Obsessive Compulsive Disorder

Obsessions are repetitive and unwanted thoughts, impulses, or images which cause huge anxiety - trying to stop them makes for even more distress.  OCD sufferers know these things come from their own mind, but cannot control them.

Compulsions are when a person is driven to repeat actions or behaviours even though he/she knows they are unhelpful and unnecessary.  Compulsions are usually linked to the obsessional thoughts, and will usually relieve the anxiety of the thoughts for a short while. e.g.  If the obsessional thought is about one's hands being dirty, repeated and excessive washing of hands can relieve the anxiety for a little while. The washing of hands will probably have to be done in an exact order, or may have to be repeated until it has been 'perfectly' done - often long after the hands have become raw and bleeding.

Actions may be rigidly ritualistic. Things will have to be done in an exact sequence or a particular number of times. They can be unseen, such as counting silently.

The relief gained from compulsive actions is usually short-lived.  The anxiety returns and, in time, doing the compulsion has less effect on it. This can lead to more and more compulsive behaviour in an attempt to stem the rising tide of anxiety.

About 5-10% of sufferers have episodes of OCD but are ok in between. Treatment can greatly improve OCD - because it is a long-term illness, treatment is often long-term also.  Many try hard to control OCD themselves, and often do not seek help until OCD has been present for many years.  The prognosis without treatment is poor, and the illness will be worse when the person is under stress.

Anxiety and panic attacks can accompany OCD.  Addictions may also become a problem if the person tried to reduce the OCD symptoms with alcohol or illegal drugs.

Treatment has two  major components - psychotherapy and medication. Each form of treatment is effective for about 70% of sufferers - a combination of the two will help 80-90%.

A psychologist works to encourage the OCD client to challenge the belief that they, or their close associates, are kept safe because of their repetitions.  It is helpful for the client to repeatedly experience the obsessions without following them with compulsive behaviours - the more this happens, and the result is not the feared disaster, the less 'magical power' the compulsions will have.  Over time, the obsessions themselves become less frequent and the anxiety starts to fade - this happens when they are not supported with the compulsive behaviours.

This form of treatment is call "exposure" and "response prevention".  Preventing the compulsions after an obsessive thought is scarey and distressing to OCD clients.  Because of this, the technique is carried out in a systematic, gradual, step-by-step way.  Homework assignments are given, to keep continuity.  Significant progress is thus achieved.