What is obsessive compulsive disorder?
Obsessive compulsive disorder (OCD) is an anxiety disorder, in which individuals suffer from repetitive alarming and intrusive thoughts. These thoughts are accompanied by intense discomfort. Which, in turn compels them to carry out compulsive acts, in order to ward off the anxiety created by the thoughts.
OCD must be distinguished from simple obsessions that do not lead to compulsive actions. Such as intrusive thoughts about losing one’s memory, harming others, or jumping from a roof-top.
Not all compulsive behaviours are evidence of OCD. For example, perfectionism in carrying out tasks is fairly common, and where not taken to extremes, is not a matter for treatment. The same applies to repetitive habits, such as elaborate bedtime routines or preparing food every day from the exact same recipe.
Around 1.2% of the population will suffer from OCD at some time in their lives, with most of these developing the problem in adolescence. Women are three times more likely to have the disorder than men.
In advanced cases sufferers find their compulsions so time-consuming that it takes over most of their waking hours.
‘OCD’ has become an over-used term to describe people with obsessional traits (even mild ones). As when we say ‘He is so OCD‘ when referring to someone who is fussy about his appearance. Clinically, the disorder is much more serious than that; it usually entails severe disruptions to work, social life and personal relationships.
Types of obsessive compulsive disorder
There are four main styles of obsessive compulsive disorder: checking, cleaning, hoarding and ritual performances.
Checking
This is the most common type of obsessive compulsive disorder. In it the person feels compelled to check items over and over again to ward off threat. The classic anxious thought here is: If I don’t do this right I won’t be safe.
Compulsions include: checking locks on windows and doors; domestic appliances (e.g. taps, washing machines and ovens); alarm clocks and documents Additionally, checking the body for signs of illness.
Cleaning
Example thought: If I don’t do this I will catch a disease.
Compulsions: cleaning the house; hand-washing; tooth-brushing; spraying articles; wiping telephones; laundering clothes. The obsession may result in avoiding places where crowds gather.
Hoarding
Obsessive thought: If I don’t do this I won’t have everything I need.
Compulsions: buying food and other domestic provisions; collecting clothes, gadgets and emergency supplies. Reluctance to let go of useless items.
Rituals
Obsessive thought: If I don’t do this something bad will happen.
Compulsions: taking a fixed number of steps in the street; repeating numbers and words; ritualistic body movements; repetitive prayers.
What is the cause of obsessive compulsive disorder?
Research indicates that OCD is at least 45% heritable in adolescents with the condition. However, it is not clear how much of this is genetic, and how much founded on modelling adults in the family. It is likely that one reinforces the other. Thus a child born with a disposition to obsessive thought finds relief in performing compulsions observed in others to soothe the underlying anxiety. It may be that anxiety is genetically inherited, while obsessive-compulsive responses develop later in order to cope with it.
The fact that most cases of OCD emerge in teenage years suggests that the disorder is both genetic and learned.
In a small number of cases OCD develops following post-traumatic stress disorder. As when people suffer a domestic disaster (fire, explosion or break-in) and obsess over it happening again.
Treatment for obsessive compulsive disorder
Standard therapy for OCD comprises four elements: thought management, calming techniques, exposure therapy and desensitisation.
Thought management
Since obsessional thoughts are at the root of the disorder, learning how to over-ride them is key to success. This can be accomplished using techniques from Cognitive-Behaviour therapy (CBT) or Acceptance & Commitment therapy (ACT). See this series of four articles here for information on how to unlock obsessional thoughts using the four principles of reframing, dismissing, disengaging and refocusing.
For information on using the acceptance and commitment approach to defuse from thoughts see this article here.
Calming techniques
These techniques address the underlying anxiety that fuels the disorder, and include relaxation procedures, breathing techniques, mindfulness and hypnosis.
Exposure therapy
The third step is to develop a plan in which the client desists from acting on the obsession through performing compulsive acts. For example, a person with a hand-washing compulsion gradually increases the amount of time that elapses from first having the thought they might catch a disease to washing their hands. First to one minute, then two, then three minutes, and so on. Typically the client instead focuses on some other behaviour that is either calming or distracting. This could include mindfulness, a breathing technique, or a rewarding activity such as giving themselves a small treat.
Through gradual exposure the client learns to tolerate the discomfort that comes with not performing the compulsion. This desensitises them to their alarming thoughts over what might happen next.
