Obsessive Compulsive Disorder (OCD) – a short guide

Contents:

• What is obsessive-compulsive disorder?
• How widespread is it?
• What causes it and who can develop it?
• Types of OCD
• Treatment
• What should I do if I have symptoms?
• Self-help tips
• Guide for loved ones: what should I do if someone I love might have OCD?

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What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a mental health condition characterised by the presence of obsessions and compulsions that interfere with all aspects of the diagnosed person’s life.

Obsessions are thoughts, images or impulses that are intrusive, unwanted (contrary to the affected person’s values) and uncontrollable, causing distress. Compulsions are mental acts or repetitive behaviours (rituals) performed in order to lessen or prevent the anxiety caused by obsessions. These components form a vicious circle in which the person is trapped, from which escape is difficult (but possible with treatment):

Most people experience irrational thoughts at some point, but unlike them, people with OCD cannot simply ignore such thoughts. This only makes them more frequent and, over time, can affect a person’s social and professional life.

The shame caused by obsessions and compulsions makes it difficult to seek professional help (it has been estimated that it takes an average of 12 years after the first symptoms appear for someone to seek help [1]). However, it is extremely important to understand that these symptoms are nothing more than signs of a treatable condition.

How widespread is it?

OCD has an average global prevalence of 2%. [2] In Romania, it is estimated that 0.6% of people (approximately 120,000 currently) live with OCD, but this value may be underestimated [3]. The age of onset is generally from adolescence up to 25 years old, but it can also appear before the age of 14 (in 1 out of 4 cases) and after the age of 35 (in very rare cases). Both genders can be affected, but onset is on average earlier in men, and they are more prone to blasphemous thoughts, whereas women are more likely to experience worries related to contamination and aggressive thoughts (see section 4). [4]

What causes it and how does it appear?

The causes of OCD are not fully understood, but several studies suggest the contribution of a genetic component and structural differences at the cerebral level.

Also, environmental factors and stressful events can contribute to the onset or even the worsening of obsessive-compulsive disorder symptoms. For example, OCD can appear in vulnerable individuals following an event with a strong impact on how the person understands the world and perceives their responsibility in avoiding danger. [5]

Another, partially complementary, explanation for the onset of this disorder is the dysregulation of the serotonin system at the cerebral level, suggested by the positive response to antidepressants in certain patients. In some cases, an autoimmune form of OCD can be triggered in children following a streptococcal infection. [6]

Types of OCD

OCD can appear in various forms, among which the most common are:

• Contamination obsessions: people suffering from this form of OCD have excessive worries about spreading germs or about contamination. These worries manifest as a strong aversion to dirt or the presence of infectious agents, accompanied by cleaning compulsions, excessive hand washing, and avoidance of objects and spaces considered contaminated;

© Mikyung Lee

• Perfectionism obsessions: affected individuals have obsessions related to symmetry, alignment, or order. The compulsive component is related to resolving imperfection and includes repeating the same actions in search of a ‘right’ feeling, that everything is ‘in order’;
• Obsessions appearing as repeated doubts: people experience irrational thoughts about potential dangers that may arise as a result of actions not performed ‘perfectly’. The compulsion manifests as repeated checking of these actions (for example, if the door is locked, if the cooker is off);
• Hoarding obsessions: the person finds it difficult to throw away objects that may be insignificant to others, as they fear they will need them in the future;
• Obsessions with religious content: this form of OCD is also known as scrupulosity and manifests through intrusive thoughts related to religion (e.g., blasphemous thoughts, obsessions about the possibility of going to hell) and the person’s morality. Compulsions that appear in this case can be: repeated prayer, seeking reassurance from a priest, pastor, etc., regarding the person’s morality, avoidance of situations/places that may produce the intrusive thought;
• Aggressive thoughts: this category of symptoms is based on the fear of causing harm to someone or oneself. People with such symptoms may have violent thoughts or, for example, intrusive worries about hitting someone with their car or stabbing someone as a result of losing control;
• Obsessions with sexual themes: in this case, there is excessive worry about being a paedophile, rapist, being attracted to a family member, or having other deviant sexual thoughts; or obsessive thoughts about the person’s sexual orientation, especially the fear of feeling attraction to the same gender (which society has labelled as immoral although it is perfectly normal).

It is important to mention that some people experience compulsions only at a mental level, having a form of OCD called Pure O. This form usually manifests through repetitive and prolonged dwelling on obsessive thoughts, ‘turning them over and over’, a process called rumination.

On the other hand, there are also compulsions within the OCD spectrum that are not necessarily accompanied by obsessions or thoughts: excessive skin picking (dermatillomania), excessive nail biting, hair pulling, and other body-focused repetitive behaviours.

In addition to the types mentioned above, some people suffer from relationship-related OCD (e.g., suspicions about a partner), existential or philosophical OCD (e.g., intrusive and anxiety-provoking thoughts about the meaning of life, death, identity, reality, or metaphysics), postpartum OCD (e.g., thoughts about the baby’s safety). You can read more about these OCD subtypes on the “International OCD Foundation” page.

Treatment

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Although obsessive-compulsive disorder is a chronic condition, it has been shown that through the use of effective treatment, symptoms can be considerably reduced, so that the person feels they can gain control over their obsessions and compulsions, and not the other way around.

The treatment method differs from person to person, so it is important for each individual to find the one that suits them best together with a specialist, depending on their needs and the severity of the condition at the start of treatment.

Treatment for OCD may include:

1. Medication: can only be prescribed by a psychiatrist and plays a role in alleviating symptoms experienced in OCD, but most often psychotherapy is also necessary for long-term results. Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), are the first line of pharmacological treatment for OCD. They are effective in most cases, but if no reduction in symptoms is observed, atypical antipsychotics (primarily used in the treatment of schizophrenia) can also be used in combination with antidepressants. Typically, the dose required for treating OCD is higher than that used for depression, but some people are sensitive to side effects even when medication is administered in low doses. Therefore, it is very important to consult a psychiatrist for any medication changes or if there are overly strong side effects.
2. Psychotherapy. In OCD, the main problem is rather the behaviour manifested as a reaction to the inability to tolerate the anxiety generated by obsessive thoughts, and not the thoughts themselves. Therefore, psychotherapy focuses on eliminating these behaviours and acquiring anxiety tolerance. The most effective form of therapy in treating obsessive-compulsive disorder is cognitive-behavioural therapy. Specifically, in treating OCD, exposure and response prevention (ERP) therapy is used, the objective of which is to reduce the anxiety caused by the presence of obsessions, without performing a specific ritual. ERP practice consists of exposure to the anxiety-generating situation, followed by prevention of the usual OCD response (compulsion or avoidance). Exposure is carried out gradually, starting with situations that cause low discomfort, after which the level of anxiety to which the person is exposed is increased. There are also situations where direct exposure cannot be achieved, such as, for example, for obsessions related to a certain illness, in which case the therapist resorts to imaginal exposure, by creating various scenarios that provoke excessive worry.
3. External support: many people suffering from this condition find support in support groups, as these reduce feelings of isolation and offer the opportunity to socialise with people going through the same situation. The family also plays a very important role, because OCD behaviours can affect others, and information on this topic from family members is an essential aspect in this recovery process, to learn how to better manage the situation.
4. Self-help strategies: it is important for the person suffering from this condition to understand their diagnosis as well as possible, to identify their behaviours, and to adopt a plan to manage their symptoms as effectively as possible.

What should I do if I have symptoms?

© Kalapa Clinic

If you believe you are experiencing some of the signs and symptoms of OCD presented above, you should know that it is very important to seek help. The first step in this direction is to consult your GP, who can then give you a referral for an assessment with a psychiatrist. The psychiatrist will establish the diagnosis, and then devise a suitable treatment plan for you. Although it is very tempting to identify with descriptions of OCD found online, avoid self-diagnosing before speaking with a psychiatrist!

In addition to the medication prescribed by the psychiatrist, it is very important to also start a psychotherapy programme to help with compulsive behaviour. The psychiatrist may be able to refer you to a psychologist who offers services covered by CNAS (see here for a list of covered services and a more detailed guide on how to access them).

Self-help tips

It is by no means easy to live with OCD and feel that you cannot control your own thoughts and behaviours. However, in addition to professional help, there are some methods you can apply to better cope with the symptoms:

• Accept your thoughts, without trying to change them or compulsively trying to understand their meaning (mindfulness practice can be helpful in this regard – see also our article);
• Learn to accept uncertainty and gradually reduce the need to seek reassurance from friends, family, or the internet;
• Try to reduce stress: stressful situations worsen OCD symptoms, so it is important to find ways to manage stress. Practice relaxation techniques, such as breathing exercises and grounding in the present moment;
• Make lifestyle changes: ensure you get enough sleep, consume protein-rich foods, and avoid alcohol and drug use;
• Try talking to a family member or friend about how you feel or join a support group.

Guide for loved ones: what should I do if someone I love might have OCD?

In addition to help from a specialist, it is important for a person struggling with such a disorder to also receive support from those around them.

The first step you can take to support someone with OCD is to educate yourself on the subject, to better understand the problem of the person next to you. When it comes to a mental health condition, a crucial aspect is how we express ourselves. Telling someone things like: Stop washing your hands or Just calm down, nothing bad will happen, is not a solution and certainly will not stop the person from performing the compulsive behaviour. We must understand that OCD symptoms are not just a whim, but they are very real and extremely distressing for the person experiencing them.

Furthermore, it is very important not to engage in compulsive behaviours yourself (for example, by offering repeated reassurance or even repeatedly checking things at the request of your loved one). Even if it may seem to help them in the moment, in reality, this only perpetuates the compulsive behaviour.

Instead, offer them support and encourage them to seek specialised help, if they haven’t already. Be empathetic and patient in daily life and, last but not least, take care of your own mental and physical health, to continue being a source of support.

© Shreyaa Krritika Das

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Useful resources in Romanian:

Psychotherapist Gabriel Dinu from GândeșteSănătos.ro: https://www.youtube.com/watch?v=431oPVr2Sm0

Article about OCD: http://carmenileapsiholog.ro/tulburarea-obsesiv-compulsiva/

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Useful resources in English:

+ YouTube Channels or Videos

OCD & Anxiety Mental Health Courses: https://www.youtube.com/channel/UCO7EghiGzi6Wxpia_hRP1lg

OCD & Anxiety Channel: https://www.youtube.com/channel/UC3ClvnrcrC-3wr27fz_HlIQ

Channel of a Certified Peer Support Specialist in OCD: https://www.youtube.com/c/ChrissieHodgesPureOCDAdvocate/videos

TED Talk “OCD – Starving the monster”: https://www.youtube.com/watch?v=AZZIxyY23IA

TED-Ed “Debunking the myths of OCD”: https://www.ted.com/talks/dr_natascha_m_santos_debunking_the_myths_of_ocd/transcript?language=ro

+ Instagram

Instagram page of an OCD-specialised psychotherapist: https://www.instagram.com/obsessivelyeverafter/

+ Books

Bruce M.Hyman, Cherlene Pedrick (2010). OCD Workbook:Your Guide to Breaking Free from Obsessive Compulsive Disorder.New Harbinger Publications; 3rd edition. Link: https://www.pdfdrive.com/the-ocd-workbook-your-guide-to-breaking-free-from-obsessive-compulsive-disorder-e157834125.html

Dr. Simon Enright, Managing Obsessive Compulsive-Disorder. Department of Clinical Psychology Berkshire Healthcare NHS. Link: https://cypf.berkshirehealthcare.nhs.uk/media/168487/managing-ocd.pdf

Eliza Burroughs, M.C., R.P et al. (2015). Obsessive-Compulsive Disorders,A Handbook for Patients and Families. Link: https://sunnybrook.ca/uploads/1/departments/psychiatry/ocd-information-guide-2015.pdf

Jon Hershfield & Tom Corboy (2013). The Mindfulness Workbook for OCD – A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy. Link: https://www.pdfdrive.com/the-mindfulness-workbook-for-ocd-a-guide-to-overcoming-obsessions-and-compulsions-using-mindfulness-and-cognitive-behavioral-therapy-e158206308.html

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Bibliography:

1. OCD Action: OCD In Brief. Link: https://ocdaction.org.uk/learn-about-ocd/ocd-in-brief/

2. Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: a world view. J Clin Psychiatry. 1997;58 Suppl 12:7-10. Link: ttps://www.psychiatrist.com/wp-content/uploads/2021/02/13305_epidemiology-obsessive-compulsive-disorder-world-view.pdf

3. Florescu et al., The Romanian Mental Health Study: main aspects of lifetime prevalence and service use of DSM‐IV disorders. Manag Health 2009;3:22–30. Link: http://journal.managementinhealth.com/index.php/rms/article/viewFile/30/104

4. Torresan RC, Ramos-Cerqueira AT, Shavitt RG, do Rosário MC, de Mathis MA, Miguel EC, Torres AR. Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder. Psychiatry Res. 2013 Sep 30;209(2):186-95. doi: 10.1016/j.psychres.2012.12.006.

5. https://www.lidiastoica.ro/tulburarea-obsesiv-compulsiva/

6. Factsheet about PANDAS: https://iocdf.org/wp-content/uploads/2014/10/PANDAS-Fact-Sheet.pd