TL;DR
What is OCD?
Obsessive-Compulsive Disorder is a mental illness that can effect anyone at all. About three in every one hundred people will develop OCD at some time in their lives [1].
The obsessions in OCD refer to presence of repetitive thoughts, images, or impulses that are stressful, and are not necessarily about real-life problems, such as “I have caused a fire through my carelessness [2, 3, 4].
Some sufferers experience compulsions as well, which are repetitive behaviours that are specific and have set rules, and may be related to the obsessions. The person comes to believe that their compulsions have some influence on preventing bad consequences [2, 3, 4].
Obsessions and compulsions can consume several hours.
OCD Case Example
‘I became obsessed with dirt and cleanliness. I washed my hands 100 times a day as indicated by my bleeding knuckles. I washed 40 tea towels at a time, I thought lice were living on my body, and itching reinforced my fear. I examined the bed at night, making sure there were no insects. I was petrified of contaminating people, thinking they might die. I wanted to wash anything I touched. I even had to buy items in shops simply because I felt I had contaminated them. I threw away food for fear of poisoning people. I became so obsessed with colours and smells that I could no longer trust my own judgement, and pestered Joe for constant reassurance. I avoided supermarket freezer sections in case I damaged them or unfroze the food, leading to peoples’ death from salmonella poisoning [5].’
NOTE (Open Me!)
Obsessions and compulsions can appear together, or alone. They can even be unrelated and occur together. For example, having a compulsion to count to seven twice on each hand to ensure a significant other doesn’t get a terminal illness.
I WANT TO KNOW MORE
A highly organised or inflexible person might have mentioned OCD to you in the past jokingly. “Oh, I need to have things this way! It’s just my OCD!”
OCD is not a personality trait, or a preference for organisation. When someone has OCD their behaviour is controlled by never-ending distressing thoughts, feelings, and strong urges. We call these patterns of thinking and behaviour obsessions and compulsions.
Common Obsessions [4, 6, 7]
- self or others getting seriously ill, poisoned/contaminated, or injured/dying
- doubting whether they’ve committed violent, aggressive, or sexually perverted acts
- religious blasphemy
- causing accidents
- having things organised/symmetrical
Common Compulsions [4, 6, 7]
- thorough hand washing
- checking (of door locks, cupboards, windows, or what they have written, like homework or text messages)
- uttering certain words/phrases or numbers
- straightening things up
- cleaning surfaces
- hoarding
Other Major Features of OCD [2, 3]
- Avoidance: fearful avoidance of things that trigger the compulsive behaviour.
- Fears of consequences: intense fear that something disastrous will happen if they don’t carry out their compulsion.
- Getting reassurance: going to other people for reassurance for things relating to their obsessions. For instance, asking “am I an aggressive person?”, in relation to obsessive thoughts of harming other people. This reassurance provides temporary comfort, but is often needed again shortly after.
- Disturbances to compulsions: if the compulsive behaviour is interrupted by something (perhaps a conversation), the person with OCD will usually feel the need to re-do the behaviour from scratch.
- Ruminations: when the person thinks for ages about a question or topic that usually doesn’t have a straightforward answer, such as “is there really a God?”.
Types of OCD
Body Dysmorphic Disorder
- intense concern with some bodily defect that is usually imagined, or blown out of proportion.
- engagement in repetitive behaviours such as checking their appearance and covering up the “flaw”.
- repetitive thoughts associated with their appearance
- may lack social contact due to reluctance to leave their home and have others see their “flaw” [2, 8]
Hoarding Disorder
- struggling to part with personal objects, regardless of their actual sentimental value, or how much they are worth
- the person’s home is usually overflowing with seemingly random objects, and it becomes increasingly difficult to use the home normally [2, 8]
Trichotillomania (Hair Pulling Disorder)
- compulsively pulling out of hair, causing extreme hair loss
- anxiety is felt before the act of hair pulling, and relief is felt whilst the hair is being pulled out [2, 8]
Excoriation (Skin Picking) Disorder
- compulsive picking of the skin, which can lead to wounds and infections
- flaws in the skin, whether real or imagined, can trigger the impulse to pick it. Stress can also prompt someone to skin-pick [2, 8]
Substance/Medication-Induced Obsessive Compulsive and Related Disorders
- OCD occurs because of a substance or medication, such as prescription medication, illicit drugs, alcohol, or environmental toxins, such as carbon monoxide
- OCD caused by a medication or substance typically goes away once the offending substance is completely removed from the body [2, 8]
Other Specified and Unspecified Obsessive Compulsive and Related Disorders
- Can include behaviours similar to skin picking, such as nail biting, lip chewing, and cheek biting
- Can also include extreme partner-related jealousy [2, 8]
Causes of OCD
There are a few suggested triggers for OCD, which do not necessarily act alone – several things may interact to trigger the disorder.
Biological Triggers
- There is evidence of OCD running in families. That is, it could be inherited through genes.
- There may be a low supply of serotonin, which is essentially a chemical brain ‘messenger’. Low serotonin might make it difficult for different parts of the brain to communicate properly.
- Additionally, we all have a brain circuit that is responsible for bringing impulses to our attention so we can behave accordingly. For example, usually people will use the bathroom, and have an impulse to wash their hands. So they do, and this impulse is removed. However, in someone with OCD, this ‘impulse-loop’ might not turn off, so they would be compelled to continue washing their hands. [7, 9, 10]
Psychological Triggers
- Behavioural theory: Something in the environment (such as shoes) has become associated with something unpleasant (dog poo) that brings up feelings of disgust and anxiety. Because this association has been established, when the person comes into contact with shoes, those anxious feelings reappear – and won’t leave until some sort of relief action is taken. So, the person may wash their hands after touching shoes. The washing behaviour is reinforced by its ability to reduce anxiety, and so becomes compulsive.
- Cognitive-behavioural theory: Everyone has intrusive, “dangerous” thoughts that are relatively normal (i.e. “What would happen if I drove into this tree?”). Someone with OCD may respond with anxiety about what the thought might mean, for instance, “am I dangerous?”. People with OCD tend to believe that harmful thoughts will lead to harmful actions. The person then engages in compulsions, which often respond to the threat that was in the obsession (for instance, they might compulsively ask for reassurance from their partner that they are not a dangerous person). [7, 9, 10]
Treatment of OCD
There are a range of treatments available for OCD. A combination of anti-depressant medication and CBT has shown to be currently most effective in treating OCD, so will be talked about in detail here.
Medication: antidepressant medications are effective for some people. Sometimes obsessive-compulsive behaviours can return after medication is stopped. Medication can be useful for people who have depression as well as OCD, and for those who are resistant to a cognitive-behavioural therapeutic approach initially. [1, 6, 11]
CBT: is the most widely used treatment for OCD and when applied to OCD is often called Exposure and Response Prevention. ERP generally works by exposing the person to situations that trigger their obsessions and compulsions. For instance, imagine someone who believes they will become very sick by touching door handles (their obsession). In therapy, this person would be asked to touch door handles repeatedly. After this, the client would probably have the strong compulsion to wash their hands thoroughly, but are asked to not engage in this usual compulsive behaviour, sometimes for several hours. This can make the client quite distressed, so they are taught different strategies to cope with the thoughts and urges they are feeling, such as relaxation and breathing techniques. Further, the therapist and client will often examine the client’s obsessions, and try to replace them with more realistic thoughts. So, as opposed to the belief “touching this door handle will make me ill”, this thought may be replaced with “lots of people have touched this door handle before, and they are not ill”. More generally, the therapist will help the client to combat the belief that everything that pops into their head is meaningful – most thoughts are just passing, and don’t have consequences [1, 6, 11].
Exposure and Response Prevention for OCD – ShalomAleichem
REFERENCES AND FURTHER READING
- Sane Australia. (2016). Obsessive compulsive disorder (OCD). Retrieved from https://www.sane.org/mental-health-and-illness/facts-and-guides/obsessive-compulsive-disorder
- Carr, A., & McNulty, M. (2006). The Handbook of Adult Clinical Psychology: An Evidence-Based Practice Approach. London and New York: Routledge.
- International OCD Foundation. (2014). What is OCD? Retrieved from https://iocdf.org/about-ocd/
- Better Health Channel. (2016). Obsessive Compulsive Disorder. Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/obsessive-compulsive-disorder
- Turk, J., Marks, I. M., & Horder, J. (1990). Obsessive-compulsive disorder: case study and discussion of treatment. British Journal of General Practice(40), 210-212.
- Mental Health Association NSW inc. (2010). Obsessive Compulsive Disorder. Retrieved from http://nnswlhd.health.nsw.gov.au/wp-content/uploads/Obsessive-Compulsive-Disorder.pdf
- Mayo Foundation for Medical Education and Research. (2017). Obsessive-compulsive disorder (OCD). Retrieved from http://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/dxc-20245951.
- Healthy Place. (2015). Types of OCD (Obsessive Compulsive Disorders). Retrieved from http://www.healthyplace.com/ocd-related-disorders/ocd/types-of-ocd-obsessive-compulsive-disorders/
- Carr, A. (2006). The Handbook of Child and Adolescent Clinical Psychology: A Contextual Approach. London and New York: Routledge.
- OCD-UK. (2017). What causes OCD? Retrieved from https://www.ocduk.org/what-causes-ocd
- Powell, T. (2009). The Mental Health Handbook: A Cognitive Behavioural Approach. United Kingdom: Speechmark Publishing Ltd.
