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Obsessive-compulsive disorderPublished by BUPA's health information team, healthinfo@bupa.com, August 2007. This factsheet is for people with obsessive-compulsive disorder (OCD), or who would like information about it. About one to two in 100 people are affected by OCD. It's often diagnosed in young adults, and affects more women than men. About one in 100 children may also have OCD.
What is OCD?People with OCD have repetitive obsessions and/or compulsions that cause anxiety. Everyone has unpleasant or obsessive thoughts occasionally; people with OCD can't ignore these thoughts. SymptomsOCD symptoms vary from mild to severe. They include obsessions (thoughts or feelings) that cause distress, anxiety caused by this distress, and compulsions (actions) which aim to stop or cancel out the thoughts or feelings causing distress. ObsessionsObsessions can include:
You may have more than one obsession and/or compulsion. CompulsionsYou may carry out compulsive behaviours to counteract the anxiety caused by your obsessions. Compulsions can include:
Compulsions can just be in the mind, such as counting in your head or thinking through the words of a song or prayer over and over again. Compulsions are usually related to the type of obsession you are experiencing. For example, repeated hand washing may follow from obsessions about dirt or contamination. You may feel that something terrible will happen if you don't carry out your compulsions. Performing the compulsion may make you feel better in the short-term but this feeling doesn't last. AnxietyYou may feel tense, anxious, guilty, disgusted or depressed about OCD. If you carry out your compulsion, you may feel better in the short-term but in the long-term your anxiety may return. Compulsive behaviours can be very time consuming, often getting in the way of normal work and family life. They can also be embarrassing. The time taken up by compulsions and the embarrassment they cause may increase your stress levels even further, making symptoms worse. OCD and depressionIf you have OCD you may also have symptoms of depression. This may be due to the emotional strain of dealing with obsessions, or because OCD and depression involve similar chemical imbalances in the brain. CausesThe exact cause of OCD is not known, but it's probably due to a combination of factors. There is some evidence that OCD runs in families - on average if your mother, father, or sibling has OCD you have a higher chance of developing it. Life events such as a new child, changes in relationships or death of a close relative may trigger OCD in some people. Particular personality types, especially perfectionists, are more prone to OCD. OCD has been linked to increased activity in certain parts of the brain and a decreased level of the natural chemical serotonin. This chemical is important in the control of mood. OCD may also be associated with streptococcal infections - a type of bacterial infection, which can cause an immune response. This may affect the brain but there is limited evidence for this. DiagnosisThis disorder can be extremely distressing. If you feel your life is being affected by the symptoms of OCD you should visit your GP. Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. You may be referred to a psychiatrist, a doctor who specialises in mental health, a psychotherapist or a counsellor for further help. TreamentGetting professional help is the best way to deal with OCD. The treatments can help you to gain control over your obsessions and to avoid carrying out compulsions. Treatment may include psychological treatments, medicines or a combination of these. Self-helpSelf-help books, the internet or support groups can be helpful. Your GP will advise you about what will be most useful to you. Negative thoughts such as "I am a bad mother if I don't check…" are not helpful. Try to not think negatively about yourself and your obsessions. Write down your negative thoughts and list the opposing positive argument. Remember to concentrate on the good things in your life. Don't use alcohol to control your feelings as this can have a negative impact on your health and wellbeing. Some people find relaxation techniques or exercise improves their symptoms. Exposure and response prevention therapy (ERP)You may find it useful to list your obsessions and/or compulsions and to challenge them yourself. You can try to overcome OCD by resisting the compulsive behaviour but not the obsessive thought. You can do this by "exposing" yourself to, but not performing your usual compulsion - such as thinking "neutralising" thoughts or touching an object. By not reacting to the obessive thought, you can realise it is harmless. This form of therapy may also be advised by a therapist (see Psychological "talking" treatments). Psychological ("talking") treatmentsThe most effective types of talking treatment for OCD are psychological therapies that help people adapt their behaviour or the way that they think (cognition). Behavioural therapyThis is usually recommended as a first treatment, especially if the main problem is compulsions. It involves sessions with a therapist, who will gradually and repeatedly confront you with the situation that you may fear. This is called exposure and response prevention (ERP). The therapist does not allow you to carry out your usual compulsive behaviour to cope with the anxiety brought about by this situation. For example, a person with an obsession focusing on cleanliness may be asked to use a public telephone or touch a door handle without washing their hands afterwards. Although many people find behavioural therapy distressing to begin with, the anxiety associated with the situation gradually eases as you learn to deal with your fear. Around seven to eight in every 10 people who have behavioural therapy find it helpful. Up to 10 to 20 weekly sessions may be required for the treatment to be effective. Cognitive therapyThis can help you by encouraging you to analyse your thoughts (cognitions) and the reasons behind your assumptions that fuel your inappropriate reactions. It's particularly useful when obsessions are the main problem. Cognitive behavioural therapy is a combination of cognitive and behavioural therapy. For more information please see Related topics. MedicinesYour GP or psychiatrist may prescribe medicines to treat OCD. The most effective medicines aim to restore the balance of serotonin in the brain. These drugs, such as selective serotonin re-uptake inhibitors (SSRIs), are also used to treat depression, and work by reducing feelings of anxiety. Clomipramine (eg Anafranil), a different type of antidepressant, may also be used. SSRIs include fluoxetine (eg Prozac) and paroxetine (eg Seroxat). These medicines usually take two to four weeks to work, but can take up to 10 weeks. SSRIs are often taken for at least a year to treat OCD. People react to SSRIs differently, so you may need to try a number of medicines before you find the right medicine for you. However, you must take care at the end of your treatment, as your symptoms may return once you stop taking the medicine. Hospital treatmentMost people don't go into hospital for OCD unless they have another mental health problem, such as an eating disorder or schizophrenia. If you have very severe symptoms, you can't look after yourself properly or if you have thoughts about suicide, your GP may suggest further treatment. Very rarely brain surgery is performed if your OCD is severe and other treatments have not helped. Your consent is needed before this can happen. Living with OCDFriends and family can help by encouraging people with OCD to ask their GP for help. This may be difficult as sometimes people with OCD may not be ready or want to ask for help. If the person with OCD chooses exposure and response prevention (ERP) therapy, encourage them to tackle difficult situations, avoid taking part in rituals or checking, and reassuring them things are OK. Agreeing to limit the number of times they can ask for reassurance or the number of people who will offer it may be helpful. This may be hard but it will help in the long-term. Don't worry that someone with an obsessive fear of being violent will actually perform their thoughts - it's very rare for someone to do this. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Adrian Winbow MB, FRCPysch, DPM, Consultant Psychiatrist, Cygnet Hospital and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2007. Expected review date August 2009.
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