Obsessive Compulsive Disorder (OCD)

What is OCD?

OCD is name given to a condition in which a person has obsessions and / or compulsions, but usually both. Most people with OCD tend to follow a set pattern of thought and behaviour:

• Obsession: A thought, image or impulse that keeps coming into a person’s mind and is difficult to get rid of. These fears or concerns can be irrational, constant and overwhelming. The obsession provokes a feeling of intense anxiety and distress.

• Compulsion:  A feeling a person has that they must repeat physical or mental acts. Usually people do this in response to an obsessive thought with the intention or reducing anxiety or distress.

The compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the pattern or cycle to begin again.

How might OCD be experienced?

There are lots of different obsessions that can affect someone with OCD, a few examples are:

• Being afraid of contamination by dirt or germs.
• Seeing disturbing pictures in your mind.
• Fear of hurting yourself or someone else.
• Worrying that your home is not safe, such as an electrical appliance left on.
• Wanting to have things in a particular order or arrangement.

There are lots of different compulsions that can affect someone with OCD (sometimes called ‘rituals’), a few examples are:

• Excessive washing and cleaning.
• Checking things repeatedly (for example, that a door is locked at least three times before you leave the house).
• Keeping objects that other people might throw away (called ‘hoarding’).
• Repeating words or numbers in a pattern.

How OCD may affect you?

Almost everyone has a disturbing thought or checks more than once they have locked the door. With OCD, the thoughts and feelings of discomfort can take over.

People with OCD may:

• Realise that their thoughts and actions are irrational or excessive, but they will not be able to help themselves from thinking the obsessive thoughts and carrying out compulsions.
• Spend much of their day carrying out various compulsions and be unable to get out of the house or manage normal activities.
• Appear to be coping with day-to-day life while still suffering a huge amount of distress from obsessive thoughts.
• Carry out their rituals and compulsions in secret or make excuses about why they are doing something.
• Not realise that repeated thoughts, such as a fear of harming other people, are common symptoms of OCD and do not mean that they will carry out these thoughts.

Types of support available

There are many things that can reduce the impact of OCD to a more manageable level. Often a combination of the following may be offered to support your recovery:

• Self-help: to develop an self-awareness.
• Medication: this may be offered to you in addition to psychological therapy.
• Psychological therapy: psychological therapies are used to the support development of effective coping strategies and solving skills.

Young people living with OCD

Signs of OCD in young people

Examples of obsessions might include:

• Thinking something bad will happen if they don’t count to a certain number.
• Worrying that things must be kept tidy.
• Worrying about germs.
• Worrying that if they don’t say something specific to a certain person, something bad will happen.

Examples of compulsions might include:

• Repeatedly checking that the front door is locked before leaving for the day.
• Washing their hands over and over again.
• Counting or repeating words in their head.
• Arranging and then rearranging items in a set order.

People with OCD will often try to stop themselves from carrying out their obsessions and / or compulsions; however this usually results in feelings of frustration or further worry and anxiety due to the obsession or compulsion not being carried out. Many young people with OCD will find that their home life, school life and friendships are affected, which can cause further anxiety, worrying and upset.

It is not uncommon for young people to experience mild obsessions and compulsions at some point whilst growing up, but this is usually due to stress or changes at home, school, with family or friends.

How can I support a young person?

• Reading information about OCD will help you to understand the condition in more detail and will help you to understand how your child is feeling. It may also help you to identify why they have developed the condition. Is there something stressful happening at home or school, has there been a big change in their life?
• You could speak to a GP to find out more information and how best to talk to your child.
• Speak to your child and encourage them to open up to you about how they are feeling, the thoughts they are having and the routines they feel they need to complete. Reassure them that you will try to work through their feelings together.
• Suggest that when they feel ready, you could speak to a GP together or a counsellor at school.
• Encourage them to share their feelings with their friends so that they understand how your child is feeling and can offer support at school.

Personal Experience

I first experienced obsessive, intrusive thoughts as a university student. In the beginning they manifested themselves only occasionally, for example, once when I was a passenger in a car I had a fear of suddenly yanking the steering wheel in the direction of oncoming traffic. While these thoughts were not pleasant they generally only occurred in ‘fleeting’ moments – for example, after I had completed the car journey the thoughts vanished, and so they didn’t have a particularly major impact on my life.

However on one occasion when I was doing the washing up I suddenly felt an urge to stab my housemate with a knife I had been cleaning at the time. This time the thought affected me considerably – I thought that I had to be evil to hold such thoughts about harming my friends. These thoughts quickly evolved – whereas previously I only held them while I was around knives, they started to involve other forms of violent acts both to myself and other people. There was no way I could escape these thoughts; I could avoid holding heavy objects or knives, but I still thought that if I wanted to I could hit someone with my fists or spit on them. The thoughts became a constant and ever-present factor in my life.

On no occasion did I want to act on these thoughts; they were just based around a ‘what if’ situation. I imagined that all it would take would be for one small loss of control to make my worst nightmares come true. I wasn’t able to enjoy a holiday with my dad because of these fears – from shouting out something inappropriate on the plane, to randomly assaulting someone in the street – these thoughts became almost constant.

I went to my GP and told her about my concerns, and was given an appointment with a psychiatrist who gave me the diagnosis of ‘OCD with primarily obsessional features’. This is a form of OCD known as ‘Pure O’ which has fewer observable ‘compulsions’ than ‘classic OCD. For example, while traditional OCD may involve compulsive activities like hand-washing, counting and checking, pure OCD compulsions and rituals are less common and are mostly mental in nature, for example, they may involve excessive rumination and avoidance of certain situations.

While I was prescribed some antidepressants, self-help guidebooks on OCD were the most helpful to me. These books explained that to have such intrusive thoughts is not the mark of an ‘evil’ person. The revulsion one experiences to such thoughts is a sign that they are a caring and moral person – after all, a ‘serial killer’ would not find such thoughts of harming others to be distressing. The typical person who is distressed by intrusive thoughts would not act on these thoughts because it would be completely contrary to his or her character.

Challenging obsessions, compulsions, and other intrusive thoughts is best done through Cognitive Behavioural Therapy (CBT). In the case of Pure ‘O’ OCD, this can be done through repeated exposure to the intrusive thoughts or scenario in a method called ‘Imaginal Exposure’. For example, if somebody had a fear, say, of causing violence to a loved one, then in this method they would write a story graphically describing them committing their worst fear with the worst possible outcome. They would then read or listen to a recording of this scenario many times each day. While this may seem counterintuitive, it has been shown that to face your fears head on rather than try to avoid them completely will, over time, reduce the ‘shock factor’ of any intrusive thoughts much in the same way that watching a horror film again and again will gradually reduce the fear it produces in us.

While this form of therapy has not ‘cured’ my intrusive thoughts, I now find them much easier to manage on a day to day basis. My fears have once again been relegated to a position of being annoying, fleeting moments rather than something that interferes with my life wherever I go.