Obsessive Compulsive Disorder
is Obsessive-Compulsive Disorder?
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.
symptoms can also occur in some cases of Depression and Anorexia
are the symptoms?
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?
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?
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.