About 2% of the population suffers from OCD at some point in their lives. It is more common than previously thought and has received a lot of attention in the media. These reports are not always correct, the terms "obsession" and "compulsion" being applied to various psychological difficulties such as gambling or overeating which are in fact quite different from OCD. A number of famous people are thought to have suffered from the problem such as Charles Darwin and Florence Nightingale.
What is OCD?
Obsessions are ideas, thoughts, images or impulses that are senseless and "get in the way". They continue even though a person may try to ignore or forget about them.
Obsessional compulsive disorder refers to the combination of these obsessions with fear and guilt, or other unpleasant emotions, which together drive the sufferer to carry out compulsions to try and rid themselves of the worry.
Compulsions, also called rituals, are usually actions that are repeated, but sometimes are thought patterns that are performed to rid oneself of a disturbing obsession. Rituals are usually carried out according to certain rules or in a rigid fashion, and are clearly excessive. The person recognises that the rituals are not reasonable but feels unable to control them. Examples include handwashing, checking, or mentally repeating phrases.
OCD can take many forms. Some people are bothered by thoughts of contamination by germs or chemicals; some are preoccupied by thoughts of causing accidents or injury; others focus on fears about home security and safety.
Effects of OCD
The severity of the problem varies a lot. Obsessional problems can and do take over peoples lives, making regular employment or family life impossible. People find they have little or no time for anything other than a pattern of checking or worrying or washing. When troubled by their OCD people experience high levels of discomfort. Sometimes this is anxiety, sometimes it is feeling miserable or depressed, other times it is just a very unpleasant feeling that things are not right.
Causes
No single cause has been identified for OCD. Research so far has failed to come up with any support for the cause being a chemical imbalance in the brain.
Those who suffer from OCD vary widely in their personality characteristics and life circumstances. There is some research evidence to suggest that certain types of upbringings and family rules may increase the likelihood of OCD.
We also know that the types of thoughts which trouble people suffering from obsessions, occur from time to time in almost everyone. For example, it is extremely common for new parents to have upsetting intrusive thoughts about harming the new baby. Research has shown that it isn't possible to tell the difference between normal intrusive thoughts occurring in people without Obsessional problems and the thoughts experienced by OCD sufferers. What is different is what these thoughts mean to them. A person who doesn't have OCD can see an intrusive thought, however strange, on "just a thought". People experiencing Obsessional problems become upset by the intrusion, and believe it may make them responsible for harm. This then effects what they feel they must do. Sufferers feel they should not ignore the thought but try very hard to "push it away" or else to "put it right" by some other thought or action. Unfortunately both these strategies make the thoughts worse, and so the vicious circle of OCD develops.
Treatment
The most widely accepted form of psychological treatment for OCD is Behaviour Therapy. This takes the form of a structured programme of self re-education. Sufferers have to confront repeatedly what they fear (a process called "exposure") beginning with the easiest situations and progressing through till all the feared items have been faced. At the same time, the persons must not perform any rituals or checks (response prevention). In some programmes rituals are reduced gradually; in others compulsions are prevented altogether. The therapist does not use force, but relies on the persons own motivation to overcome the urge to ritualise. Up to 50% of sufferers can be helped by this method.
A greater understanding of the role of cognitions in OCD has lead to the development of Cognitive Behavioural approach to the problem. This provides sufferers with a new framework for understanding their experiences. Through this they are helped to change what they understand their Obsessional thoughts to mean, and what it is necessary to do about them.
Medication of the type which effects the serotonergergic system has also been proved to be effective for some sufferers. However, since relapse very often occurs when the drugs are stopped, they should probably be combined with psychological treatments, especially for those who are depressed.
