OBSESSIVE COMPULSIVE DISORDER (OCD)Obsessive Compulsive Disorder is an anxiety disorder characterised by unwanted, intrusive thoughts (called obsessions) and behavioural or mental rituals (called compulsions).What are obsessions? What are obsessions?Obsessions are thoughts, images or impulses which come into your head no-matter how hard you try to block them out. They are always about something dangerous or upsetting and they make you feel anxious, guilty or scared in case the thought is true. Examples include thoughts like "did I turn off the stove?" (maybe the house will burn down), or "my hands are contaminated" (I might get sick). Obsessions can also be images of frightening or upsetting things, like stabbing someone or running someone over, or they may be urges to do something you don't want to do. Obsessions are always disturbing and unpleasant because they focus on things which are important to you and which you don't want to be true. Most people try to cope with their obsessions by reassuring themselves that the thought is not true or by doing something to lessen the risk of danger (e.g. checking the stove, washing your hands).
What are compulsions?Compulsions can be anything you do in response to an obsession in order to prevent it from coming true or to take away the fear created by your intrusive thoughts. They can be visible behaviours, like checking or washing, or they can be things you do in your mind that no-one can see, like praying, counting, or repeating words silently. Compulsions are also called "rituals" because most people feel like they have to do them in a very precise way, and they cannot rest until they've been done properly. So instead of performing compulsions just once, people with OCD repeat these behaviours over and over until they are satisfied that danger has been averted, or until the anxiety and distress is reduced. COMMON OBSESSION AND COMPULSION PAIRINGS:Sometimes there will be an obvious connection between the obsession and the compulsion (e.g. contamination and washing), but in other cases the connection may be more personal, depending on the individual's beliefs and superstitions (e.g. counting to a certain number to avoid harm befalling a loved one). Some examples of common symptom pairings are given below. Contamination obsessions and washing ritualsThese obsessions typically occur in situations where the OCD sufferer
comes into contact with objects that may have been touched by other people
(e.g. toilets, phones, money, groceries, letters, etc). The particular
concern varies from person to person but may involve a fear of contamination
with germs, dirt, faeces, saliva, dust mites, asbestos or HIV, to name
a few. Contact with potentially "contaminated" items is generally avoided
because it causes anxiety, but if contact occurs most OCD sufferers will
wash and clean excessively in order to get some relief from their anxiety
and reduce the possibility of danger. Washing rituals can also be associated
with obsessional doubts that pieces of glass or poisons may have gotten
onto crockery or into food. Pathological doubts and checking compulsions Checking compulsions most commonly arise in the context of leaving the
house when no one else is home, or when going to bed for the night. At
these times the individual is tormented with recurring doubts that doors
and windows may not be locked and appliances may not be switched off,
and as a consequence they fear that there may be a burglary or a fire.
Unlike others who are satisfied by one quick glance, the OCD sufferer
will have to check over and over again in order to be satisfied that everything
is safe. Other obsessions about harm frequently linked to checking rituals
include: ·
Magical thoughts and neutralising ritualsThese symptoms typically involve an intrusive thought or image of a loved
one being harmed. If this thought intrudes into the person's mind while
they are performing some activity (e.g. walking through a door), then
the person may have a compulsion to go back through the door again whilst
thinking to themselves that their loved one will be safe. This is called
mental 'neutralising' or 'undoing', as the unpleasant thought is reversed
and replaced with a good thought. These symptoms may be associated with
a wide variety of everyday activities, including dressing, eating, drinking,
reading, sitting and walking. Violent thoughts and associated ritualsIn these cases the person experiences unwanted images or thoughts of harming themselves or others. Common examples include violent images involving family or doubts that you may be responsible for hurting strangers as you pass them by. These obsessions are terrifying and result in a variety of complex avoidance and reassurance rituals. Many people with OCD end up locking sharp objects away out of sight and respond to the thoughts by checking that no-one is hurt and telling themselves that they could never do such a thing. Since the thoughts are completely inconsistent with the person's true values and beliefs, many people are also very critical of themselves about why such thoughts occur and what they might mean. Sexual outrage and associated ritualsSexual obsessions in OCD are unwanted thoughts, images or impulses which make you anxious or distressed every time they come into your mind. The are completely inconsistent with a person's true values and desires, and as a result they are often associated with high levels of shame and embarrassment in addition to anxiety or fear. Common examples include thoughts of molesting children, unwanted homosexual images, and impulses to inappropriately touch or stare at breasts or genital areas. Most people with this type of OCD respond to their thoughts by reminding themselves that they would never do such a thing, and by trying to avoid situations where the thoughts are likely to occur. How common is OCD?
What treatments have proven benefits?Two treatments have been proven to help people suffering from OCD. One is Behaviour Therapy and the other is medication with one of the serotonin selective re-uptake inhibitors (SSRIs). What is behaviour therapy? Behaviour therapy for OCD consists of graded exposure and response prevention.
This means learning to confront your fears without washing, checking,
reassuring yourself, or doing any other compulsions that temporarily take
away your fear and make you feel better. The first step involves recognising
the link between obsessions, compulsions and anxiety. Most people feel
anxious, scared or uncomfortable whenever they have an obsessional thought,
and reassured or relieved after they perform their compulsion (even if
they also feel frustrated because they're tired of performing compulsions).
Human beings don't like to feel anxious, scared, or uncomfortable, and
so when something is making you anxious it makes sense to try and do something
to take that feeling away. In this context it is easy to see why you wash
your hands if you doubt they are dirty, or why you keep checking the stove
if you doubt it might be on. But when you have OCD these behaviours help
to keep your fears alive, because the doubts always come back again, bringing
more anxiety, and so you have to keep repeating your compulsions in order
to get any relief. A good general rule is that when you have OCD the doubts
gets stronger the more you give in to them, and weaker the more you resist
them. Planning Graded Exposure and Response Prevention
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