Obsessive-Compulsive Disorder
What Is It?
Do you remember playing the game of 'not walking on the cracks on the pavement' or having to touch things a certain number of times or counting things repeatedly because if you didn’t you felt uncomfortable or had an idea that something bad would happen?
Well, obsessive compulsive disorder (OCD for short) is a bit like that only much, much worse.
Obsessions are repeated thoughts that are upsetting, for example, that you are going to get a serious illness because you have touched something dirty, that something terrible will happen to someone you love or to yourself if you don’t do something a certain number of times or even that you are going to do something bad to somebody else. These thoughts are not wanted by you they just exist and you can’t get rid of them easily. They may take up a lot of your thinking time or even all of it. Usually you will recognise them as stupid and irrational although younger children do not always.
All of us have had the occasional thought like this but we can usually just shake our heads and get on with things and don’t get upset by them.
People with obsessive compulsive disorder find these thoughts come back repeatedly and they cannot get rid of them. They believe that the thoughts are dangerous and will lead to terrible things happening. They can’t just ignore them.
Compulsions are the actions that you do, usually after the thoughts, to prevent the bad things you are frightened of happening. Compulsions may happen in your head, for example counting, or maybe things you do like washing your hands repeatedly because you are afraid of germs.
It’s a bit like believing in magic. You know that the thoughts or actions are not rational or logical but you still believe that you have to do thses things to stop the terrible things from happening.
Now all this may sound like it’s not very serious but for sufferers their whole lives can become dominated by these thoughts and actions so they have no time to do anything else. People can become very distressed even depressed about what’s happening to them and why they keep on doing senseless things or having upsetting thoughts.
Who Gets It?
About 2% of the population, even children as young as 7 can develop it!. If you have Tourette’s Syndrome you are much more likely to suffer from OCD. Other people who are more likely to get it include people who do things like bite their nails or continuosly play with their hair.
People with autistic spectrum disorders may have behaviours that look similar to compulsions but often they do not distress them.
Why Do We Get It?
We’re back to brain chemicals and the way they work again. We know that certain areas of the brain do not work the same way in people with OCD. There are a few people in whom this seems to have been triggered by an infection.
What Can I do About It?
The good news is that most people do well if treated with Cognitive Behavioural Therapy. This means working out ways of dealing with the difficulties helped by a therapist and then carrying out whatever plans you have made at your own pace. A combination of cognitive changes (changes to the way you think about what is happening) and exposure (very slowly and at your own pace coming into contact with feared situations) works well for most people.
Those of you who are mildly affected might do well using a self-help programme either from a book or over the net. This will take you step by step through ways of dealing with your fears.
For most people 10-12 sessions of therapy will be enough.
Those of you who do not respond to this approach may wish to look at prescription drugs. SSRIs (see our Anti-Depressants page) work well, but if not, a tricyclic anti-depressant called clomipramine works for about 70% of people. You need to remember it may take the drugs up to 12 weeks to work. So persevere once you have started.
Once on drug therapy
It may be helpful even if you are getting better on drugs to try or retry CBT
So most people will do well.
You must remember that OCD may return if you are under a lot of stress or sometimes for no reason at all. It is important to have a plan for what you will do if you think the symptoms are coming back.
If drug therapy has worked for you then you may need to keep on taking them for at least six months after you are better.