Obsessive Compulsive Disorder
By Deborah Condon
Imagine you are walking somewhere with a pen in your mouth. A thought may enter your head - 'what if I were to fall, what damage could this pen do?' You might shudder at the thought and remove the pen from your mouth, you might even laugh that such a notion entered your head in the first place. Or you may simply carry on as you were.
However to some people, that thought may cause such stress that they literally become obsessed with it. This is one of the symptoms of OCD (obsessive compulsive disorder).
"The 'pen in the mouth' analogy is a good way of explaining OCD. Where we can laugh it off, the person with OCD can get so caught up with the thought that something bad is going to happen, they have to create a ritual to make that thought go away", explained Leslie Shoemaker, a counselling psychologist who specialises in this area.
The exact cause of OCD is unknown, however it is widely considered to be a disorder of the brain. While it is not known how many Irish people are affected, international research suggests that 2 - 3% of the population has it - that is one in every 33 - 50 people.
"Many of those affected have mild OCD. However it can be severe. I have dealt with people who are unable to work and whose relationships with family and friends are impaired as a result of the disorder", Ms Shoemaker told irishhealth.com.
While OCD has been highlighted in films such as The Aviator and As Good As It Gets, the condition can be difficult to explain and understand, even among health professionals. In fact, American research indicates that those affected see, on average, three to four doctors over a nine year period, before they receive a correct diagnosis. Obtaining appropriate treatment can take even longer.
So what exactly are obsessions and compulsions and how do these 'work' in relation to OCD?
Obsessions are generally regarded as unwanted and intrusive thoughts, images and urges that can cause a person anxiety when they occur. The person with an obsession may see it as senseless, upsetting and difficult to discuss. The difficulty with OCD is that once an obsession has occurred, it brings about feelings of discomfort, anxiety and an urge 'to put things right'. When the person acts on this urge, this is known as a compulsion.
In other words, the compulsive behaviour is carried out to make the thought (obsession) go away, which reduces the anxiety and discomfort being experienced by the person affected. A simple example of this could be a person who has an obsession with contamination and has to wash their hands five times after touching a particular object.
There are a range of topics that people can becomes obsessed with, including:
-Health/contamination, e.g. germs, illnesses.
-Morals/religion, e.g. excessive concerns about right and wrong.
-Symmetry/order, e.g. items on a shelf must be placed in an exact place and order.
-Checking behaviours, e.g. repeatedly checking that doors are locked or that appliances such as ovens and irons are switched off.
-Hoarding/collecting, e.g. not being able to throw away items such as old newspapers or having to minutely inspect rubbish bags to ensure nothing valuable has been thrown out.
Meanwhile compulsions, i.e. the act that is carried out to lesson feelings of anxiety, can be done in the head, such as counting, or they may be more obvious, such as continually checking that the oven is off.
One of the most obvious signs of OCD is the lack of rationality associated with it, according to Ms Shoemaker.
"When it comes to something like hoarding, many people may have problems throwing certain things out. People may not want to throw clothes out in the hope that some day they may fit back into them! However the person with OCD literally cannot throw items out. This is very irrational", she explained.
Another sign, she pointed out, is the 'ritualism' with which people carry out their compulsions.
"Compulsions can be very ritualised, very mechanised. A person with OCD, for example, may have a particular routine they follow when they are going to bed. Many of us have routines, but if we are interrupted, we don't notice and carry on or we do things in a different order. If a person with OCD has their routine interrupted, they have to start the entire ritual again", she said
As with most health problems in Ireland, a person seeking help for OCD will generally approach their GP first. People may choose to go to the doctor themselves or may be encouraged to do so by concerned family or friends.
The GP may deal with the disorder or refer the patient to a consultant psychiatrist. Ms Shoemaker emphasised that whether you are seeing a GP or psychiatrist, you should be comfortable that they are familiar with the condition and are in a position to treat it.
"I always advise patients to get as much information as they can about OCD and bring it with them to the GP or psychiatrist. Ask them if this is an area that they know about and if it is not, go elsewhere. It is also essential that you feel comfortable with your doctor", she said.
People with OCD may be treated with drugs, specifically SSRIs (selective serotonin re-uptake inhibitors), which are a type of antidepressant. Another typical form of treatment is cognitive behavioural therapy (CBT). It is widely accepted that this is the best type of therapy when it comes to treating OCD.
According to Ms Shoemaker, who works in the field of CBT, the aim of it is to give a person with OCD the tools to manage the disorder. This is done using a technique known as ERP (exposure response prevention), which involves exposing the person to their fear. For example, a person obsessed with germs or contamination may be brought into a public bathroom. The person will be helped to face their obsession, without having to use a compulsion to reduce their anxiety.
"CBT can work quickly or may take some time - every case is different. Unless it is a particularly urgent case, I will see a patient usually once a fortnight. Some of these meetings will take place outside of the therapy room for the purposes of ERP", she explained.
However apart from the fact that the disorder can be misdiagnosed or missed altogether, the lack of cognitive behavioural therapists is also a major cause for concern when it comes to OCD treatment, Ms Shoemaker points out.
These therapists mostly work on a private basis and many have waiting lists. The situation in the public arena is even worse. Some Health Service Executive (HSE) areas have no cognitive behavioural therapists for public patients at all and those that do have long waiting lists.
"You can be weeks to months waiting to see a cognitive behavioural therapist. More are definitely needed. It is also difficult to find a place to train if you want to work in this area, so more courses are needed", Ms Shoemaker added.
For more information on OCD, including support group details, click on...
If you would like to join the irishhealth.com discussion on OCD, click on...
I am concerned about my 12 year old son who I feel may be suffering from OCD. He went through a phase of washing his hands until they were red and sore. At the moment he has irrational fears, goes through a routine at bedtime i.e pushing the bed so many times each way and cannot bear anything to be out of place. He gets upset if he is not allowed to the shower every day and sometimes wants to go twice a day. I am very worried and would like to hear from anyone who has the same problem and what help there is
CBT, as mentioned in the article, is really the best way to go here Anon 21:42. The sooner your son gets access to this therapy the quicker he will over come this. One method uses, can be to get him to identify when these thoughts to himself, i.e. label them e.g. this is an OCD thought, OCD is a disease, then get him to actively change his thought to something else, he can have prepared before hand. It can be very slow at first, but if he can prevent himself from acting on the thought, a little bit longer each time, he will make progress. You could try this with him in the meantime, while you wait to see a therapist, but do try to get an appointment with a therapist as soon as possible.
Hi, Just to let you know OCD Ireland has provided links to CBT therapists and psychiatrists. Just use the menu on the left side of the website (OCDIreland.org) for 'Find a Therapist'. Good luck!
I'm so delighted about this article, raising awareness is so important for OCD sufferers because the actual figures of sufferers are more than likely a lot higher. Most of us just think we're going "mad" and are embarrassed about our obsessions and try to hide it for years, until we find out it's actually something very common! As a veteran OCD sufferer I've found the website OCD-UK very very helpful. Just reading about people with the same struggles makes you feel you're not alone with this "secret illness". I've never had the privilige of receiving CBT, but I've received a lot of support from people on OCD-UK (discussion forum).
This is similar to compulsions which I had during two phases of my life - and at both times it was after I experienced a loss. I wonder does this trigger it in some cases. After a loss we desire to contol (almost in an attempt to prevent another loss which e fear) and this manifests itself as OCD??
I had OCD as a child, manifesting itself mainly as a need to run through routines of tapping my fingers, arms, toes in particular symmetrical sequences. Also, all of my physical actions had to be symmetrical, if I lifted my right arm I then had to lift the left; followed by lifing the left arm first, then the right for perfect symmetry. I'm sure it looked quite bizarre. I also washed my hands compulsively and could only open doors using my elbows. As a teenager I grew out of the compulsive stuff and but began to suffer more from obsessive thoughts. A religion teacher at school stupidly remarked that she would be afraid to even think of selling her soul to the devil in case the thought alone would be enough to make it happen. Of course I couldn't stop thinking about it and it caused be great anxiety. I somehow grew out of this also, and am only troubled occasionally by obsessive thoughts. As I can now recognise them as such they don't cause as much anxiety and I can distract myself and break the cycle. I feel very lucky to have outgrown this horrible disorder.
To Anon aside from his other compulsiuons, his desire to take a shower every day may be perfectly normal as most of us shower daily.
To Mary - yes OCD is vey common following a loss, as we try to reduce natural anxiety by reverting to patterns of behaviour that should (but often don't) make us feel safe. To anonymous posted 11.09 on 02/03 - congratulations on dealing with your symptoms so sucessfully. I wish you the very best for the future, if during difficult times you feel like reverting to your rituals, at least you know they will pass with time and effort on your part.
my son has ocd and post traumatic stress disorder. he is very distressed he is only 16 and such a lovely lad in evey way but his life is constantly controlled by the repepative thoughts he says he doesnt want to live but he doesnt want to die either i have had him at councilling for years but he didnt specialise in ocd
i would like to know the name of all the metings in ireland as i have had it for over 30 years
i have suffered for about 35 yearssometimes very bad mostily pure o tipe i have never got proper help can anyone tell me whare the is help thank you
you have to have ocd to really know what it is like the fear that it brngs for 35 years i have it but never new what it was until started reading different articles about it-i would love to see more meeting places. i would love to get involved any ideas?
To ycf - there is an OCD support group in ireland who could advise you. If you look them up on the web I'm sure you'd find their contact details? Best wishes and i hope you find the help you need.