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Obsessive Compulsive Disorder

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What is Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is thought to be one of the most debilitating of illnesses, in terms of loss of income and poor quality of life. And, after depression, alcohol and substance abuse and social phobia, OCD is the UK's fourth most common mental disorder.

It manifests itself through a number of different patterns of thought and behaviour, some of them obsessions, some compulsions, and others are examples of avoidance. Together, these can become a destructive cycle which brings great distress to many people with OCD, and to their relatives and friends.

Obsessions

Most of us have been obsessed at some time or other. Hobbies can be obsessive, as can a preoccupation with a film-star. Constantly talking about the new love in our lives might be seen as obsessive, too. But these are not the obsessions of OCD. In OCD, obsessions can be thought of as persistent thoughts, images or urges that come to mind and trigger distress. They are frequent, unwanted, and difficult to control or get rid of. Examples might include:

  • Fear of contamination, from dirt, body fluids, dangerous materials such as asbestos, etc.
  • An excessive concern with order and symmetry
  • An urge to hoard what most people would think of as useless or worn-out possessions
  • Religious or blasphemous thoughts

Compulsions

A dictionary might define a compulsion as an irresistible impulse to act, regardless of motivation. However, this could describe shoplifting, for example, binge-eating or gambling, done for instant gratification. Once again, these are not the compulsions of OCD. In OCD, compulsions are acts you repeat over and over again, in response to an obsession. Examples of OCD compulsions are:

  • Checking, to see that the car is locked or the gas is turned off
  • Mental rituals, such as repeating prayers or a set sequence of words
  • Counting, for instance the number of cracks between paving stones, or from one to a "magic" number

Avoidance Tactics

These are strategies used by those with OCD to make sure, for example, that they don't come into contact with the object of their compulsion. So someone with a fear of being contaminated by dirt might wear latex gloves all the time, avoid touching their genitals, or wait for another person to open and close doors. Someone with a fear of harming a loved one might insist on having all sharp implements locked away in drawers, and might also perform a complicated set of mental behaviours to avoid potentially thinking about causing the harm.

Can OCD be Treated?

In the majority of cases, yes. Research and clinical experience show that cognitive behavioural therapy (CBT) is effective in treating the disorder: the "cognitive" part of the therapy helps people change the way they think about things obsessively, while the behavioural component helps change their compulsive behaviour in response to their obsessions.

As a preliminary, those with the disorder might find it useful to read An Introduction to Coping With OCD, written by Lee Brosan. One of a small series of CBT booklets presented in an easy-to-read A4 format, it is often used by mental health therapists as part of a course of guided self-help treatment, and it can make a very good first step to recovery.

About the Authors

David Veale is a Consultant Psychiatrist in Cognitive Behavioural Therapy at the South London and Maudsley NHS Foundation Trust and the Priory Hospital, North London. He is an Honorary Senior Lecturer at the Institute of Psychiatry, King’s College London and President of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) 2006—8. Rob Wilson, co-author of Overcoming Obsessive Compulsive Disorder and a CBT therapist in private practice, is a tutor at Goldsmiths College, University of London.

The step-by-step approach adopted in Overcoming Obsessive Compulsive Disorder uses CBT techniques to help those with OCD break free from their obsessive behaviour and regain control over their lives.

Overcoming Obsessive Compulsive Disorder is written in two parts. Part One looks at understanding the nature of OCD and its causes. Part Two sets out strategies to overcome it. It describes:

  1. How CBT can be used as a self-help therapy for the disorder;
  2. How to prepare oneself to make the changes necessary to overcome OCD;
  3. How to keep the obsessions at bay;
  4. How to treat children and adolescents with OCD;
  5. How family and friends can help.