Obsessive Compulsive Disorder is an anxiety disorder in which the anxious thought and feelings are alleviated or neutralised by performing a repeated action. Everyone, at some time of other has experienced that moment’s doubt that forces you to go back and check on or perform and action - checking that the oven is off, that the door is locked or the like - but in people with OCD, these thoughts can cause great stress that can only be alleviated by repeating the task multiple times.
The compulsive actions aren’t necessarily mechanical or based around real world consequences. Rather than checking to see if the door is locked, a person living with OCD may feel the need to turn lights on and off multiple times to stave off sickness, or perform rituals to stave off possible future events. These rituals can take many forms, from movements, modes of dress or repeated actions.
These obsessive behaviours can negatively impact the ability to function in daily life and can lead to feelings of embarrassment or shame and a desire to hide symptoms from others. This can cause people with OCD to distance themselves from social situations or become shut-ins. Such pressure can lead to development of other anxiety disorders, such as social anxiety disorder or generalised anxiety disorder .
According to sane.org , around 2% of Australians live with Obsessive Compulsive Disorder.
Symptoms of Obsessive Compulsive Disorder
There is no clear set of symptoms for obsessive compulsive disorder, but people with the condition typically have at least one obsession and related compulsion. These obsessions and compulsions can take up hours of the day, leading to disruptions of relationships, employment and education.
Obsessions are worries or anxieties about any number of things taken to extreme levels. Obsessions may be a constant underlying stress or something triggered by an object or situation. Triggered obsessions often grow beyond their initial trigger to encompass a wider pool of related, however peripherally, objects and situations.
Obsessions can generate a wide range of negative reactions, from annoyance, disgust and anger through to severe distress, anxiety and panic. No matter the reaction to the obsession, people with OCD generally develop an excessive vigilance when it comes to avoiding their triggers or controlling their environment to limit exposure.
Common obsessions include: fear of contamination from germs, dirt, poisons, and other physical and environmental substances.
- Fear of harm - illness, injury or death.
- Fear of disorder - symmetry, orderliness or routine.
- Fear of religious issues.
- Fear of immorality.
- A need for knowledge and control.
- Fear of contamination - germs, dirt, toxins or chemicals.
- Intrusive violent or sexual thoughts.
Compulsions are actions or thoughts that are performed to avoid, counteract or prevent the threat caused by an obsession. These thoughts or actions are often repetitive, requiring the person living with OCD to perform the action multiple times to have any affect.
Unfortunately compulsions often reinforce obsessions rather than alleviating them. These ritualistic actions may provide short term relief but also any relief makes the obsession seem more real and concrete.
Common compulsions include:
- Excessive personal cleaning - hand washing, showering and tooth brushing.
- Excessive cleaning - and washing of house, household items, food, car and other areas
- Excessive checking of safety features - locks, electrical switches, appliances, and other safety features\Touching or tapping - repeating gesture a set number of times.
- Fixating on good or safe numbers or words - vocally or mentally repeating these numbers or words a set number of times.
- Repeating routine activities - picking up and putting down objects, opening and closing doors, reading or counting.
- Need for rigid rules and patterns - ordering objects, books, symmetry, etc
- Constant need for reassurance - creating situations to be reassure, such as asking questions or confessing.
There’s no shame in seeking professional help, and the easiest and most convenient way to search for and book an appointment with a doctor for a referral or find a psychologist you can connect with for therapy is with MyHealth1st.
What Causes OCD?
There is no clear cut cause of OCD, but it is believed to be caused by a number of contributing factors including genetics and environment. Having a parent with obsessive compulsive disorders appears to increase the chance of a child having the condition but it is not known whether this is because of genetic inheritance or learned behaviour.
People with OCD display irregularities with the way they process serotonin but whether this is an irregularity that leads to OCD or an irregularity caused by OCD remains to be seen.
In a safe therapeutic relationship, significant life events that may underpin OCD behaviours can be explored and worked through. These can include grief and loss (death, divorce, job loss etc), car accidents, rape, assault, domestic violence, long-term emotional abuse, war and natural disasters. Intergenerational trauma can also play a role in OCD, as can loneliness and disconnection.
Working Through, and Living With OCD
Approaches to OCD vary from person to person, and need to be tailored to an individual’s needs. Understanding OCD and its derivative - anxiety - on an intellectual level helps bring a conscious awareness to what is happening. However, being with the fear, and sometimes terror, long enough to unlock its hold can be difficult. Being in a good therapeutic relationship creates the right conditions to explore these areas. With the help of a good therapist, the person suffering OCD can come nearer to themselves and gently look at what is happening underneath the behaviour.
There are a range of therapeutic approaches:
- Acceptance and Commitment Therapy
- Dialectical Behavioural Therapy
- Psychodynamic Approach
- Cognitive Behavioural Therapy (CBT) CBT is a form of therapy designed to modify unhelpful thoughts and behaviours that may contribute to stress and anxiety. CBT provides skills to manage anxiety symptoms and control obsessions. Identify and challenge their negative or anxious thoughts and replace them with more helpful ways of thinking. A process known as Exposure and Response Prevention (ERP) helps people be gradually exposed to the source or object of their obsession, allowing them to develop an ability to resist or manage their symptoms and obsessions. Relaxation strategies (e.g., relaxation breathing and muscle relaxation techniques) are also commonly used. CBT has been found to be the effective treatment for anxiety disorders.
- Medication Antidepressant medicines that affect serotonin may be prescribed to help control symptoms for obsessive compulsive disorder. Antidepressant medications are usually prescribed in conjunction with cognitive behavioural therapy.
In addition to professional care, there are a number of things a person living with OCD can do to identify and limit symptoms to aid in their recovery. Keeping a diary of your obsessions and symptoms can better help a psychologist identify the frequency and severity of your obsessions. Trying to delay a compulsion via distraction - watching tv, playing a game or the like - can help a person gain control over symptoms. Setting time every day to take care of yourself is important, as stress can trigger obsessions and compulsions, but setting time aside specifically to worry can also be useful. Having a dedicated worry period can condition you to get your obsessions out rather than prolong their effect by trying to delay the fear with compulsions. Self-help techniques are not a replacement for professional help and should be part of a mental health plan that includes therapy and (potentially) medication.
If you need someone to talk to about your symptoms or just need a little bit of advice, the SANE Australia hotline is waiting for your call on 1800 18 7263. Beyond Blue is also available to offer 24 hour support on 1300 22 4636.