Understanding Obsessive-Compulsive Disorder (OCD)

Image of upset child

Obsessive–Compulsive Disorder (OCD) is a serious anxiety-related condition where a person experiences frequent intrusive and unwelcome obsessional thoughts, often followed by repetitive compulsions, impulses or urges.

The illness affects as many as 12 in every 1000 people (1.2% of the population) from young children to adults, regardless of gender or social or cultural background. In fact, it can be so debilitating and disabling that the World Health Organisation (WHO) once ranked OCD in the top ten of the most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life.

Based on current estimates for the UK population, there are potentially around 741,504 people living with OCD at any one time.   But it is worth noting that a disproportionately high number, 50% of all these cases, will fall into the severe category, with less than a quarter being classed as mild cases.

OCD presents itself in many guises, and certainly goes far beyond the common perception that OCD is merely hand washing or checking light switches. In general, OCD sufferers experience obsessions which take the form of persistent and uncontrollable thoughts, images, impulses, worries, fears or doubts. They are often intrusive, unwanted, disturbing, significantly interfere with the ability to function on a day-to-day basis as they are incredibly difficult to ignore. People with OCD often realise that their obsessional thoughts are irrational, but they believe the only way to relieve the anxiety caused by them is to perform compulsive behaviours, often to prevent perceived harm happening to themselves or, more often than not, to a loved one.

Compulsions are repetitive physical behaviours and actions or mental thought rituals that are performed over and over again in an attempt to relieve the anxiety caused by the obsessional thoughts.  Avoidance of places or situations to prevent triggering these obsessive thoughts is also considered to be a compulsion. But unfortunately, any relief that the compulsive behaviours provide is only temporary and short lived, and often reinforces the original obsession, creating a gradual worsening cycle of the OCD.

It has traditionally been considered that there are four main categories of OCD. Although there are numerous forms of the illness within each category, typically a person’s OCD will fall into one of the four main categories:

  • Checking
  • Contamination / Mental Contamination
  • Hoarding
  • Ruminations / Intrusive Thoughts

For many people with OCD there is often an overinflated sense of responsibility to prevent harm and an over-estimation about the perceived threat that an intrusive thought signifies. It is these factors that help drive the compulsive behaviours, because the person with OCD often feels ultimately responsible for trying to prevent bad things happening.

To some degree OCD-type symptoms are probably experienced, at one time or another, by most people, especially in times of stress where they have succumbed to the seemingly nonsensical need to perform an odd and often unrelated behaviour pattern. However, OCD itself can have a totally devastating impact on a person’s entire life, from education, work and career enhancementto social life and personal relationships.

The key difference that segregates little quirks, often referred to by people as being ‘a bit OCD’, from the actual disorder is when the distressing and unwanted experience of obsessions and compulsions impacts to a significant level upon a person’s everyday functioning – this represents a principal component in the clinical diagnosis of Obsessive–Compulsive Disorder

OCD is diagnosed when the obsessions and compulsions:

  • Consume excessive amounts of time (approximately an hour or more)
  • Cause significant distress and anguish
  •  Interfere with daily functioning at home, school or work, including social activities and family life and relationships.

OCD affects males and females equally, and on average begins to affect people during late adolescence for men and during their early twenties for women.

Sufferers often go undiagnosed for many years, partly because of a lack of understanding of the condition by the individual themself and amongst health professionals, and partly because of the intense feelings of embarrassment, guilt and sometimes even shame associated with what is often called the ‘secret illness’. This often leads to delays in diagnosis of the illness and delays in treatment, with a person often waiting an average of 10–15 years between symptoms developing and seeking treatment.

To sufferers and non-sufferers alike, the thoughts and fears related to OCD can often seem profoundly shocking. It must be stressed, however, that they are just thoughts – not fantasies or impulses which will be acted upon.

For someone with OCD, their logical mind always remains functioning, even if their OCD mind is spiralling out of control. Most people with OCD know that their thoughts and behaviour are irrational and senseless, but feel completely incapable of stopping them, often from fear that not completing a particular behaviour will cause harm to a loved one.  No matter how small the risk, the person with OCD will always feel responsible for preventing that bad event from happening.

OCD can also be a chameleon.  For some people the OCD symptoms will remain unchanged, but for others it is not unusual that over time there may be changes to the type of OCD that becomes bothersome. Equally, it is not unusual for symptoms to wax and wane over time if untreated and become a little like a rollercoaster, with the severity increasing during times of stress, perhaps at work, university or within relationships, for example.

Doubt is another characteristic of the OCD sufferer – the French once called OCD ‘la folie de doute’ which translates to ‘the doubting disease’. Doubt is one of the emotions that feeds most obsessive and compulsive behaviour and it is this inability to live with doubt and uncertainty that drives OCD. People with OCD prefer black or white answers for their OCD, rather than being able to accept shades of grey.

Left unchecked and untreated, OCD will mushroom and feed upon itself and can have the power to consume if left unchallenged.

Receiving appropriate treatment, the highest quality standards of care and support and sticking to the treatment plan is the key to long term recovery. 

OCD is indeed a chronic, but also a very treatable medical condition. Most people can learn to stop performing their compulsive rituals and to decrease the intensity of their obsessional thoughts through Cognitive Behavioural Therapy (CBT).  CBT is a form of talking therapy that focuses on the problems a person has in the here and now and helps them explore and understand alternative ways of thinking (the cognitive approach) and to challenge their beliefs through behavioural exercises.

In many cases, CBT alone is highly effective in treating OCD, but for some people a combination of CBT and medication can be effective. Medication may reduce the anxiety enough for a person to start, and eventually succeed in therapy.

Just as a person with some types of diabetes can learn to manage the disease by changing their diet and exercise habits, a person with OCD can learn to manage symptoms so that they won’t interfere with daily functioning.  This allows them to regain a much improved quality of life, but it is also possible, with the right support and treatment to achieve a complete recovery from OCD.

Fortunately, the medical profession is slowly starting to understand and identify OCD symptoms much more effectively, resulting in an improvement in treatment; however, it does still depend on which part of the country you may live in. But, in general, through charities like OCD-UK which help to raise awareness and lobby for improvements in improved access to treatment, the prognosis for people who suffer with OCD is much more hopeful than ever before.

We have produced this guide to help you understand OCD better and, more importantly, how to treat it, and to offer belief and hope that recovery from Obsessive–Compulsive Disorder is possible.


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