Obsessive-Compulsive Disorder (OCD): An Insight
Published: 25 November 2019
Published: 25 November 2019
Obsessive-compulsive disorder (OCD) is a mental illness as per the Diagnostic and Statistical Manual of Mental Disorders DSM-V (APA 2013).
OCD has been recognised as the fourth most common psychiatric disorder in Australia, following phobias, substance abuse and major depression (ARCVic n.d.).
The primary features of OCD are the presence of obsessions, compulsions, or both. They are defined by the DSM-5 as:
Obsessions are repetitive and relentless thoughts, impulses or urges that are unwanted and often intrusive. These thoughts cause anxiety and distress (APA 2013; Beyond OCD n.d.d).
Compulsions are repetitive behaviours (often the examples of hand washing and ordering are used), or mental activities such as praying, counting and or repeating words silently. The individual will feel compelled to carry out these acts in an attempt to quell their obsessive thoughts (APA 2013; Beyond OCD n.d.d.).
These obsessions and compulsions will be time-consuming, sometimes taking up more than an hour a day. They cause significant distress and either social or occupational impairment or hinder another important area of functionality (Beyond OCD n.d.d). In very severe cases, OCD can cause a person to be housebound (Better Health Channel 2017; Sane Australia 2018).
OCD typically presents during childhood or adolescence, most people are diagnosed by the time they reach their late teens (Sane Australia 2018).
It is common for people who have OCD to also live with other mental health issues such as an anxiety disorder: social anxiety or panic disorder, or a depressive or bipolar disorder (Better Health Channel 2017; OCD UK n.d.a).
People who have OCD often report feeling deep shame about their behaviours and compulsions. These feelings of shame can exacerbate the problem, and cause people to delay seeking help and treatment (Beyond Blue n.d.).
OCD previously existed under ‘Anxiety Disorders’ in the earlier edition of the DSM (DSM-IV). Experts (controversially) argued for OCD to be grouped with loosely-related conditions under the new category, ‘Obsessive-Compulsive and Related Disorders’ (now seen in the DSM-5) (OCD UK n.d.b).
It is important to note that obsessive-compulsive disorder is distinct from obsessive-compulsive personality disorder.
The essential feature of OCPD is defined by the DSM-5 as:
‘A preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. This pattern begins in early adulthood and is present in a variety of contexts … Despite the similarity in names, OCD is usually easily distinguished from obsessive-compulsive personality disorder by the presence of true obsessions and compulsions in OCD.’
- APA 2013
Close to three per cent of Australians experience OCD in their lifetime and approximately two per cent of people experience it in a 12 month period (Beyond Blue n.d.).
While it is not known what exactly causes OCD, it is generally thought that it occurs due to a combination of genetic factors, abnormalities of the brain, behavioural factors, and environmental factors. Other reasons might be a family history of OCD, social factors, and psychological factors (Beyond Blue n.d.; Beyond OCD n.d.b).
Obsessions are intrusive, unwanted and cause distress and anxiety. A person will not derive pleasure from them and they are not voluntary. A person will attempt to neutralise these through compulsions. Obsessions may include:
(DSM-5 quoted by Beyond OCD n.d.d)
Compulsions are behaviours or mental acts intended to reduce anxiety and stress, often they are not linked with what they are designed to dull or prevent in a way that would be considered realistic, and/or they are clearly excessive. They may include:
(DSM-5 quoted by OCD UK n.d.a)
A health professional will investigate the presence of obsessions (recurrent and relentless thoughts, urges or impulses) and compulsions (repetitive behaviours or mental acts). The likelihood of a diagnosis of OCD increases if:
(DSM-5 quoted by Beyond OCD n.d.d)
OCD is treatable, seeking out professional support and treatment is crucial to being able to start or resume a life that is not impeded by overwhelming anxiety and distress.
There are two main types of effective treatments for OCD. They are psychological treatment and treatment with medication (Sane Australia 2018).
The primary treatment for OCD is cognitive behavioural therapy (CBT) (Beyond OCD n.d.a; Beyond Blue n.d., Sane Australia 2018). Currently, CBT is the only form of behaviour therapy that is strongly supported by research. It is important for a person who has OCD to find a cognitive behavioural therapist who is specifically trained and experienced in OCD (Beyond OCD n.d.a).
CBT usually involves two kinds of evidence-based techniques. They are exposure and response prevention therapy (ERP) and cognitive therapy (CT).
In ERP therapy, a therapist will gradually expose the person with OCD to the situations that trigger their obsessions or compulsions. The aim of this is that over time, the person will learn to respond differently to these triggers. Eventually, the frequency of compulsions, and the intensity of obsessions will reduce (Beyond OCD n.d.a).
In CT, a person will be encouraged to identify patterns of thought that create anxiety, distress or negative behaviour, and learn to modify them. CT helps a person to understand that their brain is sending false and unhelpful messages. They learn to recognise these messages and respond to them differently (Beyond OCD n.d.a).
Medication can also be effective. Certain medications can help to restore the brain’s normal chemical balance, which may help to control obsessions and compulsions (Beyond Blue n.d., Sane Australia 2018).
A community support group may also be beneficial for someone living with OCD, it can provide an environment in which people who have OCD and their families can meet to give and receive support. As well as accessing support, they will be able to access information, self-help strategies, and coping strategies (Sane Australia 2018).
It may be useful to inform loved ones and carers about OCD to help them to understand the condition. This may take the pressure off the person who has OCD to explain and defend their behaviours, it may also relieve tension between the person who has OCD and the people they live with (Sane Australia 2018).
It can be difficult to live with someone who has OCD. Their behaviour may seem hard to understand, intense and/or disruptive. It’s important to keep in mind they are likely to be as distressed (if not more) by their symptoms as you are (Sane Australia 2018).
There are plenty of OCD resources available to help clear up misunderstandings and concerns about OCD and its symptoms.
Listen to this OCD Stories podcast episode about living with OCD:
Question 1 of 3
Which of the following is considered to be a compulsion?
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