Obsessive Compulsive Disorder (OCD) is said to affect 12 out of every 1,000 people in the United Kingdom. It is founded on fear and is a form of anxiety disorder mainly characterised by obsessing over distressing, repetitive, intrusive thoughts and images and acting out compulsively with repetitive behaviour in ways that are believed to reduce the fear being experienced as a result of the irrational thoughts.
“In other words, compulsions are actions that are used to suppress the obsession and provide relief from distress and anxiety caused by the obsession.” (Barrow & Durand, 2009).
Some common obsessions may include pathological doubt, aggressive impulses, contamination, the need for symmetry, mental rituals like counting, and sexual obsessions.
The physical manifestations of OCD may include uneasiness, apprehension, checking, washing hands, excessive praying, ordering, arranging, hoarding, and aggression.
A person experiencing Obsessive Compulsive Disorder will be having obsessive thoughts that may include worry about being contaminated, fears of behaving improperly or thoughts of approaching and impending danger.
This person will be seen to perform routines, activities or rituals in a compulsive manner such as:
- Repetitive hand washing
- Repeating phrases
- Constant house cleaning
- Lining things up
- Setting things straight on the table (placing the writing pen perfectly parallel to the pad, and the pad square to the edge of the table, and then straightening up the pad and pen for the person sitting next to you)
The need to repetitively check things is common, we have all experienced what it is like to get a way down the road and wonder whether we turned the stove off, or left the iron going, or did we lock the back door? And then we return to check on it. A person with OCD will experience this in a very strong way every time they go out the door, and may not take logical steps to change the pattern. This will result in being late for work often, missing appointments, or for some being unable to leave the house at all!
Putting things in order is another common manifestation of Obsessive Compulsive Disorder. This person will be seen to line up things in a specific order and if you move one thing, instant distress will result. Lining up cards, beads, decorations, toys and such objects will often be seen to becoming habit forming even in very young children.
Superstitions are often linked to Obsessive Compulsive thought patterns, “If I do not do this, something bad will happen, and doing this action will prevent this.” It may be extremely unlikely that the bad thing will actually happen, none the less, this action will have to be taken.
Biological differences have been explored extensively in relation to OCD. When comparing non-sufferers with OCD sufferers, it is still not known how these differences relate to the mechanisms of OCD.
Chemical balances have also been extensively explored, with medications known as Selective Serotonin Re-uptake Inhibitors (SSRIs) often being used to treat OCD. However it is not fully known why the SSRI medications seem to help some people with OCD and not others.
Environmental factors also show a significant effect on the incidence of OCD. Strong trauma, repetitive stress, major infections, and the genetic predisposition of relatives are all seen as contributing factors.
The one thing that is a common denominator to all of the causes is that there is reduced love, reduced peace and reduced comfort, associated with a repetitive thought pattern, or a series of thought patterns that are based on fear.
These thought patterns have been exercised consistently over a long period of time and that has resulted in the patterns becoming unconscious and automatic habits, occurring faster than the person experiencing them can actually think. You might say a conditioned reflex that seems impossible to stop.
To resist and fight these thoughts and habits is to bring more fear to the fear and thus increase and further strengthen the pattern.
It is important to see your doctor if you, or your close friend or relative, think you have symptoms of OCD. There may be underlying illnesses or infections that are contributing to the behaviours and fearful patterns that can be treated, and it is important to rule these out.
Your doctor’s assessment will include a series of detailed questions that will explore how much the symptoms are affecting your daily life, your ability to work effectively and your relationships with others. Your Doctor may also refer you to a mental health professional who is skilled and experienced in supporting people with OCD to receive further assessment and guidance.
In this manner, an effective team that can support you through your journey to recovery is created. This can include your doctor, mental health professionals, counsellor, psychotherapist, pharmacist, friends and family who can all stay in touch with each other and all come from the same page in relation to supporting you. Group emails are great for this, but collective meetings on a regular basis can move mountains!
When someone has just begun treatment for OCD or their symptoms are severe, a stay in hospital for assessment and treatment (usually lasting several days to a few weeks) may be helpful.
People will recover faster from an experience of trauma or repetitive stress in an atmosphere of unconditional love.
Medication and behaviour therapy both affect brain chemistry, which in turn affects OCD behaviour. These methods are the main focus of today’s OCD treatment.
It is important for a person suffering from the disorder to recognize that the obsession is a result of their thoughts, often unconscious thoughts.
Behaviour therapy, and cognitive behaviour therapy, focuses on changing patterns of thoughts, beliefs, and actions that may trigger the anxiety and obsessive-compulsive symptoms. The focus is on educating the participant to recognise the patterns when they emerge in order to foster personal control over symptoms.
The participant will experience gradual exposure to the known triggers for their obsessions and compulsions. At the same time, they will be encouraged to focus on other things that bring comfort rather than carrying out the compulsion.
For example, a compulsive hand-washer may be urged to touch an object they believe is contaminated. They will then be asked to say to themselves, “I am not going to wash my hands immediately, I am going to wait for five minutes…10 minutes etc.,”. Finally, they will ask themselves, “What would love do now?”, thus strengthening and rewarding the aspect within themselves that can wait.
The focus of OCD, repetitiveness, is used to focus on loving thoughts as opposed to fearful thoughts. This results in the participant gradually experiencing less anxiety from the obsessive thoughts and becoming more able to hold back from the compulsive actions for increasingly extended periods of time. This of course leads to an increase in experiencing comfort and love.
Systematic desensitisation techniques such as relaxation skills, slow breathing techniques, meditation, and hyperventilation control are all techniques which may support a person to manage their anxiety, thus regulating their own symptoms. They work best in conjunction with behaviour therapy, and require regular practice and repetition to do effectively.
Medication and behaviour therapy have been shown to be equally effective in reducing the symptoms of OCD. Antidepressant medications that enhance serotonin levels have been found to bring relief to the symptoms of OCD. Prescribed by doctors, these must be taken consistently for ten to twelve weeks in order to judge their effectiveness.
Some of the medications used may have side effects that could include nausea, headaches, dry mouth, blurred vision, dizziness, and tiredness. The side effects often decline after the first few weeks of treatment. A reduction in symptoms can often be enough to help people to change their lives.
Counselling and Psychotherapy, in particular couple’s therapy, have been shown to help manage relationship disruptions, enhance the experience of self-regulation skills, and at times help deal with past trauma that may have triggered the OCD behaviour in the first instance.
Behaviour therapy and medication, although proven to be helpful, may not be everyone’s cup of tea. For those, anxiety management techniques, psychotherapy, hospitalisation, and support groups may be the only options.
Support (including self-support, family, friends)
Self-care is important for the person experiencing OCD, and also for those who are affected by living and working with the person experiencing OCD.
Support groups help people experiencing OCD, their care support people and families to meet in comfort and safely. They provide an atmosphere of giving and receiving support. These groups also will include educative and social opportunities, helping participants to learn more about OCD and to develop support networks.
Support groups can be found in your local community and there are also many groups now that meet online. Contact your local mental health facility or Google one now! You might even think about starting one, who would you invite? Distance is no object these days, if you live in the UK you can join a group in Australia or the US by skype and still stay in the safety and comfort of your own home.
Recovering from OCD, just like the onset of OCD, may take time and a lot of repetition to have lasting effect. It is important to hold the attitude that, “I am now working towards recovery.” Like learning to ride a horse, it needs to be eased into slowly and gently, with occasionally falling off being an expected part of the process.
Take on tasks slowly, step by step, it may seem like two steps forward then one step back for a while, but keep an eye on the continuum and record how far you have come from the start where the choice to work on recovery and make recovery the goal was first made.
Loving choices aid recovery substantially and also help prevent relapse. Healthy diet, exercise and developing a well-balanced life between work, family and leisure can and will all help.
Unconscious habits are so fast that they are hard to stop, but we can create new habits and practice them until we become proficient! Give yourself the gift of time, but start now.