Patient Care

Obsessive Compulsive Disorder (OCD)

What is an Obsessive-Compulsive Disorder (OCD)?

Feeling driven to perform rituals over and over may indicate that you have OCD. If you have OCD, intrusive thoughts and ritualistic behaviours may literally take over your life. You have distressing, unwanted thoughts or images that do not make sense to you. These thoughts or images keep coming back despite your efforts to ignore them. You may strive to hide OCD from friends and co-workers for fear of being labelled "crazy".

OCD includes both obsessions (intrusive repeated thoughts) as well as compulsions (repeated actions which you cannot help). OCD symptoms can be severe and time-consuming. For instance, someone who feels that his or her hands have become contaminated by germs — an obsession — may spend hours washing them each day — a compulsion. The focus on hand washing may be so severe that the person suffering from OCD is unable to accomplish daily life tasks and/or is unable to function anymore.

What are the signs & symptoms of OCD?

OCD obsessions are repeated, persistent, unwanted ideas, thoughts, images or impulses that you experience involuntarily and that appear to be senseless. These obsessions typically intrude when you are trying to think of or do other things.

Typical OCD obsessions revolve around:

  • Contamination
  • Doubting
  • Insistence on symmetry
  • Hoarding
  • Religion
  • Aggression
  • Sexuality

Examples of OCD symptoms involving obsessions:

  • Fear of being contaminated from shaking hands or touching objects which others have touched
  • Doubts that you have locked the door or turned off the stove
  • Repeated thoughts that you have hurt someone in a traffic accident
  • Intense distress when objects are not orderly, lined up properly or facing the right way
  • Images of hurting your child
  • Impulses to shout obscenities in inappropriate situations
  • Avoidance of situations that can trigger obsessions, such as shaking hands
  • Replaying pornographic images in your mind
  • Dermatitis because of frequent hand washing
  • Skin lesions because of picking at the skin
  • Hair loss or bald spots because of hair pulling

Compulsions are repetitive behaviours that you feel driven to perform. These repetitive behaviours are meant to prevent or reduce anxiety or distress related to your obsessions. For instance, if you have a strong belief that you may have run over someone in your car (although this is not the case), you may return to the scene over and over again because you are just unable to shake off your doubts. You may even make up rules or rituals to follow that help control the anxiety you feel when having obsessive thoughts.

Typical compulsions revolve around:

  • Washing and cleaning
  • Demanding reassurances
  • Checking
  • Arranging or making items appear orderly
  • Rituals
  • Counting

Examples of OCD symptoms involving compulsions:

  • Washing hands until the skin becomes raw
  • Checking doors repeatedly to make sure they are locked
  • Checking the stove repeatedly to make sure it is off
  • Counting in certain patterns
What are the treatment options for OCD?

There is a difference between being a perfectionist and having OCD. Perhaps you keep the floors in your house so clean that you could eat off them. Or you like your knick-knacks arranged just so. That does not necessarily mean that you have OCD.

In OCD, your quality of life can decrease dramatically as the condition dictates most of your days and you become consumed with carrying out compulsive behaviors and rituals. Most adults can recognise that their obsessions and compulsions do not make sense. Children, however, may not understand what is wrong. But the lives of both children and adults can be severely affected by OCD. Children may find it difficult to attend school, and adults may find it difficult to work. Relationships may suffer. When the symptoms have such an influence on your daily functioning, it is more likely that you are suffering from OCD.

If your obsessions and compulsions are affecting your life, talk to your healthcare professional, such as your primary care doctor or a mental health professional. It is common for people with OCD to be ashamed and embarrassed about the condition. But even if your rituals are deeply ingrained, treatment can help.

Most OCD specialists agree that a combination of medicines and a specific behavioural type of psychotherapy is the best treatment for OCD.

Several medications have been proven effective in helping people with OCD, such as anti-depressants (for example clomipramine, fluoxetine, fluvoxamine and paroxetine). If one drug is not effective, others should be tried. A number of other medications are currently being studied.

A type of behavioural therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and is then taught the techniques to avoid performing the compulsive rituals and to deal with the anxiety.

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