What is OCD?
To the layman Obsessive Compulsive Disorder is either someone who is a bit anal of cleaning and tidying their house, or someone who washes their hands a lot. For sufferers of this condition it’s something very different.
OCD is a severe anxiety disorder which can express itself in behaviours that can include constant cleaning, frequent checking that the gas is off, that the doors are locked, counting and regularly washing hands. These actions are actually relieving the individual from great stress. Uncontrollable and unescapable, horrible thoughts will constantly be plaguing the minds of those suffering from OCD. Often these thoughts are something catastrophic and the only way they can prevent this awful thing from happening to them or their loved ones is to perform their routines. By completing their routines they believe they’re protecting others and even for a brief moment that anxiety that comes with those thoughts is taken away. Usually, this doesn’t last that long.
It effects 1.2% of the population and it hits all ages, genders and backgrounds. It is so severe that the World Health Organisation (WHO) ranks OCD in the top 10 of the most disabling /debilitating illnesses of any kind, in terms of lost earnings and diminished quality of life.
There are 2 parts to OCD – Obsessions & Compulsions.
Obsessions are the repetitive thoughts that invade the mind. They’re not just extreme worries, but are products of that individual’s mind and they often try to supress them.
Compulsions are the responses to these thoughts, rituals, routines, mental acts (like counting) that relieve the stress or even prevent the disaster they’re worried about from happening.
Like many other mental health issues, sufferers of OCD need understanding. For them their arguments for doing what they’re doing are perfectly logical, to them they make sense and other people’s arguments for not performing those actions (like not taking their shoes off in their house) is just as alien to the sufferer as the action is to those who don’t have OCD.
OCD can be both mentally and physcially exhausting. Those suffering have to contantly mentally fight against the intruding negative thoughts and trying not to conduct their compulsions, whilst physically having to do them, some of which in extreme cases can take hours. This can make things even worse, as a tired mind is more susceptible to negative thoughts, and weaker so more prone to giving in.
OCD doesn’t mean that someone is constantly cleaning or washing or counting or checking. There is a spectrum of severity with this disorder just as there is for all mental health issues. Several people can live relatively normal lives, by trying to avoid the situation that would cause those negative thoughts in the first place. Eg – if someone becomes anxious about the dirt and germs that can spread from shoes that they’ve picked up in the street, and that this may cause terrible illness, then one way they can avoid this is not to permit people to where their outside shoes inside. This obviously requires a lot of understanding and willingness to help from those they share the house with.
What causes OCD?
3 current theories as to what causes OCD:
1) Psychodynamic Theory
2) Cognitive-Behavioural Theory
3) Biomedical Theory
Here we will look at 2) & 3)
The Cognitive-Behavioural Theory suggests that everyone gets obsessive thoughts at times, but have the ability to distract themselves easily from this , but those with OCD do not have the same ability. They also will find the intruding thoughts make them anxious and this reduces their strength to ignore the thoughts. Temporary relief is obtained by a certain pattern of behaviour and this becomes a compulsive ritual. Despite bringing relief these rituals also proudcue a stronger tendency to carry them out. The reduction in anxiety acts as a reinforcer.
The Biomedical Theory has at its core that OCD is an illness of the brain concluded from evidence from neurological signs, brain scans, drug effects and the primitive content of obsessions and compulsions. Brain scans, for example, show that there is high activity in the ‘cortical-striatal-thalamic circuit’ (made up of the caudate nucleus, the orbito-frontal cortex and the cingulate cortex). This is the area of the brain that is responsible for filtering out irrelevant information and perseveration of behaviour. They also argue that the focus of OCD tends to be very restricted – mainly on germs and violence, showing itself as washing and checking. Their argument goes back to evolution where these two things were important and have stayed in our brains, but have just gone too far in those with OCD.
How is OCD treated?
Each of the models have their own treatment.
The pscyhodynamic theory has psychoanalytic therapy where they try and help the patient understand the underflying conflict by releasing their repressions.
The behavioural model has 3 techniques it tries to use – response prevention, flooding and modelling. These can help with the compulsions, but don’t tend to help with the invading thoughts.
The biomedical model uses drugs to help such as Clomipramine, which is an antidepressant which acts as a serotonin reuptake inhibitor. It helps obsessions fade and compulsions are more easily resisted. However, all drugs have various side-effects and don’t work on everyone.
So far there is no cure for OCD, though a combination of the above treatments do help. What is important that if you know someone who suffers from OCD is to be informed of what they are going through, what their trigger points are and be patient. It can be difficult to live with them, their compulsive behaviour can be annoying, but it is also annoying and exhausting for them. Getting annoyed or angry can just increase stress levels and make it worse for all concerned. Reassure them that you understand and ask them how you can help.