Obsessive Compulsive Disorder: key facts
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What is Obsessive Compulsive Disorder?
We can all be obsessive about certain things
at times, but if:
- you get awful thoughts coming into your mind,
even when you try to keep them out
- you have to touch or count things or repeat
the same action like washing over and over
you may have Obsessive Compulsive Disorder
(OCD).
Who gets OCD?
About one in every 50 people have OCD at some
point in their lives, men and women equally - about 1 million
people in the UK. OCD usually starts in the teens or early
twenties. It tends to get better and worse over time, but people
often don't seek help for many years.
What are the signs and symptoms of
OCD?
- Recurring thoughts - 'obsessions' - that make
you anxious. These can be unpleasant words or phrases, pictures in
your mind or doubts.
- The things you do over and over again -
'compulsions' - that help you to feel less anxious. You may
try to correct or ‘neutralise’ the thoughts by counting, saying a
special word, or doing a particualr ritual, over and over
again.
What causes OCD?
Many factors might play a part and one or more
of those listed below might be explanations as to why you or
someone you know is affected.
- OCD is sometimes inherited, so can
occasionally run in the family.
- Stressful life events bring it on in about
one in three cases.
- Life changes - when you have to take on more
responsibility such as puberty, the birth of a child or a new
job,
- If you have OCD for more than a short time,
an imbalance of a brain chemical called serotonin (also known as
5HT) may develop.
- You are a neat, meticulous, methodical person
– but go too far.
- If you have particularly high standards of
morality and responsibility, you may feel particularly bad when you
have unpleasant thoughts. So, you are start to watch out for them –
which makes them more likely to happen.
Helping yourself
- If you make yourself regularly think the
troubling thoughts, you can control them better. You record them –
with a microphone or on paper – and then listen back to them or
re-read them. You need to do this regularly for around half an hour
every day. At the same time, try to resist the compulsive
behaviour.
- Don't use alcohol to control your
anxiety.
- If your thoughts involve worries about your
faith or religion, talk it over with a religious leader to help you
work out if it is an OCD problem.
- Try a self help book.
Professional help
Psychotherapies
Exposure and Response
Prevention
This helps to stop compulsive behaviours and
anxieties from strengthening each other.
We know that if you stay in a stressful
situation long enough, you gradually become used to it and your
anxiety goes away. So you gradually face the situation you
fear (exposure) but stop yourself from doing your usual compulsive
rituals, checking or cleaning (response prevention), and wait for
your anxiety to go away.
Cognitive Therapy
Instead of trying to get rid of your
thoughts, it helps you to change your reaction to them. It
particularly targets unrealistic self-critical thoughts.This is
useful if you have obsessional thoughts, but do not perform
any rituals or actions to make yourself feel better. It can be used
with exposure and response prevention.
Antidepressant medication
SSRI antidepressants can help even if you are
not depressed. They can be used alone, or with CBT, for moderate to
severe OCD. If treatment has not helped at all after three months,
you can change to a different SSRI or to a medication called
clomipramine.
How effective is the treatment?
Exposure and Response Prevention
About three out of four people who complete this are helped a
lot, but one in four will get symptoms again and will need extra
treatment. About one in four people refuse to try this type of CBT,
or else do not finish it – they feel it's too much to ask.
Medication
About six out of 10 people improve with
medication and their symptoms reduce roughly by half. Medication
does help to prevent OCD coming back for as long as it is taken,
even after several years. Unfortunately, about half of those who
stop medication will get symptoms again in the months
afterwards. This is less likely when medication is combined
with CBT.
Which approach is best for me?
Mild OCD
Exposure and Response Prevention can be tried
without professional help. It is effective and has no side-effects
– but you do feel more anxious for a while. You do need to be
motivated and prepared for some hard work. Cognitive Therapy and
medication are probably equally effective.
Moderate or severe OCD
- You could choose either CBT (up to 10 hours
of contact with a therapist) or medication (for 12 weeks) first. If
you are no better, then you should try both treatments
together.
- If your OCD is severe, it's probably best to
try medication and CBT together from the start.
- Medication alone is an option if you don't
feel you can face the anxiety of Exposure and Response Prevention –
but there is more chance that the OCD will return – about one in
two compared with about one in four for Exposure and Response
Prevention treatment. Medication has to be taken for about a year,
and is obviously not ideal during pregnancy or breastfeeding.
This leaflet is made available through the
generosity of the Charitable Monies Allocation Committee of the
mental health charity St Andrew's, Northampton
© February 2009 Royal
College of Psychiatrists http://www.rcpsych.ac.uk/. Due for
review: February 2011.
You can link to, download, print, photocopy and distribute this
leaflet free of charge. But you must not change it or repost it on
a website.
Charity registration number (England
and Wales) 228636 and in Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
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