Obsessive Compulsive Disorder (OCD) affects 2 - 3% of the population - more than 500,000 Australians
OCD has been recognised as the fourth most common psychiatric disorder, after phobias, substance abuse and major depression. OCD usually begins in late childhood or early adolescence.
People with OCD experience recurrent and persistent thoughts, images or impulses that are intrusive and unwanted (obsessions), and perform repetitive and ritualistic behaviours that are excessive, time consuming and distressing (compulsions). Common obsessions include fears of contamination and fears of harm to self or others. Common compulsions include excessive handwashing, showering, checking and repeating rituals. These compulsions and obsessions may take up many hours of a person’s day. OCD can cause significant interference in family and social relationships, and daily routines, and may intrude into every activity and action.
Many people with OCD experience intense fears of something terrible happening to themselves or others, they have constant doubts about their behaviour, and frequently seek reassurance from others. Prior to identification and treatment of the disorder, families may become deeply involved in the sufferer’s rituals, causing significant distress and disruption to all members of the family [information for families].
People with OCD are typically aware of the irrationality and excessive nature of their compulsive behaviours and obsessive thoughts. They feel unable to control the obsessions or effectively limit their intrusiveness. Compulsions mostly develop into highly complex rituals, which cause high levels of frustration and anxiety for the sufferer. People with OCD are often acutely embarrassed about their symptoms and may keep them a secret for years, at times even from close friends and family. Those affected can live in their own private hell for years, while outwardly seeming to cope with and lead a relatively normal life. However, this seeming normality is only maintained at great cost in time, energy, stress and personal effort.
It is a distressing and debilitating condition, which tends to be chronic and deteriorate without appropriate treatment and support. OCD is often compounded by depression, and other anxiety conditions including social anxiety, panic disorder and separation anxiety. Conditions related to OCD include compulsive hoarding, trichotillomania (compulsive hair pulling) and body dysmorphic disorder (excessive concern over a part of the body).
What are the symptoms of OCD?
The most common obsessions involve thoughts and fears of contamination, and fears of harm to self or others. Other obsessions include thoughts, images and impulses associated with symmetry and orderliness, illness, religious or moral issues, sexual concerns, and needs to save, collect or remember things. These obsessions can vary from time to time both in nature and severity. Obsessions do not respond to logic, and produce feelings from annoyance and discomfort to acute distress, disgust and panic.
Common compulsions include excessive hand washing, showering, cleaning and checking. Other compulsions include hoarding, repeating routine activities and actions, touching and tapping, applying rigid rules and patterns to the placement of objects, needing to constantly ask or confess, and a range of mental compulsions such as counting and repeating words. The compulsions generally are excessive and ritualised behaviours, involving constant repetitions.
For example, a person with OCD may spend 2-3 hours every day in the shower, and several more hours hand washing, or washing clothes, food and household items. Their anxiety may not only be that they are dirty themselves, but that they may infect others, contaminate foodstuffs and so forth. They may know that further washing is unnecessary, but they cannot stop the feeling of needing to wash and re-wash. Similarly, compulsions to check may involve repeatedly checking light and power switches to ensure that they are off, or checking locks to ensure that they are secure, despite knowing that they had just checked them.
These compulsions and obsessions may take up many hours of a person’s day. They can intrude into many routine activities and actions – for example, walking, eating, opening a door and reading may involve complex rituals.
The following OCD Checklist describes common obsessions and compulsions experienced by people with OCD and includes a short questionnaire which you can fill in and take with you when you see your health care professional.
Treatment for OCD
Empirically-validated treatments for obsessive compulsive disorder are available in the form of psychological treatments involving cognitive-behaviour therapy (CBT), and can produce marked improvement that is commonly maintained in the long term. Specific pharmacological treatments may also be helpful, however the effects of medication used on their own are generally maintained only as long as the medications are continued.