Understanding Obsessive Compulsive Disorder (OCD)

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Do you find yourself constantly checking things over and over again? Do you have thoughts that repeatedly intrude into your life? Do you feel compelled to repeat certain rituals and behaviors? If you answered yes to any of these questions and notice that these thoughts or behaviors are taking up a lot of your time and have a significantly negative impact on your life, then you may be suffering from Obsessive Compulsive Disorder (OCD). OCD is a potentially severely impairing Anxiety Disorder that effects between 1 and 3 percent of adults and 0.5 percent of children in America.

OCD is characterised by recurring, uncontrollable thoughts (obsessions) and/or behaviors (compulsions) that the person feels compelled to repeat over and over again. For instance, a person may have a frequent, intrusive fear of being robbed and feel a compulsion to repeatedly check that their front door is locked. With OCD, obsessions generate feeling of anxiety and the person responds to the obsessive thought through repetitive compulsive behavior. While we all have intrusive thoughts at times and may for instance double-check that the door is locked now and then, people with OCD are unable to control or dismiss these thoughts. OCD sufferers have varying degrees of insight into the reality of their obsessions and/or compulsions and are significantly impaired by their symptoms with at least an hour of their time being taken up by these activities on a daily basis.

A key feature of understanding OCD is recognising the cyclical process that sustains and intensifies the symptoms. People with OCD initially are drawn to performing compulsive behaviors as a way of reducing their anxiety. For example, with the obsessive anxiety of “someone is trying to robe me,”  the compulsive behavior of repeatedly checking the front door represents an attempt to reduce the anxiety generated by the obsessive thought. Whereas the compulsion may bring some temporary relief, in the long-term the compulsion actually serves to reinforce and intensify the obsessions. This in turn would lead to an escalation of the compulsive behaviour as well as any avoidant behaviors, which in turn would generate even more anxiety and obsessions. This OCD cycle, which very easily spirals up into an intensification of symptoms, is represented in the diagram below:

OCD Cycle

While the nature of the obsessions (e.g. fear of harming someone, anxiety regarding germs/contamination, anxiety regarding personal health) and compulsions (e.g. avoidance of driving, compulsive hand-washing, repeated body checking) may vary, this cycle underpins the presentation of OCD as a disorder.

Treatment of OCD focuses on breaking this cycle. While OCD is may be a chronic, recurring condition for some, with appropriate treatment it can be effectively managed. The treatment of choice for OCD is Cognitive Behavioural Therapy (CBT) specifically Exposure and Response Prevention (ERP) and medication – usually Selective Serotonin Reuptake Inhibitors (SSRI). Studies indicate that 70-80% of patients respond well to ERP and one third to 43% recover and sustain this recovery for up to six months following ERP treatment. These treatments focus on reducing the anxiety levels the person is experiencing and supporting the person in tolerating the anxiety without resorting to following through on compulsions. Given the nature of the condition, OCD often impacts on a person’s closest relationships. Incorporating treatment approaches such as family therapy that focus on those with close ties to the OCD sufferer would only serve to further strengthen the intervention.

The prognosis for OCD sufferers is certainly much more promising than it used to be. There are effective treatments out there that can allow a person to return to a normal level of functioning without having their lives being dominated by their obsessions and/or compulsions.