OCD: From Symptoms To Treatment

First, what is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition characterised by excessive unwanted thoughts and subsequent compulsions, explains mental health and addiction recovery specialist Ray Sadoun. “In other words, patients with OCD obsess over a particular thought and then act out based on that thought. They may also practise avoidance to deal with certain thoughts. For example, they may have the recurring thought that they will die if they drive on the motorway, and so they always avoid the motorway.”

Forget perfectionism or being neat and tidy, as India Haylor, head therapist at OCD Excellence, explains – OCD can be a crippling disorder which results in a host of difficult behaviours: “OCD causes intrusive, repetitive thoughts that cause intense anxiety (obsessions) and the urge to do something to relieve that anxiety (compulsions).”

What are some of the main symptoms to look out for?

As OCD involves obsessions and compulsions, the symptoms can be separated into these two sections, says Ray. “First, obsession-related symptoms: having recurring thoughts on a regular basis, having unwanted thoughts, believing cleanliness will solve your problems, needing to be on time for everything, questioning yourself all the time, and fantasising about harming yourself or others. Meanwhile, compulsion-related symptoms include keeping your house extremely clean at all times, doing safety checks over and over again before leaving the house, excessive hand washing, avoiding going out, and repeating phrases to yourself. Obsessions usually have a theme, explains India, so some key symptoms to look out for are:

• Extreme fear of germs or dirt

• Fear of hurting yourself or someone else

• All-consuming, disabling need for perfection, e.g. keeping environment tidy, appearance, etc.

• Intensely heightened awareness of bodily functions such as breathing, blinking, and your heartbeat, etc.

• Overwhelming health anxiety, e.g. brain tumour, heart disease, etc.

• Taboo sexual thoughts that cause huge amounts of distress

• Intense uncertainty regarding sexuality, e.g. straight people worrying they are gay, gay people worrying they are straight, etc.

• Blasphemous thoughts that are against your religious beliefs

What are some of the main risk factors?

“We aren’t yet entirely clear regarding the exact risk factors for OCD,” admits India. “The eventual answer is likely to be a combination of biological, social and psychological factors. It is already established that some cases of childhood onset of OCD are triggered by an auto-immune response to streptococcal infections (PANDAS). Other factors may include co-existing disorders and trauma.”

Is it different to perfectionism?

OCD and perfectionism may influence one another, but they are not the same and can exist independently, explains India. “Perfectionism is a personality trait that causes a need for things to be 100% flawless. This can exist in many OCD compulsions, but perfectionists are not usually completely debilitated by this trait. A person with OCD however, would likely struggle to go about their day if a ritual, such as checking the stove is switched off, is not performed perfectly.”

Ray adds: “OCD is not the same as being a neat freak. When you have OCD, you don’t like your compulsive behaviour. You don’t necessarily keep everything clean because you prefer it that way, but because you fear something bad will happen if you don’t. Neat freaks do not experience extreme distress if something is out of place, unlike some people with OCD. Though people with OCD are more likely to be perfectionists, not every perfectionist has OCD. The main difference is stress-related; OCD destroys people’s lives, whereas perfectionism is much more minor.”

Is it genetic?

In short, yes, OCD can be inherited. “The brain structure of people with OCD is different to that of a neurotypical brain structure,” explains Ray. “However, OCD is also partly linked to one’s environment, too. But if you have a family member with OCD, you are more likely to develop the condition yourself. The same can be said for having other mental health conditions – people with depression, anxiety or ADHD are more likely to experience OCD.”

Do lots of people incorrectly refer to themselves as OCD? 

Many people are not aware of the severity of OCD, so they believe it’s acceptable to light-heartedly refer to themselves as having the disorder, warns Ray. “This is incredibly unhelpful as it downplays the disorder and makes sufferers feel as though they are exaggerating their distress.”

According to India, increased awareness of OCD in the popular media may be to blame for the widespread, inappropriate use of the term ‘OCD’.  “It seems to be used interchangeably with ‘perfection’ and ‘attention to detail’,” she says. “Movies such as As Good As It Gets and the US TV series Monk have portrayed OCD in a comedic setting with the ultimate outcome that OCD has been trivialised in the media and associated with cleaning, neatness and order which is wholly unrepresentative of the full spectrum of symptoms and presentations, which are often dark and distressing.”

On that note, it seems more and more people are being diagnosed with OCD – why? 

“The more people are educated about mental health conditions, the more likely they are to identify symptoms in themselves,” says Ray. “People are learning about the reality of OCD rather than the stereotypes, and they are finding that they relate to the common symptoms. Most people go to their GP and request to be assessed for OCD. The GP will ask you questions and potentially provide you with a questionnaire to fill out. They may refer you to a psychiatrist to get an official diagnosis.”

“This may not be due to an increased prevalence but is more likely a reflection of increased public and clinical awareness and improved diagnostics,” posits India. “Assessments are the first step. At OCD Excellence, we start with 50-minute assessments to give us an indication of whether OCD is present and its severity. As OCD can manifest in countless different ways, we also identify the primary and secondary sub-types before making a treatment proposal.”