You may have heard the term Obsessive Compulsive Disorder (OCD) in one context or another, as it is increasingly used in mainstream conversation. So, what is OCD? As the name may lead you to conclude, OCD is largely characterised by obsessions and compulsions.
In OCD, obsessions are involuntary, repetitive and persistent thoughts, urges, or images which are experienced as intrusive and unwanted. These obsessions can cause anxiety or distress in the person experiencing them, and the person experiencing such thoughts, urges, or images tries to suppress them or with another thought or with a compulsion.
Compulsions are repetitive behaviours (e.g. hand washing, checking, putting things in a particular order) or mental acts (e.g. counting, praying, repeating words or phrases) that a person feels driven to perform as a result of an obsession or in order to adhere to particular rigid rules. In performing these behaviours, the person is attempting to reduce anxiety or distress, or trying to prevent a feared situation or event occurring. These behaviours are excessive, and/or aren’t realistically connected to the what they are aimed at neutralising or preventing.
The content of obsessions and compulsions varies between individuals, although some themes are common. These include things like cleaning (obsessions about contamination and compulsions to clean); symmetry; compulsions to engage in repetitive rituals, counting, or putting things in a certain order); forbidden or taboo thoughts (e.g. aggressive or sexual thoughts and related compulsions); and harm (e.g. fears about harm to oneself or others and checking behaviours related to these fears). For OCD to be diagnosed, a further feature is that the obsessions or compulsions are time-consuming (e.g. more than one hour a day) and/or cause substantial distress or disruption in a person’s social or work life, or in other important areas of life.
A person’s ability to recognise how unreasonable, ineffective, or excessive their OCD beliefs (obsessions) and behaviours (compulsions) are will vary, and some people with OCD may have a related tic disorder or presentation. Other symptoms and conditions can be found to co-occur with OCD, including anxiety, depression, body dysmorphic disorder, anorexia nervosa, and alcohol/substance misuse.
Many individuals with OCD will report variation in the severity of their symptoms over time. It is common for people with OCD to avoid situations or events that can exacerbate their symptoms, for example, an individual with fears of contamination may avoid public places such as restrooms or shopping centres.
Overall, the prevalence of OCD in adults is up to approximately 1.8% of the population. Adult females have a slightly higher incidence of OCD in the population than adult men, while in children males have a slightly higher rate of prevalence than females. Furthermore, there is more variation in the pattern of symptoms in children over time. The average age of onset is between 22 and 35 years, and about 1/3 of these will begin by age 15 years.
A suitably qualified mental health professional can conduct a comprehensive assessment and develop a treatment plan with the individual presenting with symptoms of OCD. The most common treatment for OCD is a cognitive behaviour therapy (CBT) approach called Exposure Response Prevention (ERP). In brief, ERP consists of the therapist working with the client to develop and implement the following:
- Identifying the client’s goals for therapy.
- Assessment of the client’s OCD symptoms and patterns – thoughts/obsessions, feelings, behaviours/compulsions and the triggers for these. This may include the use of a structured questionnaire and/or interview.
- Teaching the client to identify and rate their level of distress or anxiety in order to monitor discomfort during tasks of ERP.
- Developing an exposure hierarchy by ranking triggering situations and the OCD responses related to them, from the least distressing to the most distressing situation.
- Developing an ERP plan – planning and working through challenging situations in which OCD triggers arise, developing goals for refraining from OCD behaviours (i.e. compulsions) in each situation/task.
- Conducting in-session exposure tasks and tasks to complete in the home or community environment.
- Reviewing progress and problem-solving if required.
If you or someone you know shows symptoms of OCD, you can contact a mental health professional to enquire about treatment, or speak to your GP about obtaining a referral.