Obsessive-Compulsive Disorder
At times, most people experience an upsetting thought, or feel the need to double-check something they know they have already checked. For example, going back to make sure the stove is turned off or the car is locked.
However, people with obsessive-compulsive disorder (OCD) have these types of experiences repeatedly and they interfere with their day-to-day life. The OCD thoughts and behaviours become very time consuming and distressing.
OCD is characterised by:
- recurring, persistent, and distressing thoughts, images or impulses, known as obsessions
- the need to carry out certain repetitive behaviours, rituals, or mental acts, known as compulsions.
Many people with OCD experience both obsessions and compulsions, whilst others have only one or the other.
Obsessions are not merely worries about everyday concerns, and compulsions are not simply habits. The symptoms of OCD are often upsetting to the individual and can lead to significant avoidance of situations which trigger their OCD thoughts or behaviours.
The repeated behaviours or rituals are generally carried out to reduce anxiety. Sometimes the compulsions (behaviours) are unrelated to the obsessive thoughts. However, the person feels a strong urge to carry out the compulsive behaviour (such as checking or washing) to prevent a feared situation (e.g., a thought that harm may come to someone they care about if they don’t complete the behaviour or ritual).
The sense of temporary relief provided by these behaviours, and the individual's reliance on them to manage anxiety, is part of the OCD cycle. As the worrying thought returns, anxiety or distress increases, and the individual feels the urge to repeat the OCD behaviour to experience the same relief, and the cycle repeats itself.
Common obsessive thoughts include:
- fear of contamination from dirt or germs
- overwhelming concern with personal safety or the safety of others
- needing objects to be organised in a certain way all the time
- thoughts inconsistent with a person's values, such as aggressive, sexual, or blasphemous thoughts.
Common compulsive behaviours include excessive or repeated:
- cleaning, for example, washing hands or scrubbing household surfaces
- checking, for example, whether doors are locked or appliances are switched off
- ordering, for example, placing objects in a particular pattern or making things look symmetrical
- mental acts, for example, reciting phrases in one's head or counting
- hoarding, for example, collecting old newspapers or other things that aren't useful or of value.
Cognitive behavioural therapy, specifically exposure and response prevention (ERP), is considered the most effective treatment for OCD. In ERP, a series of goals are developed between the psychologist and the client, based around the situations which trigger obsessions, compulsions or avoidance. With the psychologist's help, the client confronts these situations (exposure), without using their usual OCD behaviours or rituals (response prevention). Through a gradual process the client learns to 'sit with' their anxiety and as they do so, the distress and the obsessions decrease naturally, and more adaptive ways of responding to anxiety develop.
Cognitive therapy (CT) has also been found to help individuals with OCD identify and challenge unhelpful thoughts that contribute to anxiety and their beliefs around the utility of compulsive behaviours.
Managing stress more effectively may also reduce symptoms of OCD. Strategies include problem-solving and addressing sources of stress directly, increasing enjoyable and relaxing activities, maintaining a healthy lifestyle through regular exercise, getting sufficient sleep, maintaining a balanced diet, reducing or eliminating stimulants such as caffeinated beverages and cigarettes, and increasing social supports.
In many cases, psychological approaches alone will be effective in treating OCD. However, some people respond better to a combination of psychological treatment and medication.
If you are experiencing symptoms of OCD and find that they are affecting your work, school, or home life, our Psychologists are trained and qualified professionals skilled in helping people with a range of mental health and wellbeing concerns, including OCD.