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When clutter is more than excessive  - do you know whether it is OCD? 

                                

Obsessive-compulsive disorder

Nearly everyone, what ever their age, has occasionally experienced brief runs of repetitive thoughts, urges, or impulses (like having to check the door is locked several times or having 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, 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 known as obsessive-compulsive disorder (or OCD, for short).

Article with thanks to Sally Burningham, Paul Salkovskis, Victoria Bream and updated by Dr Isobel Heyman

close-up of a man's face
 

OCD is a form of anxiety disorder, which can vary from very mild to severe, and can take many different and novel forms. It can affect children, teenagers and adults. Some people are bothered by upsetting thoughts that they can't get rid of no matter how hard they try; other people feel compelled to wash or to check things, even though logically they know there is no need. When people are troubled by their obsessional problems they can experience very high levels of anxiety and distress, and can find the problem takes up a lot of their time and attention. It can interfere with a child's ability to go to school, play with their friends, and interfere with almost every aspect of their life. In adults it can disrupt a person's ability to work, their personal relationships and even lead to people becoming housebound.

People often try and conceal this distressing condition from others because they are ashamed or imagine that they are the only one to experience such strange and upsetting feelings. But it is far more common than most people realise. It has been estimated that as many as two to three people in a hundred (2-3%) are likely to experience obsessive-compulsive disorder at some point in their life.

It is important to seek help at an early stage if you are affected by obsessive-compulsive disorder, before it begins to dominate your life. See your GP or contact one of the organisations listed in help and info below.

What are obsessions and compulsions?

obsessions

Obsessions, in the context of mental health, are recurrent persistent, intrusive, unwanted thoughts, images or ideas that cause anxiety and are unacceptable to the person (for example, a child fearing that their mother will be in a car accident).

People know that these are their own thoughts (rather than hallucinations) but they also know that the thoughts are senseless and that they are worrying about them too much. However, they feel compelled to get rid of the thought, usually by doing some kind of compulsion.

The kinds of obsession that people may experience include:

  • thoughts about contamination from germs, disease, dirt or radiation
  • thoughts of causing danger or harm by leaving something crucial undone
  • ideas about harming themselves or someone they care about or about other acts of violence
  • repeated blasphemous thoughts
  • disturbing sexual images.

Compulsions

The thoughts, or obsessions, described above are usually accompanied by 'compulsions'. These may take the form of overt behaviours (such as washing or checking) or mental acts (such as mentally repeating words or phrases or checking things). These behaviours are carried out according to certain strict rules to try and control the anxiety and distress caused by the obsessions.

Sometimes the compulsion may appear to be connected to the obsession, as when fear of contamination gives rise to endless scrubbing of surfaces each time they are touched, for example. At other times there may appear to be little connection. However, all such behaviours are aimed at reducing the obsessional fears.

Although compulsions may temporarily relieve feelings of anxiety, they also make the urge to perform yet another compulsion stronger each time. Over time this worsens the problem.

Common forms of compulsive behaviour include:

  • excessive handwashing or washing clothes or objects
  • repetitive checking (that lights are turned off or that doors are locked, for example)
  • touching various objects in a specific order or performing particular actions a set number of times
  • arranging objects or carrying out activities in a particular set way
  • hoarding useless possessions.

What do we know about OCD?

OCD can affect people of all ages. It may start in childhood or develop later. Some people may have several obsessions or compulsions or their obsessions or compulsions may change over time. There is a very small tendency for obsessive-compulsive disorder to run in families. However, most people who have OCD do not have children who go on to develop it.

We do not know what causes obsessive-compulsive disorder although a number of explanations have been put forward. There are almost certainly several contributory factors. Predisposing factors may be genetic, may be related to brain chemical such as serotonin, or may be related to psychological factors and life stresses.

Psychological factors

Recent research has revealed a great deal about the psychological factors that maintain the disorder, which in turn has led to effective psychological treatment.

Whilst everyone may experience intrusive thoughts at times, the issue is how much significance the person gives to that thought what having the thought means to them. For example, a person who doesn't have an obsessional problem may experience a thought about harm coming to themselves or someone they love, and they are able to stand back from this and see it as 'just a thought'. However, people with obsessional problems become very upset about what the thought might mean. They may think that it is immoral to ignore the thought, or that simply having the thought makes them responsible for harm that might come to themselves or other people. They therefore feel compelled to act to prevent any harm from happening or to prevent themselves from being responsible for bad things happening.

One way they do this is to try very hard to suppress the thought which bothers them unfortunately this makes it occur more (tell yourself not to think of a giraffe and you will probably find that an image of a giraffe keeps popping into your mind). The compulsions listed above are designed to neutralise the thoughts, or obsessions. The bottom line is that people with obsessional problems are trying too hard to keep the thoughts out or to make sure that things are done properly or to be kept clean, and so on. The harder they try, the more difficult it gets and the more upset and anxious they get a very unpleasant vicious circle.

Treatment

There are effective treatments for OCD and it is important that the disorder is diagnosed as soon as possible and people access the correct treatments. The National Institute for Health and Clinical Excellence (NICE) has recently produced guidelines for the assessment and treatment of people with OCD.

The two effective treatments for OCD are cognitive behaviour therapy and specific medication. Everyone with OCD should be offered CBT and ideally this should be the first treatment in children. People may also benfit from medication.

The extent to which people are affected by OCD varies a great deal. Some people are only mildly affected and recover over time, often as their circumstances change. However, for those more severely affected it is a very distressing and disabling condition that if untreated may persist throughout their lives, although its course may be up and down and there may be periods of remission.

Cognitive behaviour therapy

The most effective treatment for OCD is cognitive behaviour therapy (CBT). CBT is a short-term, structured, problem-focussed and goal-directed form of therapy. It helps the person get a full understanding of how the problem works, introduces new ways of looking at it, and teaches the person the necessary skills to understand and overcome their problem. It aims to enable the person to become their own therapist when therapy ends. The NICE guideline emphasises that the CBT technique which has been shown to work best in OCD is a technique called 'exposure and response prevention'. This involves the person with OCD working collaboratively with their therapist to learn how to resist the urge to carry out compulsions, while facing up to the anxiety this produces. This is done in small steps so it is not too difficult. The target of treatment is not to get rid of the obsessional thoughts (after all, everyone gets them) but to get rid of the distress attached to the thoughts that arises due to the beliefs attached to them, and to reduce or eliminate the associated rituals.

Your GP can refer you for CBT. This form of treatment is always provided by qualified professionals such as clinical psychologists, psychiatrists, nurses, counsellors or social workers. There are a number of approaches that a therapist might use with you to tackle your obsessive-compulsive disorder.

CBT focuses very much on problems in the present rather than looking at the past. Each session usually lasts about an hour and you are likely to be offered 8-12 weekly sessions, although it could be more or less. You will also be given tasks to work on at home. For more information you might like to look at our cognitive behaviour therapy feature.

Medication

Certain antidepressant drugs can be useful in treating obsessive compulsive disorder; these are drugs which act on the serotonin system. These include the specific serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). They are also useful in treating depression which is so often associated with this disorder. High doses may be required and relapse is common if the drug treatment is stopped. Treatment with medication is often more effective if it is combined with cognitive behaviour therapy.

Tips for friends and relatives

Obsessions and compulsions can be very time-consuming and seriously interfere with someone's work, family life and other relationships. Often tasks that once took several minutes can take several hours to complete and life may become very restricted.

Parents of children with OCD have often become very caught up in their child's rituals, and part of the treatment involves cutting back and eventually stopping this involvement. Partners and friends can also find their lives disrupted. They may find themselves becoming very involved in compulsions and even going along with strange or inappropriate behaviour in order to avoid upsetting the person further. However, trying to placate the person in this way can reinforce their condition. If you find yourself in this situation seek advice from an appropriate health professional or organisation .

Try to persuade your child, friend or relative who has the condition to seek help early

  • Parents should be involved in their child's treatment
  • Get support for yourself. It is stressful if you are close to someone with obsessional-compulsive disorder.
  • Find out all you can about the condition so that you know how and when to encourage the person and when to resist whatever they are asking of you.
  • Reassure the person that they are not alone and they are not going 'mad'. Many people are affected by this disorder and help is available.  

Help and information

Organisations

OCD Action
Aberdeen Centre
22-24 Highbury Grove
London N5 2EA
Information Line: 0845 390 6232 (you can leave a message here asking for leaflets to be sent to you)
Office: 0870 360 6232
E-mail: info@ocdaction.org.uk
Website: www.ocdaction.org.uk
Offers advice and support for people experiencing obsessive-compulsive disorder and related disorders such as body dysmorphic disorder, compulsive skin picking and trichotillomania. Also provides information for carers and interested professionals. Can provide details of local support groups.

OCD-UK
PO Box 8955
Nottingham NG10 9AU

Tel: 0870 126 9506 (24 hours)
E-mail: admin@ocduk.org
Website: www.ocduk.org
Charity run by sufferers of Obsessive-Compulsive Disorder for all people who are affected by OCD. Aims to advance awareness, provide support and information, and improve the quality of life of those with OCD. Website has information about treatment, self-help, local support groups and discussion forums.

Anxiety Care
Cardinal Heenan Centre
326 High Road
Ilford IG1 1QP
Helpline: 020 8478 3400 (Wed 10am-3pm)
Telephone: 020 8262 8891
E-mail: enquiries@anxietycare.org.uk
Website: www.anxietycare.org.uk
Anxiety Care is a registered charity based in East London that specialises in helping people to recover from anxiety disorder and to maintain that recovery.

Websites

KidsHealth: Obsessive Compulsive Disorder
www.kidshealth.org/kid/health_problems/
learning_problem/ocd_p2.html

Just for kids site that covers the problems and fears surrounding OCD really well.

Obsessive Compulsive Disorder (OCD) in Children and Adolescents Website
http://psychology.iop.kcl.ac.uk/ocdkids
Children of all ages can be affected by OCD. This website provides more information about OCD in children and adolescents and also contains advice for parents and health professionals.

OCD Information for Kids Under 10
http://psychology.iop.kcl.ac.uk/ocdkids/patients/Under-tens.aspx
Webpage full of helpful info presented alongside fun graphics especially for the under tens.

South London and Maudsley NHS Foundation Trust
http://www.slam.nhs.uk/news/detail.aspx?id=96
Information for anyone wanting to know more about OCD in children and young people.

Things you need to know about OCD: Information for Young People
http://ocdyouth.iop.kcl.ac.uk
A website written by and for young people with OCD, giving information on the disorder and its treatments.

 

  

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