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OCD – Obsessive-compulsive disorder

People with OCD experience anxiety or distress from persistent thoughts and ideas which pop up in their heads automatically and seem impossible for them to ignore. Thoughts like these are  called ‘obsessions’, and sufferers may feel their anxieties can only be  relieved by carrying out a particular ritual (a compulsion), often many times. Although everyone experiences distressing thoughts from time to time, when daily life becomes punctuated by obsessions and compulsions, OCD is diagnosed.

People with OCD often feel guilty, shameful or embarrassed about their thoughts and actions and therefore may be secretive about them and not seek the help they need. This can be particularly true of men who often feel the need to ‘be strong’  and therefore ignore their OCD symptoms for as long as possible.

Symptoms of obsessive compulsive disorder (OCD)

OCD can be categorised into different types depending on the nature of the thoughts and behaviours that the person is experiencing. Some of the most common categories are:

Contamination and illness: The fear of touching things which are perceived to be dirty or contaminated which results in ritualistic and obsessive hand-washing, showering or cleaning. People with this type of OCD constantly fear that they or those around them will become ill from touching contaminated surfaces, and the only way to relieve this fear is to wash themselves or clean their surroundings. However, the relief this provides is short-lived and the behaviour is carried out repeatedly.

Checking and safety: This type of OCD can best be described by “What if…?”. People worry about not checking they have locked doors and windows before going out or turned off appliances such as the oven. The anxiety comes from feeling that you are responsible for any disastrous events that occur because you failed to check things properly. Some people will keep checking over and over again until it feels right while others will have a set number of times that something must be checked. Again, the actions provide temporary relief as one check is not enough. People may also worry that friends and family may be harmed by their actions and may keep checking that they are ok.

Order and symmetry: People with obsessions about having things in a particular order feel that their actions will stop something terrible happening to them or their loved ones. They may spend excessive amounts of time rearranging objects and may feel great distress if things are moved.

Hoarding and collecting: OCD can also come in the form of hoarding and collecting useless things that most people would throw away, e.g. old post, leaflets, packaging. The thought of getting rid of these things may be distressing to individuals with this type of OCD as they believe items are particularly important or may be needed in the future. People often feel attached to objects and hoard them to avoid the distress of separation.

Religion and moral issues: Obsessions may come in the form of anti-religious thoughts, which can be particularly upsetting to people who consider themselves to be religious. They may feel guilt and anxiety about these thoughts and repeat prayers or phrases until they feel they have done enough to restore their faith. Again the relief is temporary and the rituals have to be repeated. People may seek advice and reassurance from others to reduce their anxiety about their thoughts.

Violence and sex: This type of OCD is probably the most disturbing to the person experiencing it. The obsessions are usually completely out of character and involve physically harming loved ones, e.g. a child, or disturbing sexual acts, e.g. with a close family member. As with other types of OCD, thoughts are persistant and automatic, despite the amount of disgust, guilt or shame they cause. People with this type of OCD may worry they will be labelled a psychopath or a paedophile or fear they may act out their impulses. However this type of OCD, known as ‘pure-O’ ends with obsessions – compulsive acts are never carried out.

Although the types of OCD described here may seem very different, there are common themes between them all. The rituals or behaviours performed only provide temporary relief from the anxiety and distress – they are not carried out for pleasure or satisfaction. Secondly, the individual feels a great deal of responsibility to get the ritual right to prevent something terrible happening, even though on a conscious level they know the ritual is either excessive or unrelated to the thoughts.

Causes of obsessive compulsive disorder (OCD)

OCD is believed to be caused by a combination of genetic and environmental factors, i.e. certain combinations of genes can predispose you to developing OCD if you are also exposed to particular situations in life. Some of the factors that have been associated with the onset of OCD are: bereavement; illness; becoming a parent; a change in a relationship (e.g. new partner, separation, marriage); job loss, promotion or change in position; retirement; moving house; financial stress; family problems; and childhood abuse or neglect. However, OCD usually develops slowly and may take months to become a noticeable problem so you might not associate it with the trigger. Therapy sessions can be helpful in uncovering the main event which triggered the onset of OCD.

Dealing with obsessive compulsive disorder (OCD) at home

To get rid of OCD, the cycle of obsessions and compulsions needs to be broken. Obsessive thoughts are involuntary and automatic so it is very hard to stop these, however it is possible to regulate the compulsions. This can be done through techniques taught in ERP therapy (exposure and response prevention therapy). This technique teaches you to expose yourself to the thoughts that make you anxious and then physically stop yourself from performing the action or mental ritual that you normally do to relieve the anxiety. At first, this can increase anxiety, however over time you will realise that terrible things don’t happen because you didn’t perform the ritual. Although on a conscious level you may already know this, it will take hundreds of repetitions of the ERP techniques for this to become ingrained in your mind. The key is to persevere.

Further information about OCD

Useful websites

First Psychology's booklets

Self-help guides: There are many good self-help guides that describe in much more detail the techniques of ERP therapy and provide structured programmes to follow.

Feel free to contact us to ask about psychological therapies available at First Psychology Edinburgh  that may help with obsessive compulsive disorder (OCD).

Practitioners who work with OCD in Edinburgh: