Obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) is a condition where people have

obsessional thoughts followed by compulsives urges. These obsessions can be
intense, and typically the only way a person can relieve these intrusive thoughts is
to repeat an action until they are quelled.
This anxiety-related illness affects around 1.2% of the UKs population, and
approximately 740,000 people are thought to suffer with OCD at any one time.
Research suggests 50% of sufferers endure severe OCD symptoms, while 25%
only experience mild symptoms.
A common perception of OCD is that sufferers feel compelled to excessively wash
their hands or constantly check that doors and windows are locked. In reality, OCD
is a far more complex illness and can make day-to-day living very difficult for the
sufferer and those close to them. One of the biggest challenges for family and
friends is understanding the illness, but it can also take a toll on relationships. It is
possible, however, for people with OCD to learn ways to better manage the
condition.
On this page the illness will be explored in more depth, including OCD symptoms,
what obsessions and compulsions are, and effective treatment options.

OCD symptoms
Obsessive compulsive disorder isnt a one-size-fits-all illness; it affects every
individual differently. There are however consistent patterns of behaviour and
thoughts that are caused by OCD. These are outlined below to help you understand
the core symptoms and to help you determine whether or not you (or someone
close to you) may have the condition.
The four key behaviors that contribute to OCD are:
Obsession An intrusive, persistent and uncontrollable thought that enters your
mind.
Anxiety You start feeling stressed and anxious due to the obsession.

Compulsion You find a compulsive need to exercise repetitive acts or behaviors

because of the stress or anxiety that the obsession has caused.
Temporary relief A temporary relief from the stress or anxiety is gained from
the compulsive behavior. This cycle repeats when the obsession returns, usually
soon after.
Obsessions
If you have OCD, your obsessions will most likely fall under one or more of the
following categories:
Uncontrollable and persistent thoughts
Worries
Fears
Doubts
Images
Impulse
These obsessions can be intrusive and at times disturbing, and as a result can affect
your day-to-day life depending on their severity. Even when you begin to
understand that the obsessions are involuntary, it can be difficult to figure out why
you have them.
On the other hand, you are not likely to act on your troubling thoughts. The
compulsions are employed to relieve and prevent the thoughts from ever
happening. For example, if you think that you might harm close member of your
family, you will demonstrate compulsive behavior to stop it from occurring.
If you have OCD, you might worry about:
Catching an illness, especially ones publicized in the media.
Causing sexual or physical harm to yourself or others.
The contamination of something (an object, a person etc.).

Arranging everything in a particular order, be it symmetrical or otherwise.

Having violent thoughts.
Causing a road accident while driving.
A bad thing happening unless you check something repetitively.
You may be aware that these worries and fears are irrational, but you will be
unable to control them. Additionally, the more you try to fight them, the more
prominent they become. In most cases the feeling of discomfort that these thoughts
create is anxiety, but it can also create general unease and tension.

Compulsions
A compulsion is a natural response to the feeling of anxiety or discomfort that
derives from an obsessive thought, impulse or fear. Examples include a repetitive
set of mental formalities, physical behaviors or actions.
Compulsive behaviors are very structured - most commonly set to a routine in an
attempt to prevent the apparent danger from taking place. You might feel a
responsibility to carry out certain actions to repress the threat, as you feel that it
will harm yourself or a loved one. Sadly the relief gained from this is only
temporary. The cycle will then repeat.
For example, people who do not suffer from OCD tend to only wash their hands if
they see they are dirty or after using the bathroom. But if you are experiencing
OCD symptoms, you may wash your hands if they feel dirty, and feel compelled
to keep on washing them until they feel clean. You might do this to stop the
spread of a disease that you are frightened of getting, even though you most likely
have an extremely low risk of getting it.
Here are some examples of OCD compulsions:
The avoidance of people, places or situations to avoid an intrusive thought.
Cleaning to excess (clothes, objects, the house).
Thought patterns or mental exercises that neutralize an obsessive thought.

After a word is spoken, instantly saying another word to counteract a negative

repercussion.
The avoidance of sharp objects, such as a knife, to prevent hurting others.
Checking of locks, light switches, radiators etc. to try to prevent the dangers
associated with them i.e. getting burgled, electrical fires or pipes freezing.
These compulsions are categorized as covert (a mental act) or overt (observable by
others). A covert compulsion includes mental counting to neutralize a disturbing
and unwelcome image. An overt compulsion is physical, for example, washing, or
checking things repeatedly to quell the obsession.

OCD in children
While every case is unique, many people who have OCD say their symptoms
began in childhood. Children with OCD may worry that things aren't in the 'right
order', they may be concerned about losing possessions or have a compulsion to
collect things.
When asked why they carry out certain rituals, they may have a tough time
explaining why, saying something along the lines of 'just because'. OCD in
children can cause low self-esteem, frustration and embarrassment for the sufferer.
If you are worried your child may have OCD, going to your doctor to receive a
formal diagnosis is the first step. There are lots of professionals available who
specialize in counseling children and are able to help them discuss and manage
their symptoms in an easy to understand manner.

Types of OCD
Most cases of obsessive compulsive disorder fall under four main categories, even
though there are many strains which fall under a number of sub-categories.
The four main areas are checking, hoarding, contamination and intrusive
thoughts/ruminations.

Checking

The types of things that people with obsessive compulsive disorder feel the need to
check in order to prevent damage include:
water taps (fear of flood damage to the house and contents)
lights (fear of causing an electrical fire)
car, door and window locks (fear of car/household items getting stolen)
appliances (fear of the house burning down)
gas appliances/canisters (fear of explosions)
wallet, purse or handbag (fear of losing money, personal documents or bank cards)
re-reading emails, postcards, letters (fear of mistakes or writing something
offensive).
The amount of checking that is needed to neutralize the obsession ranges from
repeating it a few times to hundreds of times, which can take hours. This repetitive
checking can seriously affect an individuals career and personal relationships.
Hoarding
Hoarding refers to the compulsion to accumulate items. It is considered to be a
compulsive disorder symptom when the hoarding of items interrupts day-to-day
life; for example cluttering up the bedroom so there is nowhere to sleep, or if the
gathering of objects has a detrimental effect of the individual's social life or career.
A compulsive hoarder might:
buy lots of useless items
develop an emotional attachment to these things
have a limited social life due to the clutter
endanger their health by living in unsanitary living conditions
put family, neighbors and pets at risk of harm.

Contamination
This is the obsessive fear that something needs to be cleaned or washed out of fear
of contamination, and it can arise in a number of different situations that may make
an OCD sufferer feel uncomfortable:
wearing clothes (shaking them to remove bugs, dead skin etc.)
being in a crowd (fear of catching a disease from other people)
using toilets (fear of contracting germs and illnesses from other people)
shaking hands (fear of catching an illness from other people)
touching door handles, banisters etc. (fear of contracting germs and illness from
other people).

Ruminations
In the case of obsessive compulsive disorder, ruminations refer to a prolonged
phase of thinking about a theme or a question that can have a religious or
philosophical context. An example could be the fixation on what happens after
death. Sufferers might visualize heaven, hell, purgatory and what other
philosophers and religious leaders have said on the subject.

Intrusive thoughts
These are obsessional, prolonged thoughts that are often troubling in nature.
Intrusive thoughts can include sexual or violent harm to loved ones. However,
people with OCD are usually the least likely to act on them as they find them so
repugnant in nature.

Relationship OCD
OCD symptoms can occur in all areas of life, and often sufferers will notice them
affecting their relationships. Known as relationship OCD or ROCD, this form of
the condition sees intrusive thoughts and compulsions focusing on your
relationship.

Most people will experience relationship doubts from time to time, but those with
relationship OCD will experience more than most. Typical symptoms of
relationship OCD include:
Constant analysis of your feelings for your partner.
Constant need for reassurance/approval from your partner.
Doubting that your partner is being faithful, with no evidence to the contrary.
Doubts that you may be unfaithful.
Polarized thinking and an intolerance of uncertainty within the relationship.
This kind of thinking, like most OCD thinking, is incredibly exhausting and can
lead to break-ups. If you are aware that you suffer from OCD and are experiencing
intrusive thoughts about your relationship, be sure to mention this to your OCD
specialist or counselor. Both yourself and your partner may also benefit from
couples counseling - this will allow both of you to discuss how you feel and how
you can manage the symptoms.

Causes of OCD
The overall cause of this anxiety disorder is unknown, but there are multiple
related factors that might increase the chances of obsessive compulsive disorder
developing.
Stress Stressful situations and traumatic life events can cause OCD.
Approximately one in three cases are caused by stress.
Genes In some cases OCD is inherited; passed down from one generation to the
next.
Life changing scenarios OCD tendencies can occur when increased
responsibility gets too much. A birth of a child, a death of a loved one or a new job
are the kind of scenarios that change ones life enough to develop obsessive
compulsive disorder symptoms.
Personality For meticulously organized people who are already methodically
cataloguing their life possessions, symptoms of OCD might go unnoticed. These

symptoms can get out of hand - if it goes too far, they can develop the full anxiety
disorder and should seek help.
Biological changes Small changes to the balance of neurotransmitters in the
brain such as serotonin might play a role in triggering OCD. This is one of the
reasons why medication is thought to help sufferers better manage their condition.
Ways of thinking Depending on the individuals moral outlook on life, thoughts
like what would happen if I stepped in front of that train? or I might harm my
partner are usually quickly dismissed. But if someone has an extremely high sense
of responsibility and morality, they might feel that its their fault these involuntary
thoughts come into their head, which makes the thoughts more likely to return.

OCD treatment
Obsessive compulsive disorder is a treatable medical condition, and counseling in
particular has proven useful for helping sufferers to take back some control over
their OCD symptoms. Cognitive behavioral therapy (CBT) is often deemed the
most helpful form of therapy in this circumstance.
CBT for OCD

Cognitive behavioral therapy is a talking therapy that aims to help overcome

problems by recognizing and changing the way an individual thinks and behaves.
The therapy looks to teach the person that it isnt the thoughts that are the major
problem; its what the individual makes of those thoughts and how they act on
them. This is the key to recovering from OCD.
There are two types of CBT for OCD cognitive therapy and exposure response
therapy.

Cognitive therapy (CT)

Cognitive therapy is a psychological therapy that tries to change your response to
your thoughts, rather than trying to get rid of them. This can be helpful if you have
worrying, intrusive thoughts, but do not perform any actions or rituals to neutralize
them.

Exposure and response prevention (ERP)

Exposure and response prevention is a way to stop anxieties and behaviors from
getting stronger. The longer you are exposed to your fear, or stressful situation,
over time you become used to the setting and the need to perform compulsive
actions is naturally neutralized.

Medication
Even if you are not depressed, antidepressants can help moderate obsessions and
compulsions. According to research, over half of people with OCD improve after
taking medication. Unfortunately, if you stop taking medication, there is around a
50% chance of OCD symptoms returning. However, if you combine medication
with CBT for OCD, it is much less likely to return.

How Is Obsessive-Compulsive Disorder Treated?

Obsessive-compulsive disorder is treatable through ongoing interventions provided
by a child's medical practitioners, therapists, school staff, and family. These
treatments include psychological interventions (counseling), biological
interventions (medicines), and accommodations at home and school that reduce
sources of stress for the child. Open, collaborative communication between a
child's family, school, and clinicians optimizes the care and quality of life for the
child with obsessive-compulsive disorder.
Psychological Interventions (Counseling)
Counseling can help children with OCD, and everyone around them, to understand
that OCD symptoms are caused by an illness with complex genetic and
environmental origins--not by flawed attitude or personality. Counseling also can
reduce the impact of symptoms on daily life. A variety of psychological
interventions can be helpful, and parents should discuss their child's particular
needs with their clinician to determine which psychological treatments could be
most beneficial for their child.

Cognitive Behavior Therapy (CBT) is usually recommended for children

and adolescents with obsessive-compulsive disorder. In CBT, a young person is
helped to become aware of problem behaviors or thoughts in particular situations

and is then guided by the clinician to try alternative behaviors for those situations.
With younger patients, personifying the obsessions (for example, Germy" to
describe the fear of germs) allows children to "fight back" against the thoughts or
behaviors that could keep them away from peers or family activities. Cognitive
behavior therapy focuses on changing behaviors and on developing more positive
thinking patterns as alternatives to the negative thoughts that cause symptoms.
CBT and related treatments, such as exposure response prevention and behavior
therapy, are based on well-researched methods that have successfully helped
children and adolescents to increase healthy behaviors and thoughts. These therapy
approaches can enable people with OCD to tolerate their worries, without having
to perform their rituals. Young people may benefit from behavior therapy or CBT
on an ongoing basis.

Individual psychotherapy may be useful for young people with OCD,

particularly when they have ongoing stressors in their lives that make symptoms
worse. Children with obsessive-compulsive disorder often carry a sense of failure,
as if the illness was their fault. In many cases, they know that their disturbing
thoughts and rituals are generated by their own mind, which can increase their
sense of self-blame. Individual psychotherapy can help young people become
aware of and address their feelings of failure and self-blame.

Parent guidance sessionscan help parents to manage their child's illness,

identify effective parenting skills, learn how to function as a family despite the
illness, and to address complex feelings that can arise when raising a child who has
a psychiatric disorder.
Family therapy may be beneficial when issues are affecting the family as a whole.
Group psychotherapy can be valuable to a child by providing a safe place to talk
with other children who face adversity or allowing a child to practice social skills
or symptom-combating skills in a carefully structured setting.
School-based counseling can be effective in helping a child with OCD navigate
the social, behavioral, and academic demands of the school setting.