Obsessive Compulsive Disorder

  • What is Obsessive-Compulsive Disorder (OCD)? +

    Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with obsessive-compulsive disorder (OCD) feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life.

    The frequent upsetting thoughts are called obsessions. To try to control them, a person will feel an overwhelming urge to repeat certain rituals or behaviours called compulsions. People with OCD can't control these obsessions and compulsions. Most of the time, the rituals end up controlling them.

    For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

    Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence) or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

    Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognise that what they are doing is senseless, some adults and most children may not realise that their behaviour is out of the ordinary.

  • Causes +

    OCD sometimes runs in families, but no one knows for sure why some people have it while others don't. Researchers have found that several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.

  • Signs & Symptoms +

    People with OCD generally:

    Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; acts of violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly tidy
    Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again
    Can't control the unwanted thoughts and behaviours
    Don't get pleasure when performing the behaviours or rituals, but get brief relief from the anxiety the thoughts cause
    Spend at least one hour a day on the thoughts and rituals, which cause distress and get in the way of daily life
  • Who Is At Risk? +

    For many people, OCD starts during childhood or the teen years. Most people are diagnosed by about age 19. Symptoms of OCD may come and go and be better or worse at different times. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

  • Diagnosis +

    The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.

    OCD can be accompanied by eating disorders, other anxiety disorders or depression. First, talk to your doctor about your symptoms. Your doctor should do an exam to make sure that another physical problem isn't causing the symptoms. The doctor may refer you to a mental health specialist.

  • Treatments +

    Papillon treats OCD with psychotherapy, medication, or both.

    Psychotherapy

    A type of psychotherapy called cognitive behaviour therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of therapy called exposure and response prevention is especially helpful in reducing compulsive behaviours in OCD.

    Medication

    Doctors also may prescribe medication to help treat OCD. The most commonly prescribed medications for OCD are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.

    Antidepressants are used to treat depression, but they are also particularly helpful for OCD, probably more so than anti-anxiety medications. They may take several weeks—10 to 12 weeks for some—to start working. Some of these medications may cause side effects such as headache, nausea or difficulty sleeping. These side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects you may have.

    It's important to know that although antidepressants can be safe and effective for many people, they may be risky for some, especially children, teens and young adults. A "black box"—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. Anyone taking antidepressants should be monitored closely, especially when they first start treatment with medications.

    Some people with OCD do better with cognitive behaviour therapy, especially exposure and response prevention. Others do better with medication. Still others do best with a combination of the two. Talk with your doctor about the best treatment for you.

    OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitised) to them.

  • Living With +

    It is important to communicate clearly that you understand the difference between the behavioural symptoms of OCD and the person: "I know this is not you, this is your OCD." This will help to diminish the person’s feelings of guilt and low self-worth and reduce their levels of stress and anxiety. Other suggestions include:

    Encourage the person to talk about the disorder so that you can learn how it affects them and how you can be more supportive, but don’t engage in discussions about the logic of OCD as most people with OCD know their obsessions and compulsions are excessive and irrational.

    Encourage the person to seek professional help. OCD is generally not a condition that will go away without treatment. You can assist in locating an experienced therapist and offer to be involved in their treatment program. If the OCD has involved you or other family or friends extensively in rituals and avoidance behaviours, you will need to know the best ways to modify your involvement so that the treatment can be as effective as possible.

    Encourage discussion about OCD as a common and treatable anxiety condition that is nothing to be embarrassed or ashamed of. Support the person with OCD to share their experiences with family and friends – this will help to break the secrecy about OCD.

    Acknowledge improvements, however small, and encourage the person to reward themselves for their progress.Try to be patient and maintain a non-judgemental attitude – this will support the person to focus their efforts on recovery rather than dealing with anger and resentment.If their motivation wanes and they consider stopping treatment, remind them of the gains they have made.

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