Help for obsessive-compulsive disorder (OCD)

What are obsessions?

Individuals with OCD experience recurrent and persistent:

• Thoughts
• Urges
• Impulses

That are experienced as:

• Intrusive and
• Unwanted

And in most people causes significant anxiety or distress. With OCD the individual attempts to ignore or suppress such thoughts, urges, or impulses or to neutralise them with some other thought or action (performing a compulsion). A common misunderstanding about OCD is that the compulsion has to be an action, but it is important to know that the compulsion can take the form of thought compulsions.

What are compulsions?

Compulsions are defined as:

1. Repetitive behaviours, such as:

• Hand washing
• Ordering
• Checking

1. Mental acts, such as:

• Praying
• Counting
• Ritualistic ruminating
• Repeating words silently

That the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

The behaviours or mental acts are aimed at:

• Preventing anxiety or distress
• Reducing anxiety or distress
• Or preventing some dreaded event or situation

A key feature is that these behaviours or mental acts are NOT connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive. Children (and sometimes even adults) may not be able to articulate the aims of the behaviours or mental acts, and the symptoms can fluctuate with anxiety and stress

Other Features of OCD

To meet the diagnostic criteria for OCD, the obsessions or compulsions need to be:

• Time consuming eg. More than 1 hour per day
• Or cause significant distress or impact relationships, work, or other important areas of work

To be OCD, the symptoms are not attributable to:

• Drug use
• Medication
• Medical condition
• Or better explained by another mental illness

Obsessive Compulsive Disorder (OCD) vs Obsessive Compulsive Personality Disorder (OCPD)

OCD and OCPD are commonly mistaken but are significantly different.

As detailed above, OCD is defined by:

• Recurrent and persistent thoughts, urges, and impulses that are intrusive and unwanted
• The symptoms cause anxiety and distress
• The symptoms fluctuate with anxiety and with stress

In psychology terms, OCD can be viewed as an ego-dystonic illness, that is, something that is unwanted and the symptoms are as seen as unacceptable to the individual and incompatible with their values or beliefs.

In contrast, OCPD is defined:

• A strong need to always be in control
• While the symptoms do intensify during periods of anxiety or stress, generally the symptoms are consistent over time

While OCPD does cause distress, it is an illness that is ego-syntonic in that the symptoms are often seen as desirable and acceptable to the individual and in line with their values or beliefs. Individuals can meet the diagnostic criteria for both OCD and OCPD, they are not mutually exclusive.

Treatment for OCD

There are a number of effective treatment options for OCD, including Cognitive Behavioural Therapy and Acceptance Commitment Therapy. Medication and Transcranial Magnetic Stimulation (TMS) are also highly effective in treating OCD.

Suggested reading - Brain Lock: Free Yourself from Obsessive Compulsive Behaviour by Jeffrey M. Schwartz

What living with OCD is like

OCD has been the most debilitating illness I have ever lived with, and one that my brain wrestles with on a daily basis.  It’s living in a constant state of instability and fear, checking every move I make or thought I have to prevent something bad from happening, or to feed into the narratives that my mind has created. Trying to stop the unwanted thoughts from creeping in only makes them louder in my head, making it easier to slip into my compulsive checking behaviours to achieve some sort of emotional relief.  Only instead of feeling satisfied, I am left with an even stronger, more solidified version of my intrusive thoughts and checking behaviours that this cycle has fed into.
- K, Brisbane

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