Obsessive compulsive disorder

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Also known as OCD

Obsessive compulsive disorder (OCD) is defined as having obsessive, uncontrollable thoughts and performing deliberate repetitive actions (compulsions). 

To have a few obsessional thoughts or minor compulsions is extremely common, but the thoughts and actions of OCD can disrupt people’s lives in a most distressing way.

Obsessions are repetitive and unwanted thoughts, images or impulses that cause anxiety and are hard to stop. In fact, trying to stop them causes more distress. You know these things come from your own mind, just like other thoughts and impulses, but you find them hard to control.

Compulsions are repeated actions or behaviours that you feel driven to do, even though you know they are unnecessary or don't make sense. The compulsions are usually linked to the obsessional thoughts. For example, obsessional thoughts about your hands being dirty lead you to feel anxious about catching a disease. This leads to repeatedly and excessively washing your hands.

Some actions become rigid or like a ritual. You may touch things, or wash your hands in an exact way or an exact number of times. Compulsions can also be unseen to others and may include counting or praying silently, feeling that you must think particular thoughts, or see particular mental images. When you perform the compulsive action you do feel a little better initially. But then the anxiety returns. This can lead to more and more compulsive behaviour in an attempt to control the rising level of anxiety.

OCD is not a personality issue

It’s important not to mistake OCD for a personality issue. You might have what can be called an obsessional personality. You would be very careful and check things more thoroughly than most others. You may be a perfectionist and have very high standards about certain things. Usually these tendencies do not cause great problems.  

With OCD it is very different – typically OCD starts gradually and can be a minor irritation for years, eventually getting to the point where symptoms can no longer be denied. You may, for example, deal with the obsessional thought of being dirty by washing a bit more and keeping things cleaner. Taking a shower two or three times a day might not affect anyone much. If this increases so that you spend an hour in the bathroom each morning, it becomes quite inconvenient for the household. If it increases to three hours in the bathroom each day, your life has really been changed.

OCD is an unusual and sometimes frightening condition. Many people with OCD are afraid that they are “going mad” and worry about completely losing control of themselves. This does not happen. OCD also does not lead to other severe illnesses, like schizophrenia, but for some it can be just as disabling.

Who gets OCD?

OCD usually starts during childhood or in your teenage years. Most people are diagnosed by about age 19. Symptoms of OCD may come and go and be better or worse at different times. There is a clear genetic (inherited) factor in OCD. If you have OCD, your children have more risk than most people of developing the condition.

If you think you may have OCD it is most important to seek help. Start by going to see your doctor. OCD often needs the help of a mental health professional, but your doctor will help you find one who knows about this condition.

OCD usually lasts a long time, getting worse at times when you are stressed, so it’s important to seek help early, before OCD controls your life.

What causes it?

The exact cause of OCD is unknown but there is strong evidence that OCD has a physical cause in the brain, where the parts of the brain responsible for starting and stopping thoughts and actions and responding to new information do not work properly. By learning more about this, scientists may in time be able to develop better treatments.

OCD may be triggered by stresses that increase anxiety. Fatigue may also trigger OCD or make it worse, by making people generally more vulnerable and less able to cope.

Signs to look for (symptoms)

The main symptoms of OCD are the obsessions and the compulsions. These vary from person to person, but common themes are:

  • dirt and contamination, which leads to excessive washing and avoiding possible dirt
  • doubt, leading to checking things have been done properly – like locks being locked and stoves turned off
  • unusual or repulsive images in your mind, these may be about religion, sex, violence or suicide and may raise unrealistic fears about your safety  or the safety of your family or whānau.

Obsessions and compulsions are:

  • more than just excessive worries about real-life problems
  • severe enough to be time-consuming, that is, they take more than one hour a day, and cause significant distress
  • significant enough to interfere with normal daily activities and relationships. 

An adult with OCD is usually aware the obsessional thoughts or impulses are unreasonable and are a product their own mind (as opposed to feeling that someone or something else has put them there). 

How a health professional determines if you have OCD (diagnosis)

 If you’re concerned, or suspect you (or a loved one) has OCD it is important to talk to your GP. You will spend some time talking with them about your symptoms and they will look for three things:

  • If you have obsessions.
  • If you have compulsive behaviours.
  • How much the obsessions and compulsions get in the way of important daily activities you value, such as working, going to school or spending time with friends.

Your doctor should refer you to a mental health specialist so you get the expert advice and treatment you need.

Treatment options

Treatment of OCD involves two major components – psychological therapy and medication. Alone, each form of treatment is effective for 70% of those who have OCD. Used in combination, they will help 80–90% of people with OCD.

Medication

Medicines are most often used for making your mood more stable and for helping with depression (anti-depressants). If you are prescribed medication, you’re entitled to know the names of the medicines; what symptoms they are supposed to treat; how long it will be before they take effect; how long you will have to take them for and understand the side effects.

Finding the right medication can be a matter of trial and error. There is no way to predict exactly how medicines will affect you. So be patient until you find the right medication for you.

If you’re pregnant or breastfeeding no medication is entirely safe. Before making any decisions about taking medication in pregnancy you should talk with your doctor.

Talking therapies and counselling (psychological treatments)

Talking therapies are effective in the treatment of OCD, especially for the treatment of depressive symptoms. Sessions may be held on a one-to-one basis, sometimes include partners or family, or be held in a group.  The focus of psychological therapy or counselling is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery and coping. Sessions help you regain the confidence and belief in yourself that is critical to recovery.

All types of therapy/counselling should be provided in a manner that is respectful to you and with which you feel comfortable and free to ask questions. It should be consistent with, and incorporate, your cultural beliefs and practices.

Psychoeducation (providing education)

Education about OCD can be extremely important to help you, your family/whānau and supporters. Your health professional should give you information about your condition, suggest different ways to handle it, and discuss any complications which could occur.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Thanks to Janet Peters, registered psychologist, and Lisa Ducat, Like Minds, Like Mine mental health promoter, for reviewing this content. Date last reviewed:  September, 2014.