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Obsessive-Compulsive Disorder


What are obsessional problems?

Nearly everyone has occasionally experienced brief runs of repetitive thoughts, urges, or impulses, (like having to check the door is locked several times, or have doubts that they have washed their hands thoroughly enough after handling something dirty). Usually these can be dispelled easily and so cause little discomfort. For some people, however, these kinds of worries really take a hold, and they find that they get stuck in cycles of doing something over and over again, like washing their hands again and again, counting up to a certain number, or checking something several times to be sure they’ve done it right. When these kinds of behaviours become a persistent problem and interfere with the person’s life, it is know as obsessive-compulsive disorder (or OCD for short).


Obsessional problems take many different forms. Some people are bothered by upsetting thoughts which they can’t get rid of however hard they try. Others find that they feel compelled to wash even though they logically know they are clean. Yet others repeatedly check something which has already been checked adequately such as a door, cooker and so on. What all sufferers have in common is that they misinterpret these thoughts as meaning something particularly terrible that they should not ignore.


Here are some of the many concerns OCD sufferers are troubled by:


There are many more examples and even more variations on these themes.


How does it affect people?


When people are troubled by their obsessional problems they experience high levels of discomfort. Sometimes this is anxiety, sometimes it is feeling miserable or depressed, other times it is just a very unpleasant feeling that things are not right.


Obsessional problems can and do take over people’s lives, to the extent that they have little or no time for anything other than a pattern of checking or worrying or washing, or some other compulsive behaviour. It can interfere with your ability to work, it can interfere with personal relationships and almost every aspect of life. Even minor everyday tasks can take up a lot of time. For example, someone who worries about dirt and contamination may find themselves spending hours in the shower in an attempt to become really clean, or the person concerned about burglaries may take long checking doors and windows before leaving the house that they are always late for work.


Quite often, families and carers become caught up with the OCD sufferers concerns. The person may frequently ask for reassurance – did they really lock the door/ wash the milk bottles before putting them in the fridge/ not say anything offensive to the shop assistant – or may even become drawn into having to do things according to OCD rules because to refuse would lead to a lot of distress and anxiety for their loved one.


How common is it?


OCD is a very common problem. In the United Kingdom it is thought to affect 1.2% of all adults. This is thought to be an underestimate, as the disorder is often kept secret or hidden from all but the sufferer. It often creeps up on you – we all get that feeling from time to time that maybe we should just pop back to, for example, check the taps are turned off. But it becomes a problem when you find that you always have to check…perhaps several times over, and even then you don’t feel satisfied that it’s okay. Sufferers often find it embarrassing or distressing to talk about, and feel guilty or ashamed for having, such thoughts and rituals. It often feels as if no-one else has these kinds of difficulties because it’s not usually talked about. However, at the GP’s surgery 2-3% of visiting patients will have OCD.


How is it best treated?


Cognitive-behaviour therapy has been found in research to be a particularly effective treatment for obsessive-compulsive disorder. As described earlier, OCD becomes a problem when we misinterpret intrusive thoughts (which are something that everyone experiences) as meaning something particularly terrible, dangerous or threatening such as an indication that we may be responsible for causing harm to ourselves or other people. Misinterpreting the ‘obsessional’ intrusive thoughts as bad in this way leads to feeling anxious or uncomfortable and (importantly for treatment) to do particular things to put this right in some way. However, these efforts to put the thoughts right (whether it be checking, washing, asking for reassurance or distracting yourself) tends to keep the problem going and keeps you focused on these thoughts in the long run.


Treatment concentrates on at least two things. The first is what the thoughts actually mean to you as they happen. Up to now, it’s likely that you have only been able to see the thoughts in one particular kind of way. During therapy you will be helped to see the thoughts in a different light, to see them as more normal and be helped to understand that just because you’ve had these ideas pop into your head it doesn’t mean you have to do anything about them. This brings us to the second thing treatment will focus on: changing what how you deal with the thoughts/ urges or images when they occur. Whilst we have no control over what comes into our mind, we can choose whether we pay much attention to thoughts or what we do when they occur. The therapist will help you to recognise what kinds of things you are doing that keep the problem going (these things are often referred to as rituals or neutralising behaviours). Together, you can work out some behavioural experiments which are exercises to help you test out and make sense of how the problem really works. Treatment is usually offered over 12 -16 sessions.


Some people also find that antidepressant medication can be helpful, although there is no medication that is specific to OCD.


If you are a sufferer, what can you do?


Self help


When we feel anxious or worried, it often seems that the thing to do is to avoid whatever it is that makes us feel that way. However, this is not the solution to an obsessional problem and will only cause your anxiety and worries to get worse in the long term. Although it’s difficult, try to keep doing normal every day things and don’t allow OCD to take over your life. There are a number of self-help books available which can be useful for hints and tips and encourage you to make the right kinds of changes to begin to overcome these problems. Self-help groups and internet forums can be a good way of getting in touch with other sufferers so you can see that you are not alone. See the list at the end of this leaflet.


How to get help


Treatment is available from therapists on the NHS and privately. You can be referred for treatment via your doctor (GP). Ask your GP if there are local Cognitive Behaviour Therapy or Psychology services. If so, ask to be directly referred if this is possible. It may be that you will need to be referred via your local Community Mental Health Team (CMHT). The therapist should ideally be qualified in behaviour therapy or cognitive behaviour therapy. Accredited private therapists in your local area can be found through the British Association of Behavioural and Cognitive Psychotherapies (www.babcp.com; 0161 797 4484). If your local area does not have the specialist services you require, or you are unable to obtain appropriate treatment locally, your doctor can refer you direct to one of the national OCD services.


I live with someone who suffers from OCD; how best can I help them?


As a friend or family member of someone who is affected by OCD it is important to try to understand their point of view. Their fears are very real, even if by definition they are out of proportion. It is quite likely that you or others in the household have been drawn into some of their rituals; you may be pressured into giving into certain ‘rules’ eg. not being allowed to wear shoes indoors because of fears of contamination with dog mess, or having to go round checking doors and windows before leaving the house even though you don’t think it is necessary. Quite often, you may be asked for repeated reassurance about the sufferer’s concerns. While we always feel we should do our best to help them feel better, this only provides a short-term ‘fix’ and in the longer term just keeps their worries going. Trying to persuade them that that their concerns are unfounded isn’t a good approach – and some things simply cannot be disproved! It can be more helpful to provide a bit of moral support (‘I know this is really difficult for you’) and maybe a bit of a hug so as to encourage them to face up to situations they are finding difficult. And it’s also important to try to encourage them to keep up with all those ordinary everyday things – including time just to relax and do enjoyable stuff!


You can also help by encouraging the person to seek professional help (see above) and maybe go along with them to their doctor.


The need for research


Research on obsessive-compulsive disorder has helped bring the advances in treatment which many sufferers benefit from today. However, not everyone gets better with treatment and so further research is always needed. In addition the availability of these treatments is still somewhat limited. Further research is also needed to investigate how best to teach and train other therapists to provide the best possible treatment.


Opportunities to take part in research are frequently advertised on the Maudsley Centre for Anxiety Disorders and Trauma website (http://psychology.iop.kcl.ac.uk/cadat/general-information/Research-involving-anxiety-sufferers.aspx), as well as those of sufferer-led organisations.


Links, resources, self-help groups


There are a number of self-help books available. Here are a few suggestions:


Overcoming Obsessive Compulsive Disorder - A self-help guide using Cognitive Behavioural Techniques by David Veale & Rob Willson, published by Robinson, London 2005. Extremely useful for those who suffer from OCD and those who care for them.
Obsessive Compulsive Disorder – The Facts (third edition) by Padmal De Silva & Jack Rachman, published by Oxford University Press. Very popular, informative and short book suitable for sufferers, GPs or anyone who wishes to know more about OCD.
The OCD workbook - your guide to breaking free from OCD by Hyman & Pedrick, published by New Harbinger Publications . Recommended by many sufferers. A very practical workbook style approach to overcoming obsessional problems. User friendly, lots of photocopiable worksheets etc.
Stop Obsessing by Edna Foa and Dennis Greenberger, published by Bantam Books. Highly recommended by sufferers, particularly helpful in that it discusses pure obsessional types of OCD and useful techniques.
Understanding Obsessions and Compulsions by Frank Tallis, published by Sheldon Press. Very popular self-help book. Managing Obsessive Compulsive Disorder by David Westbrook and Norma Morrison. Available via www.octc.co.uk A helpful resource for anyone trying to cope without a therapist.


There are a growing number of organisations providing support for sufferers of OCD. The most well known are:


OCD Action
Aberdeen Centre
22-24 Highbury Grove
London N5 2EA
Telephone: 020 7226 4000
http://www.ocdaction.org.uk/


OCD-UK
PO Box 8955
Nottingham
NG10 9AU
Telephone: 0845 120 3778
http://www.ocduk.org/

http://www.nice.org.uk/CG031

Charity No 284286



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