Table of Contents
OCD (Obsessive-compulsive disorder) is based around obsessive thought patterns and rituals, such as fear of contamination, in conjunction with compulsions to carry out physical rituals, such as excessive washing. The rituals relieve the fear created by the obsessive thoughts. It is perfectly possible, and very common, to have obsessive thoughts without the rituals and it is equally possible to have the compulsive rituals without the thoughts although this is quite rare.
When does a ritual become compulsion? This is quite a difficult one to answer as there is a fine line between habitually doing something, and it not being a problem, to doing the same job but it being obsessive. For example, if you the vacuum the house once a day then you could say that you are “just house proud” even though to some of us that may seem a little excessive – once a week will do for most people. If, however, you find that you vacuum the house and then feel the need to do it again a few hours later as there are a few bits of fluff on the carpets, then it could be that this is becoming an obsession.
A big test would be to not vacuum the carpets one day and see how it makes you feel – were you relieved to have some extra time to yourself or were you worrying excessively because the house looks dirty or that you have not completed your daily chore. Think about it and then decide.
Examples of Obsessions
- Fear of shameful behaviour
- Death & disaster
- Perverted sexual thoughts
- Symmetrical arrangements
- Intrusive thoughts & images
- Unsatisfactory body image
Examples of Compulsions
- Repeating actions or tasks
- Confessing imaginary “sins”
The causes of OCD are unclear but there is some evidence that an imbalance of a neurotransmitter in the brain known as serotonin, or a disturbance in serotonin metabolism is associated with the disorder. This has been proved by the fact that many sufferers improve when they take medications that increase brain serotonin levels (e.g. Anafranil, Prozac, Zoloft and Paxil). Further research is still needed in this area.
Like all Anxiety Disorders, OCD can be overcome with self-exposure and CBT (Cognitive Behavioural Therapy), sometimes in conjunction with antidepressant drugs. Recovery is usually quite slow but hard work does produce positive rewards and complete recovery can be achieved.
Further details on obsessions/compulsions:
Here are some more details on examples of OCD.
Contamination – Bodily waste and/or secretion, such as urine, saliva and blood. Dirt and Germs – an urge to clean continuously.
Hoarding – Reluctance to throw things away, regardless of the value or usefulness. Rummaging through garbage to ensure nothing valuable was thrown away. Collecting useless items.
Ordering – Wanting things to be Symmetrical. Ordering everything around them. Wanting things to be “perfect”, exact. Seeking that feeling of “Just Right”. Preoccupation with aligning items such as papers, books in a certain “perfect” way.
Religion – Having blasphemous thoughts or saying bad things. The fear of being punished for these Thoughts. Concern with religious beliefs. Repeating and getting stuck on religious images and/or thoughts.
Aggression – Harming yourself. Harming loved one’s or people in general. Blurting out insults and/or obscenities. Acting out unwanted impulses, such as running someone over or stabbing a person.
Responsibility – Harming someone else by being careless yourself. Picking up pieces of glass on the street, informing people a public light is broken, take away items that may hurt others. That this carelessness or other actions of theirs may cause some terrible accidents, fires or burglary’s. The fear that what they say can be mis-interpreted and hurt someone and making them ask for assurance they didn’t. This is also part of the need to say things “Just Right”.
Sex – Sexual impulses/images/thoughts that can be extremely disturbing. Thoughts about molesting your own or other people’s children. Doubts on your own sexuality. Looking at a person of the same sex is enough to trigger this since they feel they may be giving out signs of being Homosexual, or they may feel a Homosexual will “contaminate” them just by passing by them. Thoughts or images of a violent sexual nature towards others.
Superstition – Fear of saying/thinking certain words because of the negative consequences that may result from doing so. Not being able to use certain colours, numbers or letters because they are negative, some numbers will be unlucky. Rigid adherence to excessive superstitious fears. Everything can become “negative” or “positive” and will become very rigid and omnipresent in the person’s life.
Perfection – The urge to remember certain things such as slogans, license plate numbers, names, words or event of the past. This could also be explained as the “Fear” of forgetting. The fear of saying something wrong or not “Just Right” and/or leaving details out. This makes the person go to great extend to tell everything “Just” as it was. Worrying about making mistakes. Easily bothered by the feel of clothing, textures on the skin. Small imperfections can drive the person crazy.
Miscellaneous Obsessions – Easily bothered by certain sounds and noises such as clocks ticking, loud noises or buzzing. Intrusive nonsense sounds, music, words. Certain songs will be repeated over and over in the mind.
Are you suffering?
Everyone suffers from OCD in some form or other but most of us control the feelings and it does not take over our lives. There is a fine line between obsession and normal everyday activities Things we do each day could be regarded as obsessive as they are rituals that we have to do. Examples are: brushing your teeth, washing up, vacuuming the house, dusting, emptying bins, removing out-of-date food from the fridge, showering, ironing, cleaning the bathroom, checking the doors and windows are locked and so on.
They only become an obsession when you have to carry out the task – sometimes over and over again – and are not happy until you have done so and everything is”just right”.
I do not consider myself as an OCD sufferer but I do have rituals that I like to adhere to and hence it is arguable that I am a mild sufferer.
I used to put out the cat food bowls each night on the side and the tins of cat food that they were going to get the next morning. I would even leave the fork out ready to mash the food up. Before I stopped drinking tea, I would get the cups out, with the tea-bags ready for the morning. I have stopped doing this now but for a while it was a nightly ritual.
I am a very fidgety person so if I see something that needs doing, then I will get up and do it immediately rather than leaving it until later. I can be watching a programme on TV and then see something that needs doing and I have to do it straight away rather than finishing watching the TV programme first. I have always found it hard to sit still and relax whilst I know that something else needs doing.
I am quite house-proud and hence I like things to be how I want them to be. Not all of this is OCD – a lot of it is simply because I cannot sit still for very long and always find something else to do! I sometimes find myself running around all night because everything needs to be done.
My ex partner did not suffer from OCD either but he had to check that all the doors were locked each night – regardless of the fact that I told him I have just locked them!
My point here is that all of us can be classed as obsessive to some degree or another and it is up to you to decide whether your rituals are really obsessions. If you are unsure then I would suggest that you break the ritual and see how it makes you feel – do you feel compelled to do it or can you live without doing it?
If you are confronted about your activities and find yourself saying “I can’t help doing it” or “I need to do it” then you should begin to consider whether you are developing OCD.
Obsessive Compulsive Disorder and its Treatment
By Professor Kevin Gournay, MPhil, PhD, CPsychol, AFBPsS
Obsessive/Compulsive Disorder was at one time thought to be a rare problem. However, like many anxiety states, people who suffer from Obsessive/Compulsive Disorder (OCD) keep their problems much to themselves. It is because of the very irrational nature of many obsessions that many sufferers are frightened and embarrassed about revealing their problems. Thus, until the last few years, the true incidence of the problem was unknown, there are varying estimates of the numbers of people suffering from OCD but there is an agreement that probably more than one million people in the United Kingdom have one form or other of the problem. OCD of course comprises both obsessive thoughts and compulsive behaviour and sufferers may exhibit either obsessions or compulsions alone or, more commonly, a mixture. There is no doubt, that OCD affects people across all cultures, occupations and radical groups. Before describing some of the current approaches, it is worth underlining that obsessions and compulsions per se are part of our lives. There is not one person who has not been preoccupied by an irrational idea, compelled to give into a superstitious behaviour or who has not been troubled by thoughts relating to guilt, perfectionism, or some aspect of conscience. OCD sufferers have these traits but some or all of them are magnified many times over.
What causes O.C.D?
Many years ago obsessions were thought to be caused by development factors and during much of this century most treatment approaches centered around psychoanalytic theories. However, in the last few years, it has become clear that the basis of OCD is to be found in slight differences in the structure and chemistry of the brain. These differences in themselves do not actually result in any other abnormalities but do seem to provide the basis for OCD Our knowledge of these brain differences is expanding with the recent advances in brain imaging. We are now able to scan the brain using some of the more recent developments for example, magnetic resonance imaging and positron emission tomography, also known as MRI and pet scans. However, despite the recognition that certain parts of the brain are different in OCD sufferers, we still do not know how these structural differences relate to the precise mechanisms of OCD Neither are we absolutely sure how the brain chemistry of OCD sufferers varies from the so-called norm.
Another interesting line of research is in the area of genetics and recent work carried out in several parts of the world has indicated that there may be a considerable genetic basis for OCD However, the more the picture unfolds, the more complex OCD becomes and it is probable that OCD comprises a number of different problems with some commonalities, it is also clear that the structural and chemical causes are not the entire answer. Obsessive and compulsive thinking and behaviour can also be learned from a range of experiences for example, during childhood, following traumatic events of one kind or another and, by exposure to a mother, father or significant other relative with OCD Thus, people may be born with a biological disposition to OCD but never develop the full problem, while others are born with the same predisposition but, when subject to sufficient learning experiences, develop the problem in a full blown form.
All this might sound rather complex and, indeed, as most of you know many GPs and even some mental health professionals are surprisingly ignorant about OCD but it is important to see that the condition is not caused by one simple factor.
I will now look at some of the common treatments for OCD and give a conclusion based on research findings rather than give a personal opinion.
Traditional psychoanalytic and psychodynamic psychotherapy was, for many years, the only psychological approach used in this problem and, indeed, many patients with OCD still have experiences of receiving this sort of treatment. While some patients may report receiving some benefit from these modes of treatment, the benefit is rarely reflected in change in the obsessional thoughts or the ritualistic behaviour. Psychodynamic and psychoanalytic therapies are talking treatments which aim to resolve predominantly subconscious or unconscious conflicts and thus, in the light of research findings on the nature of OCD it is obvious that chasing supposed unresolved conflicts is unlikely to achieve anything over a placebo effect. Gradually mental health professionals are accepting that these treatments are ineffective and fortunately most services have abandoned these methods as a way of helping people with OCD Although, unfortunately, in some areas of the country there are still psychiatrists, psychologists and other who continue to use these out of date ineffective methods.
While relaxation training can be quite helpful for certain types of anxiety; there is no evidence that it is helpful in the treatment of obsessional thoughts or compulsive rituals. Indeed, it is so ineffective that many researchers choose to use relaxation as a placebo treatment when trying to evaluate other treatments. Relaxation may, of course, be helpful in reducing general anxiety but anyone with OCD is wasting their time putting effort into using relaxation methods as anything more than a secondary supplement to other forms of treatment.
Patients still ask for hypnosis and it is easy to see that sufferers think that their obsessional thoughts could be susceptible to this method. However, sadly this is not the case and hypnosis treatment represents the sort of magic wand which has no place in the treatment armoury against OCD. My advice to anyone contemplating spending their money on this method, (it is not available on the NHS for the treatment of such problems), is that this is truly a waste of money and the only person benefiting will be the hypnotist and his or her bank manager.
Behaviour therapy revolutionised the treatment of obsessional rituals at the beginning of the 1970’s and brought the first real hope for sufferers. Treatments were based on the simple idea that if you helped people delay their responses to the compulsion to carry out a ritual such as hand washing or cleaning, they would experience a decline in their response and thus are able to ‘break the habit. Response prevention is linked to exposure, whereby the patient is asked, in graduated doses of difficulty, to face up to the primary source of their compulsion, i.e. the thing which they feel is contaminating them. Much of the time patients realise that their contamination fears are irrational but nevertheless any exposure to anything resembling the source of the fear produces huge anxiety which is only temporarily reduced by the ritual. Early treatment programmes were carried out. while the patient was in hospital and the method often involved having the assistance of a nurse 24 hours a day to enable the patient to be able to resist the urge. The treatments were very successful although, as one can imagine, in-patient care with 24 hour nursing cover is very expensive. However, one reason for changing this mode of treatment was that patients often thought they could hand over the responsibility to hospital or nurse or the therapist involved in the treatment. Thus, during the 1970’s treatment became much more outpatient focused, and therapists transferred their treatment efforts to the home setting. Indeed, when 1 worked with Professor Marks at the Maudsley Hospital in the 1970’s, 1 spent a considerable amount of my time in patient’s homes, helping them to deal with their obsessive fears. These response prevention treatments remain the main approach for people with obsessional rituals and the outcome of these methods is still excellent, with approximately 70% of patients who complete treatment reporting 70% or greater improvement in their symptoms. Nevertheless, behaviour therapy has never proved to be dramatically effective for obsessional thoughts although, there are some cases, which do respond to pure behavioural methods. In the last few years, better results have been obtained by using cognitive therapy in conjunction with behaviour therapy with obsessive thoughts. Cognitive therapy involves helping the patient to rationally change their thinking and therapists have developed a number of strategies to help patients deal with their obsessional worries. Commonly, cognitive behavioural procedures can help people with obsessional thoughts in between 1 0 and 20 sessions of treatment. However, good quality research on the cognitive approaches to obsessional thoughts is still in its infancy and we await larger studies.
Drug treatments have been used with OCD Antidepressants such as Annaframil (chlomipramine) may be helpful in some cases, particularly where depression is prominent. However, antidepressants only seem to confer truly long-term gains when combined with behaviour therapy. Newer compounds such as Prozac are currently being researched but, as yet, there is no evidence that they are useful in OCD Further, all drugs have side effects thus, and one must balance these against benefits.
OCD can be a crippling syndrome but behavioural methods may provide substantial benefits. No Panic and similar self-help organisations may provide benefits via not only the dissemination of behavioural advice but by collective support that professional treatments rarely provide. Sufferers should however take heart and the treatment outcome continues to improve. The future recovery prospects for people with OCD is bright but as yet sufferers still need to work hard at getting better. The No Panic help-line will provide details of self-help materials and useful books.