OCD (Obsessive Compulsive Disorder) can cause a great deal of distress. Unfortunately, many people do not seek help until they have had the problem for several years. This is partly because of the stigma attached to all mental health problems. There can also be a reluctance to talk about it because in some kinds of OCD people have intrusive thoughts they find very disturbing and shameful.
What is OCD? OCD is an anxiety problem. The pattern in OCD is that a disturbing 'intrusive' thought produces anxiety. In order to get rid of the anxiety, the person with OCD does some kind of behaviour to 'cancel out' the thought. Unfortunately, these behaviours only produce short-term relief and tend to increase the frequency of the thoughts and the behaviours.
Some people with OCD are not aware of the anxiety which is causing the behaviour. For instance, people who compulsively clean or have to have everything strictly in order, may feel low anxiety whilst they are able to do these behaviours. If they had to stop, they would probably feel very anxious.
Some people do not appear to have any noticeable 'behaviours' (or compulsions) but this is probably because all the anxiety-reducing 'behaviours' are done inside their head. For example, someone who has an intrusive image of hitting someone may say 'stop' in their head, every time this happens. This is an attempt to stop the image happening and is a type of internal compulsive behaviour.
What kinds of intrusive thoughts or images are common in OCD?
- contamination fears (someone will get ill as a result of being 'contaminated' by germs or dirt)
- uncertainty (something bad will happen if this isn't 'right')
- fear of doing something 'bad' (being violent or sexually abusive, being racist, homophobic, etc)
Common beliefs in OCD (based on Obsessive-Compulsive Cognitions Working Group, 1997):
- having bad thoughts produces bad consequences (eg "if I think of that ladder falling on someone's head it's more likely to fall on them")
- having bad thoughts means I'm a bad person
- over-responsibility ("I need to do all I can to make sure bad things don't happen, otherwise I am responsible.")
- I can and should control my thoughts
- perfectionism ("there is a right way and I should make sure I follow it")
- over-estimation of threat ("bad things are very likely to happen")
- intolerance of uncertainty ("I need certainty and without it I cannot cope")
Psychotherapy for OCD:
I have several years experience of working with people with various types of OCD (including hoarding). I always do a full assessment before assuming the problem is OCD. Sometimes, OCD-type behaviours are related to other types of difficulty, and are not OCD. Both CBT (Cognitive Behavioural Therapy) and EMDR offer useful ways to work on the problems of OCD. CBT is one of the NICE (National Institute for Clinical Excellence)-recommended treatments. It helps to understand why the problem happens, to be able to have a different attitude towards thoughts, and to change behaviour. EMDR works on processing the difficult emotional material that may underlie OCD and the anxiety that maintains it.
