Understanding mental ill-health

Obsessive Compulsive Disorder (OCD)

What is it?

Obsessive Compulsive Disorder (OCD) is the name given to an anxiety disorder in which people experience repetitive and upsetting thoughts and/or behaviours- usually both. OCD has two main features: obsessions and compulsions.

Obsessions are involuntary thoughts, images or impulses. An example would be a fear of germs, or an irrational concern with order, such as putting things away in a specific way.

The main features of compulsions are repetitive and stereotyped actions that the person feels forced to perform. This may be in order to deal with the effect of an obsession, such as repeatedly checking locks to ensure the house is safe before bed, or washing one's hands repeatedly because of a fear of germs.

People are aware that their obsessions and compulsions are irrational and excessive, but nonetheless still feel unable to control them.

OCD can be very debilitating, and left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a long-term, relapsing problem that can take years of treatment to overcome.

OCD is thought to affect around 1-2 % of the population (16 cases per 1000 people in Scotland), and it affects men and women equally.

OCD typically begins to affect people in adolescence or in the early-20s; however, at least half of adults who get help for OCD already had it as children.

OCD is listed amongst the top 10 most debilitating illnesses by the World Health Organisation.

The prevalence of OCD may have been underestimated in the past because people are often afraid to seek help and can appear to function perfectly normal despite great distress. OCD is therefore often referred to as the 'secretive disorder'.

Having some obsessive habits is not the same thing as having OCD, and it is unhelpful to draw these parallels. Most of us have some "OC" behaviours when anxious- e.g. students at exams lining up their pencils in a certain way or penalty taking footballers carrying out a little ritual before their shot. It only becomedisorder when this interferes with activities of daily living.

Common obsessions include irrational fears around contamination, fear of causing harm to self or others, hypochondria, 'unlucky' numbers and inordinate concern with order, arrangement or symmetry.

Common compulsions can be repetitious, purposeless actions that the individual feels compelled to engage in according to their own strict rules or in a stereotyped manner. Typically, the individual experiences a sense of resistance to the act but this is overridden by the strong, subjective drive to perform the action. Most often the principal aim behind the compulsive act is to generate temporary relief from the anxiety that comes from a preceding obsession.

Compulsions can be overt or covert. Overt compulsions typically include checking, washing, hoarding, and symmetrical organisation of personal belongings. Covert compulsions or 'cognitive compulsions', as they are sometimes referred to, are mental actions performed as opposed to physical motor ones, for example, mental counting, compulsive visualisation or substitution of mental images or ideas with neutralising alternatives. A practical example would be someone who feels compelled to silently repeat a string of words over and over on experiencing a negative thought.

Lack of understanding about OCD means that those living with the OCD often face ridicule by people around them and the media. Throwaway comments that make light of this serious disorder, suggest a person is inadequate or assumes that any unusual behaviour is a result of OCD can be distressing for individuals and their families.

Some of the ritual behaviour seen with OCD is the subject of comedy routines; hand washing and checking things for germs, for example, have been part of stand-up or other comedy programmes. This can trivialise a debilitating and distressing mental health problem.

Because OCD can be so disruptive, it can be difficult to continue at work. Stigma from colleagues is often more obvious with OCD than other mental health problems the behaviours are often clear.

People with OCD experience a fear of how other people will perceive and treat them, which can be reinforced by previous negative experience and ridicule.

OCD often goes undiagnosed, because of the patient's reluctance to reveal their symptoms due to feelings of embarrassment. It is also sometimes misdiagnosed as depression, which is often an outcome of OCD.

Effective treatments include Cognitive Behavioural Therapy (CBT) and antidepressants, used alone or in combination with each other.

Recovering from OCD can sometimes be a long and difficult process. However, most people do recover and many people with OCD manage their obsessions and compulsions, and are successful in personal, family and professional lives.

OCD-UK (Includes a list of support groups in Scotland and other parts of the UK)
OCD Action
OCD Youth
The Royal College of Psychiatrists