsessively worried about something which could be taken as a mild form of OCD. Major episodes, leading to the typically crippling anxiety and compulsive behaviour, can be triggered by the stress caused by life events (losing a job, getting married, the death of a close relative) or just a single intrusive thought that suddenly gets ‘stuck’ in the sufferer’s mind.

The good news is that however, the OCD started or whatever form it takes full recovery is entirely possible given time and the correct treatment.

Treatments for Obsessive Compulsive Disorder

When considering treatment for OCD it is vital that the sufferer looks for professional help – both in the form of seeing their own GP and in choosing a suitable therapist. Very often GP’s can offer medication, such as antidepressants, which will help to reduce symptoms and assist sufferers by referring them to additional ‘talking treatments’ and Cognitive Behavioural Therapy (CBT).

  It is vital that OCD sufferers choose a therapist who is familiar with treating Obsessive Compulsive Disorder, especially the principles of Exposure and Response Prevention (ERP). This is the gold standard for treating OCD and is seen as being highly effective in helping sufferers. ERP is focused on reducing rituals (the ‘compulsions’ part of OCD) while also challenging unhelpful beliefs about control, responsibility and guilt. ERP works to help people face the subject of their obsessive worries and resist carrying out compulsions. All this is done in a gradual, managed way starting with smaller elements and working toward the bigger issues.

For those who have a less urgent condition, psychoanalytic psychotherapy can be helpful in exploring how the OCD developed and was triggered. By exploring the background, experiences and beliefs with a qualified therapist who is familiar with treating OCD, individuals can gain valuable additional understanding around, and learn control over, this highly debilitating condition.

Finally, support from family and friends can be very helpful in helping people to deal with Obsessive Compulsive Disorder but they must be careful that this doesn’t turn into ‘enabling behaviour’, which can make OCD worse. In general, friends and family are discouraged from giving reassurance or carrying out rituals with or for sufferers. Both of these actually result in the OCD getting worse over time. Hard as it might be it is better in the long term to concentrate on being patient, staying calm and trying as much as possible not to judge sufferers. Remember that they may have kept their condition secret in fear of being rejected by others. Instead, learn as much as you can about OCD and encourage sufferers to access the professional support widely available. Love, support and open acceptance will provide your family member or friend with a welcome sense of being understood. 

What are your experiences with Obsessive Compulsive Disorder?

We would be delighted to hear your own personal experiences with OCD – either as a sufferer yourself or if one of your family or friends has been diagnosed with this condition. Sharing your story, experiences and successes can help others find the strength and courage to finally address the misery and fear which is so central to this mental illness. Leave your comments, tips and observations below.

Alternatively, why not get in touch with us now to arrange a friendly, no obligation chat about how talking treatments could help you or someone you love afflicted with Obsessive Compulsive Disorder.

Thank You!

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