Obsessive-compulsive disorder (OCD), formerly considered a type of anxiety disorder, is now regarded as a unique condition. It is a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviors. People with OCD are plagued by recurring and distressing thoughts, fears, or images (obsessions) they cannot control. The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). The compulsive rituals are performed in an attempt to prevent the obsessive thoughts or make them go away.
Although the ritual may temporarily alleviate anxiety, the person must perform the ritual again when the obsessive thoughts return. This OCD cycle can progress to the point of taking up hours of the person's day and significantly interfering with normal activities. People with OCD may be aware that their obsessions and compulsions are senseless or unrealistic, but they cannot stop them.
The symptoms of OCD, which are the obsessions and compulsions, may vary. Common obsessions include:
- Fear of dirt or contamination by germs
- Fear of causing harm to another
- Fear of making a mistake
- Fear of being embarrassed or behaving in a socially unacceptable manner
- Fear of thinking evil or sinful thoughts
- Need for order, symmetry, or exactness
- Excessive doubt and the need for constant reassurance
Common compulsions include:
- Repeatedly bathing, showering, or washing hands
- Refusing to shake hands or touch doorknobs
-Repeatedly checking things, such as locks or stoves
- Constant counting, mentally or aloud, while performing routine tasks
- Constantly arranging things in a certain way
- Eating foods in a specific order
- Being stuck on words, images or thoughts, usually disturbing, that won't go away and can interfere with sleep
- Repeating specific words, phrases, or prayers
- Needing to perform tasks a certain number of times
- Collecting or hoarding items with no apparent value
You cannot prevent obsessive-compulsive disorder (OCD) from starting. But the best way to prevent a relapse of OCD symptoms is by staying with your therapy and taking any medicines exactly as they have been prescribed.
Home Treatment -
Taking care of yourself every day is important in dealing with obsessive-compulsive disorder (OCD). This includes taking your medicines as directed every day and doing the homework your therapist gives you to do at home, such as self-directed exposure and response prevention exercises. With exposure and response prevention therapy, you repeatedly expose yourself to an obsession, such as something you fear is contaminated, and deny yourself the ritual compulsive act, which in this case would be washing your hands.
It's also important to involve family members and loved ones in your treatment, especially if your doctor suggested that you participate in therapy together. Keeping lines of communication open may help you deal with relationships that have become strained during your illness.
Reducing overall stress in your life, although not proven treatment for OCD symptoms, may help you cope. Tips to relieve stress and anxiety include:
Taking slow, deep breaths.
Soaking in a warm bath.
Listening to soothing music.
Taking a walk or doing some other exercise.
Taking a yoga class.
Having a massage or back rub.
Drinking a warm, nonalcoholic, noncaffeinated beverage.
Eating a healthy, balanced diet and avoiding certain foods or drinks may also help you reduce stress.
Avoid or limit caffeine. Coffee, tea, some soda pop, and chocolate contain caffeine. Caffeine can make stressful situations seem more intense. If you drink a lot of caffeine, reduce the amount gradually. Stopping use of caffeine suddenly can cause headaches and make it hard to concentrate.
If you drink alcohol, do so in moderation. If you are feeling very stressed, you might be turning to alcohol for relief more often than you realize. If you drink, limit yourself to 2 drinks a day for men and 1 drink a day for women.
Make mealtimes calm and relaxed. Try not to skip meals or eat on the run. Skipping meals can cause your blood sugar to drop, which will make other stress-related symptoms worse, such as headaches or stomach tension. Eating on the run can cause indigestion. Use mealtime to relax, enjoy the flavor of your meal, and reflect on your day.
Avoid eating to relieve stress. Some people turn to food to comfort themselves when they are under stress. This can lead to overeating and guilt. If this is a problem for you, try to replace eating with other actions that relieve stress, like taking a walk, playing with a pet, or taking a bath.
Obsessive-Compulsive Disorder (OCD) is indeed a chronic, but equally a very treatable, medical condition.
The treatment found to be the most effective in successfully treating OCD is Cognitive Behavioural Therapy (CBT). In many cases, CBT alone is highly effective in treating OCD, but for some people a combination of CBT and medication is also effective. Medication may reduce the anxiety enough for a person to start, and eventually succeed in therapy.
However what we know is that left unchecked and untreated OCD will mushroom and feed upon itself and can have the power to consume if left unchallenged. It is therefore important to seek professional medical advice and support the moment someone recognises OCD type symptoms.
Just as a person with some types of diabetes can learn to manage the disease by changing their diet and exercise habits, a person with OCD can learn to manage symptoms so they don’t interfere with daily functioning and allow them to regain a much improved quality of life. For some people it is even possible to achieve complete recovery from OCD.
Receiving the very highest standards of care, support and appropriate treatment for OCD, and sticking to the treatment plan, are the key to long term recovery from Obsessive-Compulsive Disorder.
But despite the breakthroughs in awareness, understanding and treatment of OCD, many GPs and mental health professionals may still not recognise the symptoms of the disorder or even know how to correctly treat it. Therefore, it’s important that you learn to recognise the behaviours and symptoms associated with OCD and, if seeking help for yourself or someone you care for, to understand which are the most appropriate treatments for it, whether this be through gaining access to treatment on the NHS, or locating a suitably qualified private therapist who is trained to treat OCD.
Even when improvement through treatment is made, it can be difficult to keep the momentum going in staying well. Knowledge is a powerful tool that is linked to success in understanding and treating OCD and we have produced this guide to help you identify and overcome difficulties that may place barriers in the way of recovery. We also want to offer belief and hope that recovery from Obsessive-Compulsive Disorder is possible.
Many people with OCD often go undiagnosed for many years, partly because of a lack of understanding of the condition themselves and also amongst health professionals. This is often because of the intense feelings of embarrassment, guilt, and sometimes even shame, associated with what is often called the ‘secret illness’ - a person with OCD is often reluctant to talk about their problems. This often leads to delays in diagnosis of the illness and delays in treatment, with a person often waiting an average of 10-15 years between symptoms developing and seeking treatment.
Fortunately, the medical profession is slowly starting to understand and identify OCD symptoms better which is starting to lead to an improvement in treatment, although this is still very sporadic depending which part of the country you may live. However, in general, through charities like OCD-UK helping to raise awareness and lobby for improvements in access to treatment, the prognosis for people who suffer with OCD is much more hopeful.
Before any kind of treatment for Obsessive-Compulsive Disorder can commence you should always consult your GP. Many GPs still have little or no knowledge of the wide range of symptoms of OCD, although thankfully this is now slowly changing.
OCD often goes unrecognised and undiagnosed by GPs, frequently because of the patient’s reluctance to divulge their symptoms due to their intense feelings of embarrassment, guilt and sometimes even shame. It is also sometimes misdiagnosed as general anxiety or depression, the depression often a result of the OCD. You may therefore have to tell your GP what OCD is, as well as what your symptoms are. You may also wish to refer your GP to the clinical classifications of the illness on our website and the National Institute for Health and Clinical Excellence (NICE) guidelines for the identification, treatment and management of OCD and BDD.
Residents in England may be able to self-refer for CBT through their local ‘Improving Access to Psychological Therapies (IAPT)’ service without the need to see their GP.
In general, doctors, nurses and other healthcare professionals in the NHS are all expected to follow NICE’s clinical guidelines.
When you first see a health care professional about your symptoms, it is very important that you are honest and open about your thoughts and behaviours, no matter how embarrassing they may seem. Almost certainly, they have heard it all before – and by being honest, you will help them to identify the most suitable treatment for you.
Many OCD sufferers have depression and thoughts about harming themselves or others, and for some suicidal thoughts are also a feature – it is important to discuss these feelings openly and honestly.
Also, many people with OCD, especially those with thoughts of a physical, sexual or harmful nature, are fearful of the consequences if they tell anyone about what goes on their heads. Whilst we generally encourage people with OCD to be honest and open about their thoughts and symptoms, you may wish to talk with your GP or therapist in general terms first of all until you feel comfortable that they actually understand OCD. Generally, most therapists that do understand OCD will have heard your story many times before, and will probably read between the lines and will help you by asking direct questions which will make it easier for you to open up.
If you are uncomfortable or even unsure what to say to your GP, then we have created a GP ‘Ice Breaker’ printout for you to present to your GP at the appointment to help you feel more comfortable in approaching the subject. You can download a copy from our website or please send us a stamped addressed envelope and we will post a copy out to you.
Some people worry about having the tag OCD and Mental Illness on their medical records, due to the fear of possible employment related consequences in the future. Whilst this is an understandable concern, we know that left unchecked and untreated, for many people OCD will mushroom and impact on your daily life to the extent that you would be incapable of work because of the immense amount of time and energy spent on the OCD. Ultimately each individual will need to make their own choice about seeking treatment, but our general belief and experience is that having OCD on your medical records is rarely a problem and seeking treatment is the main priority.
After an initial appointment your GP should refer you to your local Community Mental Health Team (CMHT) or Improving Access to Psychological Therapies (IAPT) team, or its local equivalent. Here you are likely to be seen by an appropriate clinical psychologist or psychiatrist who will ensure a correct diagnosis and recommend a course of treatment. Subsequent treatment may then involve a psychologist, psychiatrist or another mental health professional such as a community mental health nurse (CPN).
It’s likely that a team of people – your GP, a psychologist or therapist, a psychiatrist and a psychiatric community nurse – will be involved in your care. You should ask for a written agreement about their roles and the form your care will take. This agreement, sometimes called a ‘care plan’ or ‘treatment plan’ should be discussed with you and, if appropriate, your family or carers.
The most important thing to remember is that the treatment found to be the most effective in successfully treating OCD, and the one you should be offered, is called Cognitive Behavioural Therapy (CBT). You need to be sure to ask the person treating you how much they know and understand about this approach and, more importantly, the implementation of it for treating OCD. Our guide ‘finding a therapist’ may be of help for those looking to seek treatment privately, and could also be helpful for those seeking treatment through the NHS.
CBT is a form of talking therapy which focuses on the problems a person has in the here and now and helps them explore and understand alternative ways of thinking (the cognitive approach) and to challenge their beliefs through behavioural exercises. Sometimes people may benefit by adding medication to their treatment plan alongside the CBT.
Exposure and Response Prevention (ERP) should also form part of the CBT treatment. This involves being exposed in a very structured way, with the support of your therapist, to whatever it is that makes you feel anxious, without then engaging in the checking or other OCD behaviours.
Recent research suggests that people sometimes believe that they are receiving Cognitive Behavioural Therapy from their health professional when in fact they are receiving another form of 'talking' therapy, or counselling, which might be less effective. It is widely recognised that CBT is the most effective treatment for OCD because it focuses on the 'here and now' of the problem as opposed to other talking therapies which tend to focus on ‘past problems’.
Medication is not recommended as a sole treatment method, although in practice your GP may well offer drug treatment straight away because of the long waiting lists for Cognitive Behavioural Therapy. If this happens, it should be your choice whether to accept the medication, and if you do, you should also discuss the possible side effects with your GP.
In many cases, CBT alone is highly effective in treating OCD, but for some people with OCD a combination of CBT and medication is more effective. This usually takes the form of antidepressants which act in the Serotonin System, and they are called SSRIs (Selective Serotonin Re-uptake Inhibitor).
We do not know exactly why SSRI’s can sometimes be helpful for people with OCD, but they can sometimes work by reducing the severity of the obsessive-compulsive symptoms, or by ‘taking the edge off’ some of the anxiety caused by OCD. However, CBT should always be the principal method of treatment. Medication can always be introduced alongside CBT to act as ‘water wings’, to ease the anxiety and make the CBT that little bit easier to face.
If you do not feel particularly upset, depressed or suicidal and your GP is offering you medication, you should question why you have been offered medication, and discuss this with your GP.
Most GPs will listen to your personal wishes with regards to treatment options, but if your GP refuses to refer you for Cognitive Behavioural Therapy until you have taken medication you should challenge this if it is not something you wish to use. You may wish to contact OCD-UK for advice in this situation.
Towards the end of psychological treatment, your healthcare professional should advise you on how you can use the techniques you have learned if symptoms come back. However, the NICE guidelines for the treatment of OCD does suggest that if a person needs to be re-referred because of further occurrences of OCD or BDD, after previous successful treatment and discharge, then that person should be seen as soon as possible and not placed on a routine waiting list.
Occasionally you may only be offered group CBT and sometimes it can be helpful for people who have the same type of OCD problems to receive therapy as a group. However, for other people group therapy may not be appropriate, so you can ask to be referred for individual CBT if that is your preference, although wait times for individual therapy may be longer.
Some sufferers include alternative therapies and dietary factors in tackling their OCD. Success of these methods is not clinically proven and our experience has shown that treatments like hypnotherapy, NLP, EFT and many other alternative therapies rarely have a long term impact on successfully treating OCD.
Looking after our general health is perhaps one of the key, but often overlooked aspects that can certainly be beneficial to our overall well being. Good health can have a positive impact on our mood, which in turn can play a significant part in helping reduce the anxiety caused by OCD; this includes eating a good healthy balanced diet, regular exercise and keeping regular sleep patterns. Many people with OCD have reported that running and physical exercise really help improve their general feeling of wellbeing.
Of course many people with OCD decide to try and beat OCD themselves using resources they pick up from self-help books, support groups and websites like this one. There are many self-help resources out there, but it is important that you are careful and do not assume everything you read on the internet is correct. Sometimes being able to run things past a trained mental health professional can be better than attempting the self-help route.
Remember that whether seeking professional help or going down the self-help route: Knowledge is Power - the more you know about OCD, the better equipped you and your family will be to deal with it.