Understanding-Ocd 2016 v2
Understanding-Ocd 2016 v2
understanding
obsessive compulsive
disorder (OCD)
Understanding obsessive compulsive disorder
(OCD)
What is OCD? 4
Useful contacts 25
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Understanding obsessive compulsive disorder
What is OCD?
Obsessive compulsive disorder (OCD) is an anxiety disorder. It has two
main parts: obsessions and compulsions.
It's not about being tidy, it's about having no control over your
negative thoughts. It's about being afraid not doing things a certain
way will cause harm.
You might find that sometimes your obsessions and compulsions are
manageable and other times they are impossible to live with. They may be
more severe when you are stressed about other things like work,
university or relationships.
If you experience OCD during pregnancy or after birth, you might get
diagnosed with post-natal or ante-natal OCD. You can find out more about
this diagnosis on the Royal College of Psychiatrists website (see 'Useful
contacts' on p.25).
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What is OCD?
If you experience OCD, it's likely that your obsessions and compulsions
will have a big impact on how you live your life:
Related disorders
There are some other mental health problems that are similar to OCD
because they involve repetitive thoughts, behaviours or urges. They are
sometimes called habit disorders.
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Understanding obsessive compulsive disorder
Co-morbidity (having more than one diagnosis at the same time) with
OCD is common, but it can sometimes make OCD difficult to diagnose and
treat. For example, if you experience OCD you might be living with other
mental health problems as well, such as anxiety or depression. See Mind's
guides Understanding anxiety and Understanding depression for more
information.
Lots of people have misconceptions about OCD. Some people think it just
means you wash your hands a lot or you like things to be tidy. They might
even make jokes about it. This can be frustrating and upsetting, especially
if people who think this are friends or family, colleagues or even
healthcare professionals.
Stigma can make OCD feel difficult to talk about but it's important to
remember you are not alone. Here are some options for you to think
about:
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What are the symptoms of OCD?
One of the most difficult things about OCD is how people per-
cieve it. Intrusive thoughts and compulsions take a greater toll, yet
people don't seem to understand that.
You might feel you can't share them with others or that there is something
wrong with you that you have to hide. You do not choose to have
obsessions - but you might feel upset that you are 'capable' of having
such thoughts.
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Understanding obsessive compulsive disorder
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What are the symtposm of OCD?
You might experience more than one type of obsession. They are often
linked together. For example you might experience a fear of contamination
and a fear of doing someone harm by accidentally making them ill.
You can read more about the different types of obsessions on OCD UK's
website (see 'Useful contacts' on p.25).
Compulsions
Compulsions are repetitive activities that you feel you have to do. The aim
of a compulsion is to try and deal with the distress caused by obsessive
thoughts. You might have to continue doing the compulsion until the
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Understanding obsessive compulsive disorder
anxiety goes away and things feel right again. You might know that it
doesn't make sense to carry out a compulsion - but it can still feel too
scary not to. Repeating compulsions is often very time consuming and the
relief they give you doesn't usually last very long.
Compulsions can:
••be physical actions
••be mental rituals (people who only have mental compulsions
sometimes refer to their OCD as Pure O)
••involve a number (for example, you might feel you have to complete a
compulsion a specific number of times without interruption).
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What treatment is available?
Avoidance
You might find that some activities, objects or experiences make your
obsessions or compulsions worse. For example if you are worried that you
might stab someone then you might avoid the kitchen because you know
there are knives there.
Sometimes it might feel easier to avoid situations that mean you have to
do a compulsion. For example if you have to do a long and time
consuming ritual every time you leave the house, you might just decide
it's easier to stay indoors. But avoiding things can have a major impact on
your life.
Pure O stands for 'purely obsessional'. People sometimes use this phrase
to describe a type of OCD where they experience distressing intrusive
thoughts but there are no external signs of compulsions (for example
checking or washing). The name is slightly misleading as it suggests that
there are no compulsions at all.
If you have 'Pure O' you will still experience mental compulsions - but you
might not be aware of them. Because they are not as obvious as physical
compulsions it can sometimes be difficult to define exactly what these
compulsions are. Here are some examples of internal compulsions:
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Understanding obsessive compulsive disorder
••checking how you feel (for example, you might check to see if you are
still in love with your partner)
••checking bodily sensations (for example, you might check to see if you
were aroused by an intrusive thought)
••check how you feel about a thought (for example, you might check
whether you are still 'appropriately disgusted' by the thought)
••repeating phrases or numbers in your head
••checking if you still have a thought (for example, first thing in the
morning)
‘Dysfunctional’ beliefs
If you have 'dysfunctional' beliefs you might think that you could actually
act on the intrusive thought. This makes you anxious or scared. You may
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What causes OCD?
Personal experience
Biological factors
Studies have also looked at genetic factors and how different parts of the
brain might be involved in causing OCD, but have found nothing
conclusive.
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Understanding obsessive compulsive disorder
You can read more about the possible causes of OCD on OCDUK's website
(see 'Useful contacts' p.25).
Some experts have noted that some children seem to develop OCD
symptoms very suddenly after having a streptococcal (or strep) infection
such as strep throat or scarlet fever. However, we don't know why and no
research has yet been able to identify a physical cause to explain the link.
Some children show OCD symptoms for a while and then they fade.
To get treatment on the NHS you should visit your doctor (also known as
your GP). If your GP thinks you may have OCD they will refer you to a
psychiatrist (or another mental health professional) for an assessment, so
you can be given a diagnosis of OCD if the mental health professional
thinks that's correct.
What treatment you are offered will depend on how severe your OCD is
and how you respond to initial treatment. If the treatment you have been
offered isn't helping, talk to your doctor or psychiatrist. There may be a
more intensive treatment available.
If your OCD is very severe then you may be referred to a specialist OCD
service. Unfortunately not all areas have specialist services and you might
have to travel outside your local area.
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What treatments can help?
If you think that you are starting to experience symptoms of OCD again,
talk to your doctor. You should be referred directly to the waiting list for
more treatment rather than being placed on the waiting list for
assessment again.
You might feel scared about telling anyone, even a doctor, about how
graphic or distressing your obsessive thoughts can be. You may be
ashamed of your obsessions or worry that the doctor might report you to
the police or social services. Or you may find it hard to admit how much
time your compulsions take up.
These feelings can make it difficult to get the right help. But the type of
treatment you are given depends on the intensity of your OCD and how
much it affects your life, so the more honest you are, the more likely you
are to get the best help for you.
There's a lot of evidence that CBT is effective for treating OCD. But it can
be challenging and may make you feel more anxious at first. Talk to your
doctor or psychiatrist about whether you are ready to start CBT.
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Understanding obsessive compulsive disorder
OCDAction have a CBT checklist to help you make sure that the CBT you
are receiving is the most effective for treating OCD (see 'Useful contacts'
on p.25).
Can I go private?
ERP is a type of CBT that is recommended for treating OCD. ERP works by
helping you confront your obsessions and resist the urge to carry out
compulsions.
During ERP your therapist will support you to deliberately put yourself in a
situation that would usually make you feel anxious. Instead of performing
your usual compulsion you will be encouraged to try and tolerate the
anxiety. Your therapist may even suggest that you do something that
makes you feel even more anxious.
ERP helps you to see that the uncomfortable feelings will eventually go
away even if you don't perform a compulsion. As ERP continues people
find that their obsessions cause them less anxiety and the anxiety they do
feel goes away faster. They feel less need to do compulsions. This is called
habituation.
You would always start by confronting situations you find easy and
building up slowly to more difficult situations.
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How can I help myself?
Your doctor may offer you medication alongside CBT. If there is a long
waiting list for CBT your doctor may suggest you take medication while
you are waiting as well.
I’ve been on meds for the last three years and my OCD is so
much more controllable.
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Understanding obsessive compulsive disorder
Some people with mild OCD find that they can use self help resources to
develop their own coping strategies - or you may use them while you are
waiting for treatment or alongside it. These are often based on cognitive
behavioural therapy (CBT). You may have to try a few different options to
find the one that works for you:
Many people find it hard to talk about OCD. You might worry that people
won't understand. You might have kept your OCD secret for such a long
time that it feels very scary to put some of your experiences into words.
Strengthening the relationships around you may help you feel less lonely
and more able to cope.
••Talk to someone you trust about your OCD. Find a quiet space to
talk where you won't be interrupted. You could show them this
information (especially our section for family and friends) to help them
understand. Some people find it helpful to write their feelings down in
a letter and then talk about it together.
••Spend time with friends and family. You might not feel ready to
talk openly about your OCD yet. But spending more time with friends
and family may help you feel more comfortable around them and, in
time, more able to share your experiences.
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How can I help myself?
You could contact your local Mind to find a support group near you. You
can also find specific support groups for OCD through OCDAction and
OCD-UK. See 'Useful contacts' on p.25.
Online support
If you don't want to attend a support group or can't find one locally then
you could think about looking for online support:
See 'Useful contacts' on p.25 and search 'online support' on Mind's website
for more information.
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Understanding obsessive compulsive disorder
Learn to relax
••Manage your stress. Your OCD can get worse if you are stressed
and anxious.
••Try some relaxation techniques. Relaxation can help you look
after your wellbeing when you are feeling stressed, anxious or busy.
••Try mindfulness. You might find that your CBT therapist includes
some principles of mindfulness in your therapy. Mindfulness can help
you manage unwanted thoughts and reduce stress and anxiety. It can
be helpful as part of recovery from OCD.
••Try to get enough sleep. Sleep can give you the energy to cope
with difficult feelings and experiences.
••Think about your diet. Eating regularly and keeping your blood
sugar stable can make a difference to your mood and energy levels.
••Try and take some exercise. Exercise can be really helpful for your
mental wellbeing.
Search 'sleep', 'food and mood' and 'exercise' on Mind's website for more
information.
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How can other people help?
Your loved one may find it difficult to talk about their obsessions and
compulsions. They may have kept them secret for a long time and be very
worried about your reaction. It can help to acknowledge this and encour-
age them to talk about their experience in a way that feels comfortable to
them.
••Be patient. Remember that their fears are very real to them, even if
they seem unrealistic, irrational or extreme to you.
••Stay calm and don't judge. It can be upsetting to hear about some
obsessive thoughts, but your loved one may be scared you will judge
them or think that there is something wrong with them. Make it clear
that you love and support them regardless.
••Find out as much as you can about OCD. This will help you
understand what your loved one is going through. Reading personal
experiences can help too.
One of the hardest things about living with someone with OCD is work-
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Understanding obsessive compulsive disorder
ing out how to deal with their compulsions. You may find it difficult not to
help with compulsions, or get involved (this is sometimes called accommo-
dation). For example you might:
••check locks for them
••reassure them that they didn't cause an accident
••reassure them that an obsessive thought doesn't mean anything
You may have found that refusing to help with rituals, or offer reassur-
ance, increases their anxiety and makes life harder for both of you. But
helping someone with their compulsions is not usually helpful in the long
term.
Try and work out some alternatives together. Your approach might depend
on what your loved one thinks about their compulsions and whether they
are receiving treatment. Here are somethings you could try:
••Agree on an approach that feels right for you both. For example, you
might decide that you will say 'we've agreed I won't answer questions
like that to help you overcome your OCD' or 'I'm here for you and I
love you but I'm not playing OCD's game today'.
••Encourage them to challenge compulsions where appropriate. For
example, instead of offering reassurance you could try and help them
think about why they want to do a compulsion again.
••Offer a hug or other emotional support instead of helping with a
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How can other people help?
compulsion.
••Seek advice. If they are getting treatment you could both talk to their
doctor or therapist about the best way to manage compulsions.
••Accept that sometimes it will be impossible not to offer reassurance or
to help with a compulsion.
Your loved one may find it difficult to talk to their doctor about their OCD
and seek treatment. Here are some ways you could support them:
••Remind them that the appointment will be confidential and the GP is
there to help them access treatment. Offering to go with them could
also help make things easier. Take a look at our page on supporting
someone to seek help.
••Some parts of treatment for OCD can be challenging. During
treatment they may be agitated, tired, anxious and depressed. Try to
be patient and ask them what you can do to make things easier.
••They may feel that things will never get better, especially if they are
finding treatment hard or their symptoms come back. You can offer
hope. Remind them that most people with OCD do benefit from
treatment and show them personal stories of people who have
recovered.
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Understanding obsessive compulsive disorder
You can find out more about looking after yourself in our pages on how to
cope as a carer and improving and maintaining your wellbeing. You can
also visit the Carers UK website. See 'Useful contacts' on p.25.
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Useful contacts
What withdrawal problems can antidepressants cause?
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