Obsessive-compulsive Disorder


Obsessive-compulsive disorder (OCD) is a condition where you have recurring obsessions, compulsions, or both.

Obsessions are unpleasant thoughts, images, or urges that keep coming into your mind. These could be issues like:

  • Fears about contamination with dirt, germs.
  • Worries about doors being unlocked, fires left on, causing harm to someone.
  • Intrusive thoughts or images of swearing, blasphemy, sex, someone harmed.
  • Fear of making a mistake or behaving badly.
  • A need for exactness in how you order or arrange things.
  • A compulsion to collect things that others might throw away.

Compulsions are thoughts or actions that you feel you must do or repeat. Usually the compulsive act is in response to an obsession. A compulsion is a way of trying to deal with the distress or anxiety caused by an obsession. For example, you may wash your hands every few minutes in response to an obsessional fear about germs.

How does obsessive-compulsive disorder affect your life?
The obsessions that you have with OCD can make you feel really anxious and distressed. The severity of OCD can range from mildly inconvenient to causing severe distress.
OCD affects people in different ways. For example, some people spend hours carrying out compulsions and, as a consequence, cannot get on with normal activities. Some people do their compulsions over and over again in secret (like rituals).
They fear that other people might think they are crazy. Some people with OCD may feel ashamed of their symptoms, especially if they contain ideas of harming others, or have a sexual element.

What causes obsessive-compulsive disorder?
The cause of OCD is not clear. Also, the chance of developing OCD is higher than average in first-degree relatives of affected people (mother, father, brother, sister, child).

Who gets obsessive-compulsive disorder?
It is thought that between 1 to 3 in 100 adults have OCD. OCD is usually a chronic (persistent) condition.

How is obsessive-compulsive disorder diagnosed?
A detailed assessment is then needed for OCD to be diagnosed. This may either be carried out by your doctor. The assessment will look at any obsessional thoughts and compulsions that you have and how they affect you and your daily life.

What is the treatment for obsessive-compulsive disorder?

  • Cognitive behavioural therapy (CBT); or
  • Medication, usually with an SSRI antidepressant medicine; or
  • A combination of CBT plus an SSRI antidepressant medicine.

Cognitive behavioural therapy
CBT is a type of a specialist psychological therapy. It is probably the most effective treatment for OCD.
Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as OCD. The therapist helps you to understand your current thought patterns - in particular, to identify any harmful, unhelpful, and false ideas or thoughts which you have. Also, to help your thought patterns to be more realistic and helpful.
Behavioural therapy aims to change behaviours which are harmful or not helpful - for example, compulsions. Cognitive behavioural therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours.

How can you get CBT?
Your doctor may refer you to a therapist who has been trained in CBT. This may be a psychologist, psychiatrist, psychiatric nurse.

How effective is CBT for OCD?
Of those who complete a course of CBT, there is a marked improvement in more than 3 in 4 cases. Symptoms may not go completely, but usually the obsessions and compulsions become much less of a problem.

Medicines used to treat obsessive-compulsive disorder
SSRI antidepressants
SSRI antidepressant medicines can also reduce the symptoms of OCD, even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin, which may be involved in causing symptoms of OCD. SSRI antidepressants include: citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline.

Are SSRI antidepressants addictive?
SSRIs are not tranquillizers, and are not thought to be addictive. If addiction does occur, it is only in a minority of cases.)

What is the prognosis for obsessive-compulsive disorder?
If OCD is not treated, obsessive thoughts and compulsions may not improve and may get worse in some people. However, with treatment, many people's symptoms can be brought under control and some people may be completely cured.

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