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Encyclopaedia


Obsessive compulsive disorder

Introduction

Obsessive compulsive disorder (OCD) is a common mental health condition in which a person has obsessive thoughts and compulsive behaviours.

It affects men, women and children and can develop at any age. Some people develop the condition early, often around puberty, but it typically develops during early adulthood.

OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.

This page covers:

Symptoms of OCD

If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours.

  • An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.
  • A compulsion is a repetitive behaviour or mental act that you feel you need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought.

For example, someone with an obsessive fear of their house being burgled may feel they need to check all the windows and doors are locked several times before they can leave the house.

Read more about the symptoms of OCD.

Getting help for OCD

People with OCD are often reluctant to seek help because they feel ashamed or embarrassed.

But there's nothing to feel ashamed or embarrassed about. It's a health condition like any other – it doesn't mean you're "mad" and it's not your fault you have it.

There are two main ways to get help:

  • visit your GP – your GP will ask about your symptoms and can refer you to a local psychological therapy service if necessary
  • refer yourself directly to a psychological therapy service if that is possible in your area

If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they seek help.

OCD is unlikely to get better without proper treatment and support.

Treatments for OCD

There are some effective treatments for OCD that can help reduce the impact the condition has on your life.

The main treatments are:

CBT will usually have an effect quite quickly. It can take several months before you notice the effects of treatment with SSRIs, but most people will eventually benefit.

If these treatments don't help, you may be offered an alternative SSRI or given a combination of an SSRI and CBT. Some people may be referred to a specialist mental health service for further treatment.

Read more about how OCD is treated.

Causes of OCD

It's not clear exactly what causes OCD. A number of different factors may play a role in the condition.

These include:

  • family history – you're more likely to develop OCD if a family member has it, possibly because of your genes
  • differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
  • life events – OCD may be more common in people who've experienced bullying, abuse or neglect and it sometimes starts after an important life event, such as childbirth or a bereavement
  • personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, as may those who are generally quite anxious or have a very strong sense of responsibility for themselves and others

Support groups

Living with OCD can be difficult. In addition to getting medical help, you might find it helps to contact a support group or other people with OCD for information and advice.

The following sites may be useful sources of support:

OCD Action and OCD-UK can also let you know about any local support groups in your area.

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Symptoms

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

This pattern has four main steps:

  • Obsession – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind.
  • Anxiety – the obsession provokes a feeling of intense anxiety or distress.
  • Compulsion – repetitive behaviours or mental acts that you feel driven to perform as a result of the anxiety and distress caused by the obsession.
  • Temporary relief – the compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon returns, causing the cycle to begin again.

It's possible to just have obsessive thoughts or just have compulsions, but most people with OCD will experience both.

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point, such as thinking they may have forgotten to lock the door of the house, or even sudden unwelcome violent or offensive mental images.

But if you have a persistent, unpleasant thought that dominates your thinking to the extent it interrupts other thoughts, you may have an obsession.

Some common obsessions that affect people with OCD include:

  • fear of deliberately harming yourself or others – for example, fear you may attack someone else, such as your children
  • fear of harming yourself or others by mistake – for example, fear you may set the house on fire by leaving the cooker on
  • fear of contamination by disease, infection or an unpleasant substance
  • a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way

You may have obsessive thoughts of a violent or sexual nature that you find repulsive or frightening. But they're just thoughts and having them doesn't mean you'll act on them.

Compulsive behaviour

Compulsions arise as a way of trying to reduce or prevent anxiety caused by the obsessive thought, although in reality this behaviour is either excessive or not realistically connected.

For example, a person who fears contamination with germs may wash their hands repeatedly, or someone with a fear of harming their family may have the urge to repeat an action multiple times to "neutralise" the thought.

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they can't stop acting on it and feel they need to do it "just in case".

Common types of compulsive behaviour in people with OCD include:

  • cleaning and hand washing
  • checking – such as checking doors are locked or that the gas is off
  • counting
  • ordering and arranging
  • hoarding
  • asking for reassurance
  • repeating words in their head
  • thinking "neutralising" thoughts to counter the obsessive thoughts
  • avoiding places and situations that could trigger obsessive thoughts

Not all compulsive behaviours will be obvious to other people.

Getting help

It's important to get help if you think you have OCD and it's having a significant impact on your life.

If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they seek help.

OCD is unlikely to get better on its own, but treatment and support is available to help you manage your symptoms and have a better quality of life.

There are two main ways to get help:

  • visit your GP – your GP will ask about your symptoms and can refer you to a local psychological therapy service if necessary
  • refer yourself directly to a psychological therapy service - if your local services accept self-referrals

Contact your GP or care team immediately if you ever feel you can't go on. You can also phone the Samaritans on 116 123, or NHS Direct Wales on 0845 46 47.

Related problems

Some people with OCD may also have or develop other serious mental health problems, including:

  • depression – a condition that typically causes lasting feelings of sadness and hopelessness, or a loss of interest in the things you used to enjoy
  • eating disorders – conditions characterised by an abnormal attitude towards food that cause you to change your eating habits and behaviour
  • generalised anxiety disorder – a condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event
  • hoarding disorder – a condition that involves excessively acquiring items and not being able to throw them away, resulting in unmanageable amounts of clutter

People with OCD and severe depression may also have suicidal feelings.

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Treatment

Obsessive compulsive disorder (OCD) is a treatable condition. The treatment recommended will depend on how much it's affecting your life.

The two main treatments are:

  • psychological therapy – usually a type of therapy that helps you face your fears and obsessive thoughts without "putting them right" with compulsions
  • medication – usually a type of antidepressant medication that can help by altering the balance of chemicals in your brain

A short course of therapy is usually recommended for relatively mild OCD. More severe OCD may require a longer course of therapy and/or medication.

These treatments can be very effective, but it's important to be aware that it can take several months before you notice the benefit.

You can get treatment on the NHS through your GP, or in some areas by referring yourself to a local psychological therapy service.

Psychological therapy

Therapy for OCD is usually a type called cognitive behavioural therapy (CBT) with exposure and response prevention (ERP).

This involves:

  • working with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions
  • encouraging you to face your fear and let the obsessive thoughts occur without neutralising them with compulsive behaviours – you start with situations that cause you the least anxiety first, before moving onto more difficult thoughts

The treatment is difficult and may sound frightening, but many people find that when they confront their obsessions, the anxiety does eventually improve or go away.

People with fairly mild OCD usually need about 10 hours of therapist treatment, combined with exercises done at home between sessions. A longer course may be necessary in more severe cases.

Medication

You may need medication if psychological therapy doesn't help treat your OCD, or if your OCD is fairly severe.

The main medications prescribed are selective serotonin reuptake inhibitors (SSRIs). These can help improve OCD symptoms by increasing the levels of a chemical called serotonin in your brain.

You may need to take the medication for 12 weeks before you notice any effect.

Most people require treatment for at least a year. You may be able to stop if you have few or no troublesome symptoms after this time, although some people need to take medication for many years. Your symptoms may continue to improve for up to two years of treatment.

Don't stop taking SSRIs without speaking to your doctor first, as this can cause unpleasant side effects. When treatment is stopped, it will be done gradually to reduce the chance of this happening. Your dose may need to be increased again if your symptoms return.

Side effects

Possible side effects of SSRIs include:

There's also a very small chance that SSRIs could cause you to have suicidal thoughts or want to self-harm. Contact your GP or go to your nearest accident and emergency (A&E) department if this happens.

Most side effects improve after a few weeks as your body gets used to the medication, although some can persist.

Further treatment

Further treatment by a specialist team may sometimes be necessary if you've tried the treatments above and your OCD is still not under control.

Some people with severe, long-term and difficult-to-treat OCD may be referred to the National OCD Service in London.

The service offers assessment and treatment to people with OCD who haven't responded to treatments available from their local and regional OCD services.

To be eligible for this service, you must have been diagnosed as having severe OCD and have received:

  • treatment with at least two different SSRIs at recommended doses for at least three months
  • at least two attempts at psychological therapy, both in a clinic and at home
  • additional treatment with another medication, such as a different type of antidepressant called clomipramine, or an SSRI at a dose higher than normally recommended

Most people's condition improves after receiving treatment from the National OCD Service.

OCD support groups

Many people with OCD find support groups helpful, as they can:

  • provide reassurance and coping advice
  • reduce feelings of isolation
  • offer a chance to socialise with others
  • provide information and advice for family members and friends

The national charities OCD Action and OCD-UK can provide information about support groups in your area:

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 24/11/2016 10:34:35

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