OCD – What’s the real story?

Obsessive Compulsive Disorder (OCD) is presented in many ways in the media and pop culture, and who of us hasn’t said, ‘I think I’m a bit OCD’? But what is OCD really like? Who does it affect? And what help is there?

Fast Facts:

  • About 1 in 50 of us suffer with OCD at some point in our lives
  • Usually develops between 18-24 years of age
  • 1 in 3 OCD sufferers also experience anxiety and depression
  • 80% of people with OCD do not get better without professional help
  • Psychological treatment (sometimes with the addition of medication) works

Obsessive Compulsive Disorder (OCD) is an anxiety-related condition involving frequent, intrusive thoughts which the sufferer may try to alleviate by repetitive behaviours or rituals. The anxiety caused and compulsive nature of OCD behaviours means that day-to-day functioning can be severely impaired. Because of this, the World Health Organisation (WHO) ranks OCD as one of the top ten most debilitating conditions in the world in terms of impact to quality of life and loss of earnings.

People with OCD have many of the same intrusive thoughts that are experienced by the non-anxious general population. For example, in one study, the urge to hurt a family member was experienced by nearly 50% of all participants (Purdon & Clarke, 1993). Similarly, intrusive thoughts on themes of contamination (germs, dirt, or disease), harm caused by carelessness (e.g. leaving the gas on), religious or blasphemous thoughts, sexual thoughts, and the need for order and symmetry, are almost universal. What causes these normal intrusions to develop obsessions? Purdon and Clarke find that the thought about swerving into oncoming traffic was experienced by 55% of non-anxious women and 52% of non-anxious men. In most people, this thought is easily dismissed because it is seen as a random thought, with no hidden meaning. However, for someone with OCD, the thought might trigger a belief that there is something more serious behind it. Perhaps they really wish to harm others, in which case, maybe it would be better to prevent any risk of sudden violence by stopping driving all together. The meaning attached to a thought and the response to it is what characterises the difference between a normal intrusive thought and an obsessional one.

Symptoms of OCD can generate feelings of shame and embarrassment, which coupled with a lack of understanding of the condition means sufferers can go undiagnosed, and thus untreated for years. The average wait between first development of symptoms and treatment is between 10-15 years. It is essential therefore that practitioners be aware symptoms of OCD and the interventions available to effectively treat this chronic condition.

NICE government guidelines recommend Cognitive Behavioural Therapy (CBT) as the first-line treatment for mild-moderate OCD. Studies increasingly show the efficacy of CBT in improving symptoms and reducing impairment to daily functioning as a result of distress (Wilhelm, 2005). For more severe cases, a combination of CBT and medication may be necessary. Medication can help reduce obsessions and comorbid anxiety and/or depression, in turn helping patients engage better in therapy. The aim of treatment is long-term recovery, thus CBT is highly recommended for all cases as not all people benefit from medication, and once stopped the effects are rarely long-lasting – on average, about 1 in 2 of those who stop medication develop a recurrence of OCD symptoms after stopping it. Once learnt, however, skills taught in CBT are useful long after therapy comes to an end.

Further reading

Overcoming Obsessive Thoughts by Purdon and Clarke

Talking Back to OCD by March and Benton

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