Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder that affects about 2% of the population. The causes of OCD are not yet determined but researchers believe that there is a genetic and neurological component, and also an environmental component. People with OCD have persistent thoughts and urges that cause them so much distress, that they try to suppress or neutralize them by performing specific behaviours or mental acts.
What are Obsessions and Compulsions
Obsessions are persistent thoughts, images or urges that are unwanted, intrusive, and cause anxiety or distress. Examples include recurrent worries about getting sick, thoughts about harm befalling a loved one, unwanted sexual images, or the need for things to be symmetrical or ‘just right’. These can lead to feelings of anxiety, guilt, disgust, or something being not quite right.
Compulsions are repetitive behaviours or mental acts in response to the obsession, usually to try to get rid of the bad feelings, or prevent some dreaded event from happening. Examples are excessive washing or cleansing, constant checking or reassurance seeking, compulsively replacing bad images with good ones, ordering and arranging things, or repeating certain thoughts or actions.
At some point in their lives, most people experience obsessive thoughts or compulsive behaviours to some degree. But they don’t necessarily all have OCD. To have OCD, the obsessions and compulsions must be extreme and cause feelings of distress, must be time consuming (taking up 1 hour or more per day), and must interfere with the person’s functioning or stop them from doing activities they would like to do, or need to do.
The OCD Cycle
People with OCD find their obsessions very distressing, and often try hard to avoid anything that triggers the thoughts, images or urges. For example, if a person with OCD has the thought that they might spread germs to their loved ones and make them ill, this will cause them high anxiety and distress, and they will likely try to avoid anything that will trigger that anxiety. They might avoid touching public door handles that they think are germy, or using public bathrooms. This avoidance leads to even lower anxiety tolerance over time, leading to even more avoidance. If they do touch the door, the ensuing anxiety is often so high that it is not tolerable, and they engage in a compulsion: a behaviour, mental act, or ritual to neutralize the anxiety. This compulsion brings immediate relief. This becomes an OCD cycle, where an action triggers an obsession, which triggers anxiety, which is then neutralized by a compulsion, and then it repeats. This cycle provides short-term relief but makes things much worse in the long run.
Sometimes mild OCD passes on its own, but most OCD tends to get worse or reoccur over time unless treated. The good news is that there are several treatments for OCD that have been shown to be effective. The most common are:
1) Psycho-therapeutic interventions such as Cognitive Behaviour Therapy (CBT) with Exposure with Response Prevention (ERP) – this is a supported approach done with a trained professional where the person is helped to gradually and systematically confront their fears without engaging in compulsions. This leads to new learning and behaviour changes over time. Acceptance and Commitment Therapy (ACT) for OCD is another highly effective therapeutic approach.
2) Medications – OCD responds well to medications known as Selective Serotonin Reuptake Inhibitors (SSRI’s). Although medications address the severe anxiety and compulsive behaviours, it is still often advised to engage in therapeutic treatment as well, because gains are not maintained after medication-only treatment.