Sherry-Lee Smith
BA (Psych) Hons MAPS MAAP EMDRAA ISST CEDC
Psychologist
Perth, Western Australia
What is Obsessive Compulsive Disorder (OCD)?
Obsessive compulsive disorder is a mental health issue which is distressing to sufferers and impairs their ability to function in daily life. OCD is characterised by persistent thoughts, ideas, images, doubts or impulses (obsessions) that are experienced as disturbing, along with repetitive behaviour or mental rituals (compulsions) aimed at reducing anxiety.
Obsessions stimulate anxiety and are intrusive, unwanted and distressing. They are often experienced as irrational to the person experiencing them.
Common obsessions include;
- Fear of contamination (by dirt, germs, bodily waste, chemicals or other substances)
- Fear of illness, harm or death (to the self or significant others)
- Aggressive obsessions (fear of hurting the self or others, violence, fear of being responsible for something terrible happening)
- Sexual obsessions (“forbidden” sexual thoughts, such as incest or involving children, homosexuality or aggressive sexual behaviour)
- Religious or moral obsessions (worry about thinking or saying something blasphemous, being consumed with always doing the right thing)
- Number obsessions (safe numbers, bad numbers etc.)
- Symmetry or exactness obsessions (alignment, perfection etc.)
Compulsions are repetitive behaviour or mental rituals that an individual feels compelled to perform in response to experiencing an obsession. The purpose of the compulsions is to alleviate or reduce the anxiety and distress created by the preceding obsession. The more successful the compulsion is at reducing the anxiety the more powerful and difficult to resist it becomes.
Common compulsions include;
- Checking (things are locked, turned off, that somebody isn’t hurt or sick, something bad hasn’t happened, that a mistake hasn’t been made)
- Repeating (rereading or rewriting, repeating activities)
- Counting (counting and recounting)
- Symmetry, ordering or arranging (straightening or arranging items)
- Washing or cleaning
- Touching
- Excessive prayer
- Avoidance of objects, substances or situations
- Repetitive reassurance seeking
Obsessive-compulsive related disorders include body dysmorphic disorder (body image related obsessions and compulsions), hoarding disorder, trichotillomania (hair pulling disorder), excoriation (skin picking) disorder, body-focused repetitive behaviour disorder (including nail biting, lip biting and cheek chewing) and illness anxiety disorder.
OCD is a common mental health issue that impairs the functioning of a large number of people. The life time prevalence for OCD is estimated to be 2-3% of the population. However, some researchers argue this is an underestimate and that many cases of OCD go undiagnosed and untreated. People who suffer from OCD tend to experience impairment in several areas of life including occupational performance, academic achievement, and social functioning. The severity of OCD symptoms tends to wax and wane over time relative to the amount of stress a person experiences, even when the person has engaged in treatment. It can be a chronic and debilitating condition if not treated. Sometimes OCD symptoms can also change over time. For example the subject of obsessions may differ or the compulsions used to reduce anxiety may change.
Most people who suffer from OCD recognise that their fears and rituals are irrational and excessive. Because they have this level of insight they are more often than not distressed by their own thoughts and behaviour. Nonetheless, they feel almost powerless to stop them.
The onset of OCD is usually gradual and tends to manifest during adolescence or early adulthood. However, childhood onset or later life onset is not uncommon. Stressful life experiences such as family illness, death of a significant other, marital problems, divorce, sexual difficulties, or pregnancy often precipitate the onset of OCD.
OCD in children and adolescents
The prevalence of OCD in children and adolescents is 1-3% of the population, similar to the number of adults who suffer from this debilitating condition. However many more have obsessive compulsive tendencies that are not clinically diagnosable but are noticeable nonetheless. OCD in children is often not identified and treated in a timely manner. This is often due to symptoms being mistaken for other behavioural problems, such as not handing in homework or taking too long completing work because it needs to be perfect, resistance to completing chores due to fear of contamination or refusing to go to sleep because rituals haven’t been completed. Furthermore children are often reluctant to discuss their fears openly and tend not to have insight into the irrational and excessive nature of their thoughts and behaviour.
Factors that contribute to the development of OCD
OCD is a complex neurobiological disorder. There are various factors thought to influence the development of OCD. It is most likely an interaction between biological, psychological and social factors. Some of the factors thought to contribute to the development of OCD are:
- A genetic predisposition
- Ineffective functioning in the frontal cortex area of the brain
- Serotonin imbalances
- Intrapsychic conflict – conflict occurring within the mind
- Ambivalent sense of self – difficulty managing contradictory aspects of the self
- Personality characteristics – see next section
- Cognitive distortions/information processing errors – such as black and white thinking, perceiving things as more negative or less positive than they are, only paying attention to information that confirms a negative view, making guesses about the future and negative events, believing you know other people’s intentions
- Traumatic events in early childhood
- Stressful life events – such as the death of someone close, divorce, moving house, pregnancy etc.
Personality characteristics and thinking patterns commonly seen in people with OCD include;
- Perfectionism/criticalness – belief towards themselves and other that mistakes are unacceptable and perfection is desirable
- Excessive conscientiousness
- Strong need for control and autonomy
- Overemphasis of intellectual processes – thinking that the presence of a thought increases the likelihood that an event will happen
- Rigidity
- Inflated sense of responsibility and guilt – a belief that a person has the ability to cause or prevent negative outcomes
- Intolerance of uncertainty – believing that it is possible and necessary to be certain that undesired events do not happen
- Overestimation of danger – thinking danger is more likely to happen than it is
How medical treatment or counselling/psychotherapy can help
Severe OCD is a difficult condition to treat. It is common for suffers of OCD to hide their symptoms and treat it like a secret problem. Nonetheless it is important to seek treatment from medical and psychological professionals. With perseverance most patients can expect some reduction in symptoms. However, it is common for some level of symptoms to persist despite treatment and relapse of symptoms in stressful times can be problematic.
OCD can often be successfully treated with a combination of medical and psychological interventions. People with OCD may be prescribed antidepressants know as serotonin reuptake inhibitors (such as Prozac or Zoloft) or tricyclic antidepressants (such as Anafranil). Improvements usually take up to 6 weeks and it is recommended that medication should be continued for a minimum or 6 months and sometimes for 1-2 years. If you are considering medication for OCD you should discuss this with a medical professional such as a general practitioner (GP) or psychiatrist.
Various psychological treatments may be helpful for reducing symptoms of OCD. Intervening at any point in the OCD cycle can improve functioning. Psychological treatment may address any of following;
- Relaxation techniques
- Clarifying and addressing underlying relationship problems
- Thought-stopping techniques
- Psychoeducation
- Recognising and correcting unhelpful thinking patterns
- Developing alternative coping strategies
- Behavioural experiments (designed to encourage helpful thinking patterns)
- Exposure to anxiety provoking experiences with the aim of reducing anxiety
- Problem-solving
- Recognising and relabeling obsessive thoughts
- Correcting unhelpful beliefs that underlie OCD symptoms
- Breaking negative reinforcement cycles of OCD
- Reducing stress
- Developing alternative anxiety management strategies
- Developing emotion regulation skills
- Identifying and addressing factors that trigger or exacerbate OCD symptoms
- Developing realistic ways of viewing reality
- Addressing feelings of ambivalence towards the self and building a more integrated and differentiated view of the self and others
Tips to help with OCD
- Postpone OCD rituals whenever you can – this will assist you in learning to sit with the anxiety
- Remember that unpleasant feelings always reduce when given enough time
- When you notice an obsessive thought arising, refocus your attention to something else
- Write down obsessive thoughts or worries
- Anticipate OCD urges– know your triggers and help yourself resist the compulsion by creating mental pictures or notes that remind you the compulsion is unnecessary (for example when you lock the door, make a mental picture of the locked door and say to yourself “the door is now locked”)
- Try slowly cutting back on compulsive behaviour. If you check 10 times that the door is locked, try checking 8 times and then 6 etc.
- Reduce your vulnerability to OCD by eating a healthy diet, getting regular exercise and enough sleep
- Try not to isolate yourself
- Make friends with your OCD – get to know your triggers, the more you can anticipate and identify OCD thoughts the more power you will have to manage your OCD
- Practise relaxation techniques
- Limit intake of alcohol and nicotine
- Manage the stress in your life – OCD symptoms tend to get worse when you are under stress
Tips for family members and friends
- Learn as much as you can about OCD
- Take care of yourself and seek professional help if you need it
- Try not to participate in their rituals – this only reinforces and entrenches OCD symptoms
- Try not to let OCD take over the family or relationship
- Criticism and negative comments can make OCD worse – try to create a calm and supportive environment
- Acknowledge improvements however small
- A non-judgemental attitude is helpful
- Try viewing OCD as separate from the person not like a character flaw
- Remember that it is normal to feel frustrated, angry or resentful when OCD interferes with your life
- Encourage the person to talk about their OCD so you know how it affects them and how you can help
- Encourage your loved one to get professional help
If you are experiencing any difficulties with obsessive compulsive disorder or related disorders and would like help please contact Sherry-Lee Smith via email at admin@sherryleesmith.com
Phoenix Holistic Health Centre
Upstairs Unit 4 / 131 Herdsman Parade
Wembley, Perth Western Australia
Sherry-Lee Smith
Principal Psychologist