OCD: From Symptoms To Treatment

You might joke about having OCD tendencies but in actual fact, it’s a real disorder and comes down to far more than having a clear kitchen table or racks of organised shoes. To find out more – including the ways to treat it – we asked two of the country’s leading OCD experts to answer some key questions.
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First, what is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition characterised by excessive unwanted thoughts and subsequent compulsions, explains mental health and addiction recovery specialist Ray Sadoun. “In other words, patients with OCD obsess over a particular thought and then act out based on that thought. They may also practise avoidance to deal with certain thoughts. For example, they may have the recurring thought that they will die if they drive on the motorway, and so they always avoid the motorway.”

Forget perfectionism or being neat and tidy, as India Haylor, head therapist at OCD Excellence, explains – OCD can be a crippling disorder which results in a host of difficult behaviours: “OCD causes intrusive, repetitive thoughts that cause intense anxiety (obsessions) and the urge to do something to relieve that anxiety (compulsions).”

What are some of the main symptoms to look out for?

As OCD involves obsessions and compulsions, the symptoms can be separated into these two sections, says Ray. “First, obsession-related symptoms: having recurring thoughts on a regular basis, having unwanted thoughts, believing cleanliness will solve your problems, needing to be on time for everything, questioning yourself all the time, and fantasising about harming yourself or others. Meanwhile, compulsion-related symptoms include keeping your house extremely clean at all times, doing safety checks over and over again before leaving the house, excessive hand washing, avoiding going out, and repeating phrases to yourself. Obsessions usually have a theme, explains India, so some key symptoms to look out for are:

  • Extreme fear of germs or dirt

  • Fear of hurting yourself or someone else

  • All-consuming, disabling need for perfection, e.g. keeping environment tidy, appearance, etc.

  • Intensely heightened awareness of bodily functions such as breathing, blinking, and your heartbeat, etc.

  • Overwhelming health anxiety, e.g. brain tumour, heart disease, etc.

  • Taboo sexual thoughts that cause huge amounts of distress

  • Intense uncertainty regarding sexuality, e.g. straight people worrying they are gay, gay people worrying they are straight, etc.

  • Blasphemous thoughts that are against your religious beliefs

What are some of the main risk factors?

“We aren’t yet entirely clear regarding the exact risk factors for OCD,” admits India. “The eventual answer is likely to be a combination of biological, social and psychological factors. It is already established that some cases of childhood onset of OCD are triggered by an auto-immune response to streptococcal infections (PANDAS). Other factors may include co-existing disorders and trauma.”

Is it different to perfectionism?

OCD and perfectionism may influence one another, but they are not the same and can exist independently, explains India. “Perfectionism is a personality trait that causes a need for things to be 100% flawless. This can exist in many OCD compulsions, but perfectionists are not usually completely debilitated by this trait. A person with OCD however, would likely struggle to go about their day if a ritual, such as checking the stove is switched off, is not performed perfectly.”

Ray adds: “OCD is not the same as being a neat freak. When you have OCD, you don’t like your compulsive behaviour. You don’t necessarily keep everything clean because you prefer it that way, but because you fear something bad will happen if you don’t. Neat freaks do not experience extreme distress if something is out of place, unlike some people with OCD. Though people with OCD are more likely to be perfectionists, not every perfectionist has OCD. The main difference is stress-related; OCD destroys people’s lives, whereas perfectionism is much more minor.”

Is it genetic?

In short, yes, OCD can be inherited. “The brain structure of people with OCD is different to that of a neurotypical brain structure,” explains Ray. “However, OCD is also partly linked to one’s environment, too. But if you have a family member with OCD, you are more likely to develop the condition yourself. The same can be said for having other mental health conditions – people with depression, anxiety or ADHD are more likely to experience OCD.”

Do lots of people incorrectly refer to themselves as OCD? 

Many people are not aware of the severity of OCD, so they believe it’s acceptable to light-heartedly refer to themselves as having the disorder, warns Ray. “This is incredibly unhelpful as it downplays the disorder and makes sufferers feel as though they are exaggerating their distress.”

According to India, increased awareness of OCD in the popular media may be to blame for the widespread, inappropriate use of the term ‘OCD’.  “It seems to be used interchangeably with ‘perfection’ and ‘attention to detail’,” she says. “Movies such as As Good As It Gets and the US TV series Monk have portrayed OCD in a comedic setting with the ultimate outcome that OCD has been trivialised in the media and associated with cleaning, neatness and order which is wholly unrepresentative of the full spectrum of symptoms and presentations, which are often dark and distressing.”

On that note, it seems more and more people are being diagnosed with OCD – why? 

“The more people are educated about mental health conditions, the more likely they are to identify symptoms in themselves,” says Ray. “People are learning about the reality of OCD rather than the stereotypes, and they are finding that they relate to the common symptoms. Most people go to their GP and request to be assessed for OCD. The GP will ask you questions and potentially provide you with a questionnaire to fill out. They may refer you to a psychiatrist to get an official diagnosis.”

“This may not be due to an increased prevalence but is more likely a reflection of increased public and clinical awareness and improved diagnostics,” posits India. “Assessments are the first step. At OCD Excellence, we start with 50-minute assessments to give us an indication of whether OCD is present and its severity. As OCD can manifest in countless different ways, we also identify the primary and secondary sub-types before making a treatment proposal.”

OCD causes intrusive, repetitive thoughts that cause intense anxiety (obsessions) and the urge to do something to relieve that anxiety (compulsions).
India Haylor

Is there a particular age group which tends to be more susceptible?

Young people are more likely to suffer with OCD. “Diagnoses are common in teenage years, as this is when young people begin to gain more independence and accept more responsibility,” says Ray. “Symptoms are more likely to show at this stage because the young adult is learning how to interact in the world.” India adds: “Older teens and young adults are the most likely age group to develop OCD, but it’s important to know it can appear at any time.”

At what point would you describe OCD as a problem?

There is an OCD spectrum, so some people will suffer less than others. “OCD becomes a problem when it affects the daily life of the individual, causing them to experience intrusive thoughts and carry out compulsions regularly,” says Ray. In short, the experts will tell you OCD is a problem when it starts to impact and impair a person’s daily life. “In our experience, the severity of OCD varies directly with a person’s ability to manipulate their life around OCD and often, the people in their lives,” explains India. “In other words, if a person gives up work to focus on OCD, their OCD is likely to become severe. Similarly, if a parent of a child with OCD becomes heavily involved in collusion and reassurance, the child’s OCD is likely to deteriorate significantly.”

What are some ways to treat it?

Both Ray and India agree the best way to treat OCD is through therapy. “Therapists will provide OCD patients with coping mechanisms, such as relaxation techniques, journaling and thought-stopping. It can also be helpful to attend OCD support groups, as this reduces the stigma surrounding the disorder and allows the patient to learn how others cope with their symptoms,” adds Ray.

Seeing as most mental health treatments in the UK are required to be scientifically evidence-based, as yet the only evidence-based treatment for OCD is cognitive behaviour therapy (CBT). “At OCD Excellence, we have a protocol developed over 18 years which is CBT-based and supplemented with Acceptance Commitment Therapy (ACT),” explains India. “Any effective OCD treatment programme will require a particular focus on behaviour work due to the habitual and ritualistic nature of OCD compulsions.”

Is possible to self-treat with different exercises or techniques?

“OCD is notoriously difficult to self-treat,” warns India. “There can be so many different sub-types of OCD which co-exist together, and OCD can morph and change at a moment’s notice. In other words, a person may get on top of a particular set of symptoms and then another set of symptoms that can seem entirely unrelated will appear.” What’s needed, she says, is a combination of robust behaviour work (tackling the compulsions) and cognitive work (to address the obsessions and thought patterns), which can be tough for a person to try at home. “Getting educated about OCD is a good place to start,” adds India. “There are some books that make suggestions for tasks and exercises to try at home but in most cases, it’s best tackled with the support of a therapist.”

“If you are experiencing OCD in a minor way, I would recommend purchasing David Burns’ book on CBT called Feeling Good,” says Ray. “It is not specific to OCD, but it provides you with excellent skills to keep your mental health on track. Burns teaches you how to challenge your thoughts and replace them with logical alternatives, something that is incredibly important when you experience intrusive thoughts.”

So, at what point would you recommend seeing a professional? 

“We always recommend seeing a professional as soon as life starts to become more difficult due to OCD,” says India. “Sadly, many people will suffer for a long time before seeking help. The lead time between onset of OCD and seeking help used to be 11 years. While this has improved somewhat, there is still a long way to go.”

“I agree. Seek professional help when OCD is causing you stress,” says Ray. “Overthinking once in a while is natural, but you do not have to put up with unpleasant recurrent thoughts on your own. Even if you believe your OCD is minor, it’s better to see a professional before it gets worse. They will provide you with essential coping skills for managing OCD, which involves recognising the absurdity of your thoughts and finding the strength to avoid compulsions. They will also validate your experiences with OCD so that you realise you are a victim of the disorder, and it is not your fault that you are suffering.”

Any other helpful resources you could recommend in the meantime?

“I would highly recommend the YouTube video ‘Real Talk – Living with OCD’ by Rose and Rosie,” suggests Ray. “It’s a real-life account of an influencer who battles OCD, so you will learn about the symptoms of OCD and the ways it can manifest in different people. Ultimately, listening to other people’s experiences is a great way to remind yourself that you are not alone.”
 

For more information follow @OCDExcellence on Instagram or visit OKRehab.org

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