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Obsessive Compulsive DisorderThe Psychology Service
Obsessive Compulsive Disorder

What is Obsessive-Compulsive Disorder?

The two main aspects of OCD are that the person suffers an “obsession” i.e. a fear that some harm will result if they do not engage in a particular behaviour in a particular way, or a particular number of times, the “compulsion”. The compulsion can also be a thought, for example having to mentally recite a special form of words. At the mild end of the spectrum OCD can shade into normal behaviour, such as being very careful in attending to home security or personal hygiene. There are also numerous examples of superstitions such as “touching wood” or avoiding walking under ladders, which are common in most cultures. In OCD, however, the person struggles with the obsession, and with their need to carry out the compulsive behaviour, knowing both to be illogical or excessive.

Obsessive-compulsive symptoms can also occur in some cases of Depression and Anorexia Nervosa.

What are the symptoms?

In milder cases of OCD, the disorder may be confined to a narrow range of behaviours, and does not interfere unduly with the person’s daily life. In more severe cases, however the person can spend hours trying to complete a simple task such as washing their hands, and they can wash so excessively that their hands become raw and inflamed. The compulsion is accompanied by considerable anxiety, which paradoxically does not necessarily reduce as the compulsive behaviour is carried out, but commonly actually increases. They struggle to resist the need to carry out the compulsive behaviour, but will usually succumb. The anxiety will often lead to avoidance of situations which tend to trigger the obsession, and in severe cases the person can become virtually housebound. Unfortunately, succumbing to the need to carry out the compulsive behaviour and avoidance of triggering situations both have the effect of exacerbating and prolonging the disorder.

How long does it last?

OCD usually begins in adolescence or early adulthood, but can also begin in childhood. It mostly runs a chronic fluctuating course with episodes, commonly at times of stress, where it becomes more severe, but with some symptoms always present. In a minority of cases, however, the person is symptom-free between episodes.

What is the treatment?

The treatment of choice is CBT, usually in combination with anti-depressant medication. Specific techniques include “exposure and response prevention” i.e. repeatedly practising exposure to the triggers for the obsession, while deliberately resisting the compulsion. Cognitive techniques have also been used to good effect in challenging the obessional thoughts. In very severe cases the person may be admitted to a specialist CBT based inpatient programme for the initial stages of their treatment.

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