Obsessive-compulsive (OCD)
Overview
Obsessive-compulsive disorder (OCD) is an anxiety disorder that usually develops in late childhood or the teenage years. It begins gradually and varies in severity throughout life. OCD can significantly interfere with daily life and cause great distress. OCD is treatable but without proper treatment it can become a long-term, debilitating condition.
Obsessive-Compulsive Disorder (OCD) is a different illness to Obsessive-Compulsive Personality Disorder (OCPD). This fact sheet is about Obsessive-Compulsive Disorder (OCD) only.
Signs and symptoms
As its name suggests, OCD has two kinds of symptoms: obsessions and compulsions.
Obsessions are intrusive and unwanted thoughts, images or urges that keep coming into the mind and causing distress or anxiety.
Compulsions are repetitive behaviours or ritualistic actions that a person does over and over in an attempt to reduce anxiety or prevent something bad from happening. Compulsions are time-consuming and distressing.
The types of obsessions and compulsions a person experiences may change over time though certain themes often show up, including the following:
1. Obsessions
- an excessive fear of being contaminated by dirt or germs
- uncertainty and doubt leading to repetitive checking and counting
- a need to follow a strict routine
- silently repeating a word or phrase or prayers
- extreme thoughts about illness, accidents or death to the person or to others and the need to prevent this harm
- unwanted sexual or violent thoughts
- thoughts about acting inappropriately in public
- preoccupation with religious or moral issues
- needing reassurance from others
There may be other behaviours not listed here that would be considered a symptom of OCD. When diagnosing, the concern is with any behaviour that is an obsession.
2. Compulsions
Common compulsions include:
- excessive house cleaning, hand washing, showering, tooth brushing. An obsession about germs may also lead to avoiding touching others’ hands and surfaces such as toilets.
- needing things to be orderly or symmetrical, or following certain patterns
- hair pulling and skin picking
- hoarding random objects
- repeatedly checking that doors have been locked and appliances turned off
- repeating routine activities and actions such as picking something up, opening a drawer, moving from one place to another
- touching or tapping out a sequence a certain number of times
- fixating on particular words or numbers that are considered “safe”
- repeatedly asking questions
While compulsions may be acted out to relieve anxiety about an obsession, they usually have the opposite effect and make the obsessions seem more real, which leads to greater anxiety.
Obsessions and compulsions usually occur together with OCD though it is possible to have only obsession symptoms or only compulsion symptoms. Obsessions and compulsions can interfere with home life, social interactions, work and school.
When a person with OCD tries to ignore or stop their obsessions and compulsions, they often find their distress or anxiety increasing.
For some people, obsessions are always on their mind. For others, they can be triggered by certain sounds, smells, situations or objects.
Causes of obsessive-compulsive disorder
There are lots of theories about what causes OCD. Possible explanations are:
- OCD is a genetic condition inherited from family members
- OCD is due to differences in brain chemistry, structure or function
- A person gets caught in a cycle of believing their thoughts and maintaining the symptoms
- A person learns the obsessions and compulsions from another family member and they then become repetitive and use them to try to lower their anxiety
It is likely that a combination of genetic and environmental factors contributes to the development of OCD. Symptoms can get worse if a person with OCD is experiencing stressful life events or undergoing hormonal changes.
OCD affects two to three percent of the population (more than 500,000 Australians).
How is obsessive compulsive disorder diagnosed?
Professional diagnosis
The doctor will want to know if the person is having obsessions or compulsions that are interfering with daily living. Discussion will focus on thoughts, feelings and behaviours and a diagnosis will be made after the doctor has gathered enough information. The doctor may ask to speak to family members to help make the diagnosis.
The person’s obsessions and compulsions must be:
- taking up a lot of time each day
- be excessive
- be causing a lot of distress
- interfering with daily activities
When assessing a person for OCD, the doctor will consider whether the symptoms could be due to other conditions, such as depressions, schizophrenia, obsessive-compulsive personality disorder, tic disorders, eating disorders, substance abuse, ADHD, or other anxiety disorders. OCD symptoms can be similar to these mental illnesses. It is also possible to have OCD and another mental illness together. It may therefore take time to figure out a person’s diagnosis.
Self-diagnosis
The behaviours that a person with OCD has are not the same as worrying about everyday problems or wanting to have things clean and tidy and orderly. People with OCD are usually aware of their obsessions and compulsions. Some people may not consider their obsessions and compulsions to be excessive or unreasonable. Others know that they are but feel unable to control or resist them. If these behaviours are taking up a significant amount of time and are interfering with daily routines and social interactions, it is a good idea to seek professional help. Some people may feel ashamed of their obsessions and compulsions and may try to keep them a secret, but it is better to get help as OCD can be treated.
Treatments
OCD is usually a lifelong condition but treatment will help a person gain better control over their obsessions and compulsions and stop these from ruling their life. There are three main ways to help people with OCD and often using a combination of all three works best.
- Psychological treatments
- Anxiety management techniques
- Medication
Psychological treatments
The most common type of psychological therapy recommended for people with OCD is cognitive behaviour therapy (also called CBT). Other treatment options that may be offered by a psychologist include family therapy, counselling and help with goal setting.
Cognitive behaviour therapy
Cognitive behaviour therapy (also called CBT) is used by specialist mental health professionals to change a person’s thinking patterns and behaviour. Therapy includes gently exposing the person to situations that trigger their obsessions and compulsions and helping them to learn ways to resist the compulsive behaviour. These situations are practiced daily until anxiety eventually decreases.
Anxiety management
A range of techniques can help a person with OCD to manage their obsessions and compulsions. These include meditation, slow breathing techniques and relaxation training. These techniques are most effective when they are used with a CBT program.
Medication
For some people with OCD, antidepressants may be suggested. These can help the brain to restore its chemical balance. Antidepressants can only be prescribed by a medical doctor (GP or psychiatrist). It can take a few weeks before antidepressants start to work and, in that time, they can cause side effects, which should eventually go away. If a person decides to stop taking antidepressants, they should talk to their doctor first, as the dose should be reduced slowly. If the person does not find antidepressants helpful, the doctor may suggest other psychiatric medications.
The doctor needs to know if the person is taking other medications, including prescription, over-the-counter, herbs or supplements, as antidepressants can make some other medications less effective and may cause reactions when combined.
For a person with severe, debilitating OCD who does not respond to the treatments listed above, a psychiatrist may recommend other types of treatment, including: deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS). These approaches are only offered to adults. DBS sends electrical impulses to the brain to help regulate the brain’s abnormal impulses. TMS involves placing an electromagnetic coil against the scalp. Magnetic fields send a pulse to the nerve cells in the brain.
Self-help
As well as the treatment options discussed above, the person with OCD might find it helpful to try some of the following things:
- Delay the urge to do a compulsive behaviour by distracting yourself with something else (exercise, read, play a game).
- Keep a journal and write down thoughts or worries. Note how repetitive they are.
- Anticipate urges. If the person knows there are certain things they always compulsively check, pay extra attention to doing it the first time (for example, say out loud that it has been done). When the urge to check later comes up, re-label it as “just an obsessive thought” instead of checking again.
- Allocate a set time each day for worrying and leave the rest of the day free of obsessions and compulsions. When thoughts or urges come to mind, write them down and wait until the “worry time” to do them.
More ideas via Better Health Channel.
Education
It may be helpful to learn more about OCD by reading websites like this one, information sheets from health professionals, and talking to professionals and other people who have OCD (or family members with OCD), either through support groups or online forums.
Help & Support
OCD is distressing and disruptive mental health issue for the person with the illness and for their family members. OCD can significantly affect a person’s quality of life, their relationships, cause health issues and may lead to suicidal thoughts and behaviour. Therefore, professional help is recommended. With help, a person with OCD can bring their symptoms under control.
If OCD is not treated, the obsessions and compulsions can become entrenched and regular routines, like going to school or work may become impossible, as the person tries to actively avoid anything that will trigger their obsessions. Early treatment allows the person with OCD to regain control of their life more quickly. People with severe OCD may need long-term or intensive treatment. If the person with OCD is also experiencing other mental health problems, a professional can help to work out the best treatment plan.
Next Steps
Help is available and there are a number of ways to find it. If one of these options doesn’t work, it is worth trying another until the right support is found.
Talk to a GP
A GP is the first person to see before seeking help from a psychologist or psychiatrist. Many GP practices have their own website which give information about their doctors’ particular interests. Sometimes this can help in choosing a doctor to see. After talking to the GP, they can write a letter (a referral) to a psychiatrist or psychologist to help get their support. If the person starts medication, the GP may suggest regular appointments to monitor how it’s going.
Support groups
There are support groups for people with OCD and their families. Mental Health Foundation Australia offers information about face-to-face meetings (in Melbourne) and zoom support.
Websites
OCD Australia
An online hub containing the different resources for dealing with OCD. Includes a link to an online test for OCD, and where and how to find treatments. Visit site(Opens in a new tab)
OCD? Not Me!
An eight-stage online OCD treatment program for young people aged 12 – 18 years. It was developed by researchers at Curtin University, and also provides support for families. Visit site(Opens in a new tab)
ReachOut
Donec quam felisultricies necetur ridiculus Aenean vulputate eleifend telnecpell esque euader pretium quissem. Visit site
ReachOut
Head to Health (a Australian Government resource) can help you find digital mental health services from some of Australia’s most trusted mental health organisations. Find apps, online programs, online forums, and phone services, as well as a range of digital information resources. Visit site(Opens in a new tab)Videos
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