What is OCD?

Obsessive-Compulsive Disorder, OCD, is a mental health condition that consists of obsessions, compulsions, or both which adversely interfere with your quality of life. OCD occurs in roughly 2 per cent of the general population worldwide (Sasson et al. 1997)

Most people have heard of OCD or watched programs about it on television. People often think of it as hand washing or repeatedly having to perform some ritual, but there is a lot more to Obsessive Compulsive Disorder than that.

How is OCD diagnosed?

Mental health professionals use a diagnostic handbook; The Diagnostic and Statistical Manual for Mental Disorder, Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013) 

Up until the new edition of The Diagnostic and Statistical Manual for Mental Disorder DSM in 2013,  OCD fell under the classification of anxiety disorders which included other disorders such as panic disorder, social phobia, simple phobia, GAD and post-traumatic stress disorder. When classified as an anxiety disorder, the defining diagnostic criteria for OCD, was anxiety.

OCD was given a separate category in 2013 with The Diagnostic and Statistical Manual for Mental Disorder DSM-5 known as obsessive-compulsive and related disorders. This change was significant as the defining diagnostic criteria for OCD are now obsessions and compulsions.

Having obsessions and compulsions though are not sufficient for a diagnosis of OCD to be made. To be given a diagnosis, the mental health professional will be interested in how much the obsessions and compulsions are impacting on your life, how much distress they cause you, and how much of your time they affect.

Symptoms

Obsessions

Obsessions can be thoughts or images. You might have obsessive or intrusive thoughts relating to somehow causing harm to yourself or others. 

For example, you may be afraid that your actions might somehow cause harm. You might be concerned that something you do or do not do, may make someone ill or even kill them. You may be afraid that you might become sick or die yourself by contracting some disease.

Worked example

You’ve just left for work and are worried that you might not have turned off the curling irons. You start to obsess that the house could burn down, resulting in damage to the property and injury or loss of life.

If you have OCD, you will feel solely responsible should this happen. 

Understandably, if you are concerned that you might cause harm to yourself or others, you will take steps to stop this from happening. This concern might mean ensuring that everywhere is spotlessly clean and germ-free. The obsessive thoughts then lead to rituals, otherwise known as compulsions.

Compulsions

Compulsions are developed in a way to reduce the anxiety associated with obsessive thoughts and images. 

Compulsions are, for example, feeling compelled to go back to the house and check the curling irons are turned off, unplugged and that you can see the plug is far away from the socket.

We all have compulsions or rituals to a certain degree.

For example, think about superstitions, throwing salt over the shoulder, not putting an umbrella up indoors, not walking under ladders or splitting a post or pole with a friend when out walking.

Do you think that throwing salt over the shoulder will stop something from happening? Or that a long term friendship may be lost because while out walking you both walked either side of a post? Maybe not, but a lot of us do not risk it or “tempt fate” all the same. 

It becomes problematic, however, when the compulsions or rituals interfere with daily life.

What causes OCD?

When OCD becomes a problem

If you have OCD, you will realize that the compulsions are more complicated than the examples given above. For example, if you cannot get the thought out of your head that you may cause harm to yourself or to the people you care about, by spreading germs or contaminating them in some way, you will not risk causing this harm.

These thoughts and feelings will raise your anxiety and fear levels sky high, and once you wash your hands or clean the kitchen, your anxiety goes down a little. This washing, along with the temporary relief provided is the start of the compulsions.

However, your anxiety and fears quickly return, and you wash your hands and clean again. Stress lowers but promptly returns, so you wash again. A vicious cycle suddenly emerges, thought, compulsion, thought, compulsion, until it all becomes a blur and is just something that you do.

Not being able to carry out compulsions, creates anxiety in itself. You may feel very distressed if you are not, for example, able to wash your hands. It can feel terrifying.

For some people, the things that they do to reduce the anxiety, in an attempt to avoid something terrible from happening can seriously interfere with daily life. It can take hours to get out of the house in the morning.

Work is problematic as you may not want people knowing what you do, but you still have to do it. And your anxiety is not as well controlled anymore by just washing your hands or cleaning.

Types of OCD

People who clean 

With OCD you may have a fear (as mentioned above) that somehow you can contaminate yourself or others, or somehow make people around you ill. You may obsess about germs and will try to ensure against the spread of germs by cleaning not only yourself but also surfaces and objects.

You may also have difficulty touching things as this would pass germs onto your hands that you have already washed. Even showering can be problematic. Once in the shower, it can be challenging to use shampoo or shower gel, you might find that you need to clean this as you go along, or may also have to avoid touching the shower screen or clean it as well.

As you can see from this brief example, everyday things become complex and create an extreme amount of external anxiety. For people who do not have OCD, you are probably not aware how often we touch things as we go about our day.

The alarm clock when we wake up. Door handle for the bathroom, all the objects in the bathroom. In our home, we can have some degree of control over this. Once we leave the house, however, there are door handles, toilets, people bumping into us, which for a person with OCD, can cause extreme anxiety, discomfort and fear.

People, who hoard

Do you have difficulty throwing things out and your home is so cluttered that it is difficult to move freely? Some people with OCD experience pain throwing things out and would experience a spike in anxiety at the thought of it.

You might need the things at some stage. Not being able to discard items can cause problems in relationships and your living environment as closets may be overflowing, work surfaces covered and piles of “stuff on the floor.” Again, this is a symptom of the underlying anxiety that OCD creates.

People who check

Nearly every one of us experience this to a certain degree. Leaving the house, only to return to verify that the alarm was on, the oven was turned off.

However, if you “check” as a result of OCD, it can affect your quality of life. It becomes more complicated than just checking that the oven is off. You may have developed a routine that you check a certain number of times, only to leave the house, and wonder “is it off?”

This thought causes your anxiety to spike, and your brain quickly learns that your stress decreases (albeit temporarily) when you return to the house and check again. Which leads to on to:

People who repeat

With the oven example, you may have to check it a certain number of times or wash your hands a certain number of times. You might repeat certain words or phrases in your head.

All of the above examples, although different, have one big thing in common. They all exist to lower your anxiety for a while. You have the thought (obsession), and you carry out a compulsion, and stress goes down for a while.

However, it does not stay down, and the cycle starts to repeat, only now, it takes more compulsions or rituals to help to control your anxious thoughts.

There are also what are known as Maintaining Factors in OCD.

Often the people around you, who love and care about you may be maintaining your OCD. Again, we do not mean to, but we try to help the person we care about, by not touching the things that have been disinfected, or eating somewhere else, or driving back to check that the oven is off.

You perform these behaviours to try to help the other person, but long term, it stops you from fully recovering, as you do not get the chance to see that everything is ok.

Regardless of what way your OCD manifests itself, I always see one common factor. That somehow something bad will happen, and it will be your fault.

This “something bad” can be causing harm to others. Something bad happening to you or your family. You can have disturbing intrusive thoughts that you believe that you could harm others. These can be sexual or inflicting bodily harm and are very frightening indeed. Having these thoughts does not mean you are a bad person.

These thoughts may lead you to avoid children or other people, or staying away from the knives in the kitchen or removing them in case you hurt someone. They are just thoughts. Alarming ones yes, but thoughts all the same.

Everyone that I have worked with, with OCD has never carried out any of the scary thoughts they have in their head. Nor have they unwittingly caused harm to others. This in itself can be problematic, as the person may believe that they have prevented something bad from happening by the rituals (compulsions) they perform and are very reluctant to stop doing them, in case something bad happens.

But this is what people who have recovered from OCD achieve. Firstly by reducing and finally eliminating their compulsions and then, seeing their thoughts for what they are – just mental activity in their brain. Cognitive Behavioral Therapy is what I mostly use to help people recover from OCD.

How to get over OCD

Treatment for OCD

The cornerstone of therapy is to help you to reduce and eliminate your compulsions and for you to stop having distressing thoughts and images. To achieve this, we work with your thought processes and help you to reduce your overall levels of anxiety.

When you are feeling calmer, you are then in an excellent position to start working towards reducing and finally eliminating your compulsions.

What to expect if you meet with a mental health professional.

People often start with a visit to their doctor, who will refer them to a psychologist or psychiatrist. I’m a psychologist and will give you a brief outline of what will happen if you attend a psychologist.

Assessment

Your first and maybe second appointments are used to undertake an assessment.  

During the assessment you will be asked questions about;

your obsessions (the unwanted thoughts and images) to identify the type of obsession (if any), how often they happen, and whether or not they interfere with your quality of life.

The psychologist will ask about the things you do to help cope with the obsessions. The things that you do to cope are known as compulsions. Again, the psychologist will record the type of compulsion, how often you do this, how much it bothers you, and how much it interferes with your quality of life.

The psychologist will score your answers, and depending on your score, you will be told you do not have OCD, or you have mild, moderate or severe OCD.

Further Reading.