What is OCD

Obsessive-compulsive disorder (OCD) is classified as an anxiety condition where the person experiences "recurrent persistent and intrusive thoughts, images or impulses (obsessions) alone or followed by compelling repetitive behaviours (compulsions) which intend to neutralise the obsessions".

The obsessions are viewed as unwanted and unacceptable. They provoke strong emotions like fear, anxiety, frustration, or anger. Obsessions are not worries about real issues. The person recognises that they are a product of their mind but feels no control over them. 

Compulsions are defined as repetitive behaviours or mental acts that are performed in response to obsessions. The role of the compulsions is to stop dreaded events from occurring or to prevent/reduce distress.

Examples of compulsions include repetitive and excessive cleaning or washing, checking, physical or mental rituals, ordering, hoarding, and miscellaneous (for example, mental rituals, excessive list making, need to touch, rub or tap, blink or stare, etc.).

     The most common symptoms of OCD 

• Intrusive and unacceptable thoughts, images, urges, or doubts that involuntarily flood the mind

•  Thoughts about what the obsessions mean

• Thoughts about what having these obsessions says about the person

•  Feelings of anxiety, fear, tension, worries, embarrassment, shame, disgust, or guilt

•  Attempts to suppress the intrusions or to push them away

•  Acting in a peculiar way (physically, mentally, or both) to ensure that the concerns will not happen

•  Searching for safety

•  Neutralising intrusions with physical or mental actions or rituals (compulsions)

•  Attempts and acts aim to reduce the sense of personal responsibility 

•  Reassurance seeking

•  Avoiding fearful situations, etc.

Usually, the person struggling with OCD realises that the content of the obsessions is unreasonable and exaggerated. However, they are irresistibly compelled to act, ignore, suppress or "neutralise" them with some other thought or action. Often, people with OCD find that these thoughts are repetitive, persistent and scary. Obsessional thoughts frequently relate to feeling responsible for others, fear of harm and contamination, and also may have sexual or religious content. Sometimes, positive/pleasure-giving thoughts can also become distressing.

The most common OCD thinking styles relate to themes of responsibility: "Thinking this means I am responsible, and now have to prevent it from happening" or thought-action fusion, "Thinking it is as bad as doing it "(assumption), "I thought it so I must want to do it" (interpretation), "Thinking this will make it happen", etc. 

What maintains the OCD cycle is the repetition of the compulsions. The repetitiveness evokes mistrust in one's memory, senses and cognitive skills. Repeating actions reduces certainty ("Have I done it correctly?"). Repetition evokes doubt, which evokes more significant repetition, so the doubt becomes a conceptual rather than a perceptual process.

What causes OCD? 

OCD results from complex interactions of situational, social, neuro-biological, historical and psychosocial factors rather than a single cause. People are more likely to experience OCD if :

• They hold strong beliefs about responsibility, importance of thoughts, perfection, and control.

•   Early experiences involving responsibility for preventing bad things from happening (e.g., too much responsibility too early, trauma, etc.)

•  Life changes and transitions, new situations involving responsibility, and a sense of not being in control can be powerful triggers. 

Prevalence

1 in 5 people with OCD have an onset in childhood before the age of 10, with a relatively low lifetime prevalence of 1.6%. If untreated, there is chronic waxing and waning of the severity of symptoms. Often, OCD causes deterioration in daily functioning and general quality of life.

Treatments for OCD

Obsessive-compulsive disorder (OCD) should only be diagnosed by a mental health professional or a doctor. 

Psychological therapies, medications, or both can treat OCD.

According to the National Institute for Health and Care Excellence (NICE) Guidelines, CBT is recommended in the UK as a first-line treatment for OCD.

CBT is also recommended by the American Psychiatric Association (APA) as an effective first-line treatment - 12-16 weekly sessions of 50 min each. Follow-up sessions in 1,3 and 6 months are recommended for relapse prevention.

Psychological treatments for OCD 

• Cognitive behavioural therapy (CBT) 

• Exposure and response prevention (ERP)

 Psychological treatment can be combined with medications in moderate and severe presentations. 

References

American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and Statistical Manual of mental disorders (5th ed., text rev.) https://doi.org/10.1176/appi.books.9780890425787.x06_Obsessive_Compulsive_and_Related_Disorders 

International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11. Licensed under Creative Commons Attribution-NoDerivatives 3.0 IGO licence (CC BY-ND 3.0 IGO).

National Institute for Health and Care Excellence (NICE),Obsessive-compulsive disorder and body dysmorphic disorder: treatment,Clinical guideline [CG31]Published: 29 November 2005.Retrieved from https://www.nice.org.uk/guidance/cg31

Obsessive Compulsive Disorder. https://www.advanced-recovery-therapy.com/obsessive-compulsive-disorder.html