OBSESSIVE-COMPULSIVE DISORDER (OCD)

WHAT IS OCD? 

Obsessive-compulsive disorder (OCD) has two main parts:

• Obsessions are unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind. They can make you feel very anxious (although  some people describe it as mental discomfort rather than anxiety).

• Compulsions are repetitive activities that you do to reduce the anxiety caused by the obsession. It could be something like repeatedly checking a door is locked, repeating a specific phrase in your head or checking how your body feels.

“It's not about being tidy, it's about having no control over your negative thoughts. It's about being afraid not doing things a certain way will cause harm.” 

You might find that sometimes your obsessions and compulsions are manageable, and other times they may make your day-to-day life really difficult. They may be more severe when you are stressed about other things, like life changes, health, money, work or relationships.

WHAT'S IT LIKE TO LIVE WITH OCD?

If you experience OCD, it's likely that your obsessions and compulsions will have a big  impact on how you live your life. For example:

• Disruption to your day-to-day life

Repeating compulsions can take up a lot of time and you might avoid certain situations that trigger your OCD.

• Impact on your relationships

You may feel that you have to hide your OCD from people close to you–or your doubts and anxieties about a relationship may make it too difficult to continue.

• Feeling ashamed or lonely

You may feel ashamed of your obsessive thoughts, or worry that they can't be treated. This can make you feel isolated and lonely.

• Feeling anxious

Some people feel that they become slaves to their compulsions and have to carry them out so frequently that they have little control over them.

“I knew it was irrational ... but tapping certain objects would ease the effect of the terrible intrusive thoughts. It would be time-consuming but at least then I could feel like I wasn't a bad person.”

RELATED DISORDERS

There are some other mental health problems that are similar to OCD because they involve repetitive thoughts, behaviours or urges:

~Perinatal OCD is when you experience OCD during pregnancy or after birth.

~Body dysmorphic disorder (BDD) involves obsessive worrying about one or more perceived flaws in your physical appearance and developing compulsive routines to deal with worries about the way you look.

~Compulsive skin picking (CSP) is the repetitive picking at your skin to relieve anxiety or urges. It can be experienced as part of body dysmorphic disorder (BDD).

• Trichotillomania is a compulsive urge to pull out your hair.

• Hoarding is when you collect, keep and find it hard to get rid of things, to the point where it affects your day-to-day life.

• Obsessive compulsive personality disorder (OCPD) is a type of personality disorder. It has some related traits to OCD, but is a different and separate condition.

OCD AND STIGMA

Lots of people have misconceptions about what OCD is. Some people think it just means you wash your hands a lot or that you like things to be tidy. They might even make jokes about it, or describe themselves as a ‘little bit OCD’. This can be frustrating and upsetting, especially if someone who feels this way is a friend, colleague, family member or a health care professional.

These are some options that you can also think about:

a. Show people this information to help them understand more about what your diagnosis really means.

b. Get more involved in your treatment

c. Know your rights

d. Take action with mind

“One of the most difficult things about OCD is how people perceive it. Intrusive thoughts and compulsions take a greater toll, yet people don't seem to understand that.”

WHAT ARE THE SYMPTOMS OF OCD? 

Obsessions

Obsessions are persistent thoughts, pictures, urges or doubts that appear in your mind again and again. They interrupt your thoughts against your control, and can be really frightening, graphic and disturbing. They may make you feel anxious, disgusted or uncomfortable.

You might feel you can't share them with others, or that there is something wrong with you that you have to hide. You might feel upset that you are capable of having such thoughts.

Remember: obsessions are not a reflection of your personality. People with OCD are very unlikely to act on their thoughts. 

Compulsions

Compulsions are repetitive activities that you feel you have to do. The aim of a compulsion is to try and deal with the distress caused by obsessive thoughts. You might have to continue doing the compulsion until the anxiety goes away and things feel right again. You might know that it doesn't make sense to carry out a compulsion –but it can still feel too scary not to. Repeating compulsions is often very time-consuming and the relief they give you doesn’t usually last very long. 

Compulsions can:

• be physical actions

• be mental rituals (people who only have mental compulsions sometimes refer to their OCD as Pure O)

• involve a number (for example, you might feel you have to complete a compulsion a specific number of times without interruption).

WHAT IS 'PURE O'?

Pure O stands for 'purely obsessional'. People sometimes use this phrase to describe a type of OCD where they experience distressing intrusive thoughts, but there are no external signs of compulsions (for example, checking or washing). The name is slightly misleading as it suggests that there are no compulsions at all.

Here are some examples of internal compulsions:

• checking how you feel (for example, you might check to see if you are still in love with your partner)

• checking bodily sensations (for example, you might check to see if you were aroused by an intrusive thought)

• check how you feel about a thought (for example, you might check whether you are still upset by the thought)

• repeating phrases or numbers in your head

• checking if you still have a thought (for example, first thing in the morning).

WHAT CAUSES OCD? 

There are different theories about why OCD develops. None of these theories can fully explain every person’s experience, but researchers suggest that the following are likely to be involved in causing OCD:

• Personal experience

Some theories suggest that OCD is caused by personal experience. For example:

* If you've had a painful childhood experience, or suffered trauma, abuse or bullying, you might learn to use obsessions and compulsions to cope with anxiety. 

* If your parents had similar anxieties and showed similar kinds of compulsive behaviour, you may have learned OCD behaviours as a coping technique.

* Ongoing anxiety or stress, or experiencing a stressful event like a car accident or starting a new job, could trigger OCD or make it worse. 

* For some women, pregnancy or birth can trigger perinatal OCD.

• Personality 

Some research suggests that people with certain personality traits may be more likely to have OCD. For example, if you are a neat, meticulous, methodical person with high standards, you may be more likely to develop OCD.

• Biological factors

Some biological theories suggest that a lack of the brain chemical serotonin may have a role in OCD. However, it's unclear whether this is the cause or an effect of the condition. Studies have also looked at genetic factors and how different parts of the brain might be involved in causing OCD, but have found nothing conclusive.

HOW CAN I HELP MYSELF? 

Obsessions and compulsions can take over your life, and leave you feeling helpless. However, there are some things you can try to help manage your OCD and improve your  wellbeing. Remember that different things work for different people at different times. If something isn't working for you (or doesn't feel possible just now), you can try something else or come back to it another time.

A. Try self-help resources

Self-help resources for OCD are designed to help you develop coping strategies and are

often based on cognitive behavioural therapy (CBT). Make sure any resources you use 

are properly accredited. 

B. Build a support network

~Talk to someone you trust about your OCD

~Spend time with friends and family

“Sharing the obsessive thoughts made them feel less powerful.”

C. Try peer support

Making connections with people with similar or shared experiences can be really helpful. 

You could try talking to other people who have OCD to share your feelings, experiences and ideas for looking after yourself.

“I remember wishing I could just talk to someone who could tell me they had felt what I was feeling.”

LEARN TO LET GO

• Manage your stress. Stress and anxiety can make OCD worse. 

• Try a relaxation technique. Relaxation can help you look after your wellbeing when 

you are feeling stressed, anxious or busy. 

• Try mindfulness. Mindfulness can help you reduce stress and anxiety. For some people, it can be helpful as part of recovery from OCD. 

LOOK AFTER YOUR PHYSICAL HEALTH

a. Get enough sleep. Sleep can give you the energy to cope with difficult feelings and 

experiences.

b. Think about your diet. Eating regularly and keeping your blood sugar stable can make a difference to your mood and energy levels. 

c.Try to do some physical activity. Any kind of physical activity counts – from a chair-based exercise regime to dancing round the 

kitchen – the important thing is to find something that works for you.

WHAT TREATMENTS CAN HELP? 

The type of treatment you are given depends on the intensity of your OCD and how much it affects your life, so the more honest you are, the more likely you are to get the best help for you.

WHAT TALKING THERAPIES MIGHT I BE OFFERED? 

• Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) focuses on how your thoughts, beliefs and attitudes 

affect your feelings and behaviour.

• Exposure and response prevention (ERP)

ERP encourages you to confront your obsessions and resist the urge to carry out compulsions. During ERP, your therapist will support you to deliberately put yourself in a situation that would usually make you feel anxious. Instead of performing your usual compulsion, you will be encouraged to try and tolerate the anxiety.

• Cognitive therapy 

Cognitive therapy focuses on identifying and changing negative feelings about yourself, to help you change unhelpful responses and behaviours.

WHAT MEDICATION MIGHT I BE OFFERED? 

You may be offered the following medications for OCD, either on their own or alongside talking therapy:

• Selective serotonin reuptake inhibitors (SSRIs) –a type of antidepressant that has also been shown to be effective in treating OCD

• Clomipramine –a tricyclic antidepressant, which you may be offered if an SSRI doesn’t work. 

HOW CAN OTHER PEOPLE HELP? 

Your loved one may find it difficult to talk about their obsessions and compulsions. They may have kept them secret for a long time and be very worried about your reaction. It can help to acknowledge this and encourage them to talk about their experience in a way that feels comfortable to them:

• Be patient. Remember that their fears are very real to them, even if they seem unrealistic, irrational or extreme to you.

• Don’t judge. It can be upsetting to hear about some obsessive thoughts, but if you act shocked or judge them, they will be less likely to share their thoughts and feelings with you in future. Make it clear that you love and support them regardless.

• Find out as much as you can about OCD. This will help you understand what your loved one is going through. 

One of the hardest things about supporting someone with OCD is how to deal with their 

compulsions. You may find yourself helping them (this is sometimes called accommodation). For example:

• helping them carry out their compulsions 

• offering reassurance about their obsessive thoughts and behaviours. 

Refusing to help can increase someone’s anxiety and makes things more difficult for both of you. But helping someone with their compulsions is usually not helpful in the long term. Every time someone acts on a compulsion (including asking for reassurance), it reinforces the belief that the compulsion is the only way to deal with their anxiety.

HOW CAN WE MANAGE COMPULSIONS IN OTHER WAYS? 

Try and work out some alternatives together. Your approach might depend on what your loved one thinks about their compulsions and whether they are receiving treatment. Here are some things you could try:

• Agree on an approach that feels right for you both. For example, you might decide 

that you will say 'we've agreed I won't answer questions like that to help you overcome your OCD'.

• Encourage them to challenge compulsions where appropriate. For example, instead of offering reassurance, you could try and help them think about why they want to do a compulsion again.

• Offer a hug or other emotional support instead of helping with a compulsion.

• Seek advice. If they are getting treatment, you could both talk to their doctor or therapist about how to manage compulsions.

• Accept that sometimes it will be impossible not to offer reassurance or to help with a compulsion.

HELP THEM TO ACCESS TREATMENT

Your loved one may find it difficult to talk to their doctor about their OCD and seek  treatment. Here are some ways you could support them:

~Remind them that the appointment will be confidential and the GP is there to help 

them access treatment. Offering to go with them could also help make things easier.

~Some parts of treatment for OCD can be challenging. During treatment, your friend or family member may be agitated, tired, anxious or depressed. Ask them what you can do to make things easier during this difficult time. 

~They may feel that things will never get better, especially if they are finding  treatment hard or their symptoms come back. You can offer hope. Remind them that most people with OCD do benefit from treatment.

OBSESSIVE-COMPULSION DISORDER 

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