Anxiety in Adults

Obsessive-Compulsive Disorder (OCD)

What is Obsessive Compulsive Disorder (OCD)?

Obsessive Compulsive Disorder (OCD) is characterized by the occurrence of intrusive unwanted and distressing thoughts, images or impulses, otherwise known as ‘obsessions’. Compulsions are the behaviours that a person with OCD engages in to reduce the distress caused by their obsessive thoughts. The media portrayal of OCD often misconstrues the true distress involved in OCD, giving the image of a perfectionist, or someone who has an overly clean house. This can be one symptom of OCD, but OCD symptoms are by no means limited to individuals who clean excessively (see below).

Often people engage in thought suppression (e.g. trying to ignore or stop your obsessions), but unfortunately that only increases distress and anxiety. Ultimately people feel driven to perform compulsive acts to try to ease stress. Despite efforts to get rid of the thoughts they keep bouncing back leading to the vicious cycle of OCD. OCD often centers around certain themes — for example, a fear of getting contaminated by HIV and as such the compensatory behaviour may be washing hands with detol until they are raw.

Obsessions are repetitive, cause significant distress or anxiety for people with OCD and these individuals often experience an intense need to reduce their anxiety by engaging in compulsive behaviours or mental acts. Obsessional thoughts can come in any form, but some common obsessional thoughts include:

  • Fear of being contaminated by touching objects others have touched
  • Doubts that you've locked the door or turned off the stove
  • Intense stress when objects aren't orderly or facing a certain way
  • Images of hurting yourself or someone else that are unwanted and make you uncomfortable
  • Thoughts about shouting obscenities or acting inappropriately that are unwanted and make you uncomfortable
  • Avoidance of situations that can trigger obsessions, such as shaking hands
  • Distress about unpleasant sexual images repeating in your mind

Compulsions are performed to alleviate anxiety, ‘get rid of’ the obsessional thoughts or to avoid possible negative outcomes are believed to occur if the act is not performed. Compulsions may be mental acts performed within our mind, or physical observable behaviours. Compulsions, like obsessions, can come in many different forms but some common examples include:

  • Checking e.g. checking locks of doors or windows repeatedly, checking appliances are switched off repeatedly, checking taps are not on
  • Cleaning e.g. excessive cleaning of self, house or clothing
  • Repetition e.g. of phrases in mind, of words aloud, routines
  • Counting
  • Reassurance seeking
  • Avoidance e.g. of situations that trigger intrusive thoughts
  • Strict ritualistic activities e.g. strict order of morning routines,
  • Ritualistic eating patterns due to fears other than weight gain e.g. particular eating order, crockery/cutlery
  • Hoarding items of limited value e.g. newspapers,

Symptom Checklist

  • Are you bothered by repetitive disturbing thoughts?
  • Do these repetitive (obsessional) thoughts cause you significant distress?
  • Do you feel compelled to do particular mental or physical acts to counteract your anxiety or get rid of your intrusive thoughts?
  • Do you find it difficult to not engage in your compulsive behaviours, or find it difficult to stop engaging in the behaviour once you have started?
  • Do you spend an excessive amount of time doing your physical or mental compulsions?

How Common is OCD?

OCD is the fourth most common mental health condition and affects both males and females of all ages. Research indicates that OCD is as common as diabetes or asthma.

OCD can occur at any age, with onset in childhood common (see Child OCD section) but adolescence is the most typical age of onset. Postpartum (after pregnancy) is also a common time for OCD to emerge. Individuals with OCD often delay seeking treatment due to embarrassment or shame of their symptoms. Over time, obsessional thoughts can intensify, or additional obsessional thoughts emerge. When left untreated, compulsive behaviours tend to also intensify, with individuals tending to take longer to complete their compulsive behaviours or additional compulsive behaviours emerging.

What Treatments are Recommended for OCD?

If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective. The psychological treatment which has consistently shown to be most effective for OCD is Cognitive Behavioural Therapy (CBT). There are a wide range of medications which can assist with severe OCD also. Recent research spanning 12 separate studies indicates that CBT for OCD typically has an 83% success rate.

CBT for OCD involves several stages of treatment, typically over 12-16 appointments. As with treatment for all anxiety disorders, the exact components of treatment are individualized depending on your particular difficulties, and the duration of treatment will depend on multiple factors. A typical course of CBT initially focuses on identifying and challenging unhelpful thoughts and practicing anxiety management strategies such as cognitive defusion and abdominal breathing. The second phase of CBT for OCD involves exposure and response prevention (ERP), this essentially involves gradual and repeated exposure to underlying fears until the fears reduce significantly or diminish. The rationale for ERP is that it provides information for the client regarding their feared catastrophe, and also allows them to practice using alternative strategies to manage anxiety other than their compulsions or avoidance.

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