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Trigger warning: this episode contains discussion about suicide and self-harm.
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If you feel suicidal call 999 immediatly
If you need to talk you can contact:
Mental Health Resources:
Rethink Mental Illness
Mind The Mental Health Charity:
- Infoline: 0300 123 3393 (Our lines are open 9am to 6pm, Monday to Friday (except for bank holidays)
- Text: 86463
Obsessive Compulsive Disorder
Imagine that your mind gets stuck on a particular thought or image (which is the obsessive thought)
Then this thought or image gets constantly replayed in your mind, over and over and over again no matter what you do . . .
It’s not like you want these thoughts – it feels like an avalanche, its overwhelming . . .
Along with these thoughts you start to have intense feelings of anxiety . . .
Anxiety is a normal emotion that people feel because this emotion tells you to respond, react, protect yourself and do something to reduce that anxiety. It’s our brain’s warning system indicating that you’re in danger.
But this can cause confusion because on one hand, you recognize the fear you are feeling doesn’t make any sense, it’s not reasonable yet it feels real
But your brain is lying to you causing you to question why this would be happening?
Why would you be experiencing feelings if they weren’t true? Feelings don’t lie . . .
- Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
- Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
- Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
- Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colours, or arrangements.
- Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.
Unfortunately, if you have OCD, they do lie. If you have OCD, the warning system in your brain is not working correctly. Your brain is telling you that you are in danger when you are not.
When scientists compare pictures of the brains of groups of people with OCD, they can see that on average some areas of the brain are different compared to individuals who don’t have OCD. Those tortured with this disorder are desperately trying to get away from paralyzing, unending anxiety.
It becomes a vicious cycle:
How many people are affected?
- There are literally millions of people affected by OCD
- It’s the fourth most common mental illness in many western countries
- It affects men, women and children regardless of their race, religion, nationality or socio-economic group.
- Best estimates for the USA are about 1 in 100 adults – or between 2 to 3 million adults currently have OCD.1,2
- This is roughly the same number of people living in the city of Houston, Texas.
- There are also at least 1 in 200 – or 500,000 – kids and teens that have OCD.
- This is about the same number of kids who have diabetes.
- In terms of at school:
- Four or five kids in any average size elementary school will have been diagnosed with OCD.
- In a medium to large high school, there could be 20 students struggling with the challenges caused by OCD.3
- Current estimates suggest that 1.2% of the population have OCD, which equates to 12 out of every 1000 people
- Therefore, it can be considered that, approximately 741,504 people are living with OCD at any one time.
- 50% of all these cases will fall into the severe category, with less than a quarter being classed as having mild cases.
- These estimates are still considered to be underestimated
- Many people affected by OCD suffer in silence because of embarrassment and fear of being labelled.
- Others are unaware that their suffering is a recognised medical condition
Most of us have worries, doubts and superstitious beliefs. It is only when your thoughts and behaviour make no sense to other people, cause distress or become excessive that you may want to ask for help. OCD can occur at any stage of your life. If you experience OCD you may also feel anxious and depressed and you may believe you are the only one with obsessive thoughts.
- An obsession is an unwelcome thought or image that you keep thinking about and is largely out of your control. These can be difficult to ignore.
- These obsessions can be disturbing and are accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.”
- These OCD obsessions are time consuming and get in the way of important activities the person values, which is important as it determines whether someone has OCD — the psychological disorder — rather than having an obsessive personality trait.
- You might believe that something bad will happen if you do not do these things. You may realise that your thinking and behaviour is not logical but still find it very difficult to stop.
What Obsession in OCD is not
- Occasional thoughts about getting sick or about the safety of loved ones is normal
- Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD. While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxietythat gets in the way of day-to-day functioning.
Misuse of language
- We use “obsessing” or “being obsessed” commonly in every-day language.
- Casual uses of the word means that someone is preoccupied with a topic or an idea or even a person.
- “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it.
- You can be “obsessed” with
- A new song,
- A new TV series
- A podcast
- A food
- But you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession.
- In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.
- A compulsion is something you think about or do repeatedly (repetitive behaviour) to relieve anxiety. This can be hidden or obvious. Such as saying a phrase in your head to calm yourself. Or checking that the front door is locked.
- People with OCD are aware that they will only experience temporary relief and that the compulsion is not a solution but the problem is for them is that they feel that they don’t have a better way to cope.
- Compulsions can also include avoiding situations that trigger obsessions.
- These compulsions are time consuming and get in the way of day to day life.
- In most cases, individuals with OCD feel driven to engage in compulsive behaviour and would rather not have to do these time consuming and many times torturous acts.
What compulsions are not:
- Not all repetitive behaviours or “rituals” are compulsions. Bedtime routines, religious practices, and learning a new skill involve repeating an activity over and over again, but are a welcome part of daily life.
- Behaviours depend on the function and context:
- Arranging and ordering DVDs for eight hours a day isn’t a compulsion if the person works in a video store.
- Behaviours depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library.
- Certain activities such as Bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life.
- Similarly, you may have “compulsive” behaviours that wouldn’t fall under OCD, if you are just a stickler for details or like to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like.
Common OCD obsessions and compulsions
Like all other mental health conditions, OCD can only be diagnosed by a trained professional and there are no blood tests or brain imaging tests to diagnose OCD. The diagnosis is made based on the observation and assessment of the person’s symptoms.
OCD can start at any time from preschool to adulthood. Although OCD does occur at earlier ages, there are generally two age ranges when OCD first appears, between ages 10 and 12 and then between the late teens and early adulthood.
Related problems for people with OCD
Some people with OCD may also have or develop other serious mental health problems, including:
- depression – a condition that typically causes lasting feelings of sadness and hopelessness, or a loss of interest in the things you used to enjoy
- eating disorders – conditions characterised by an abnormal attitude towards food that cause you to change your eating habits and behaviour (we see that xxx has was misdiagnosed to begin with anorexia)
- generalised anxiety disorder – a condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event
- a hoarding disorder – a condition that involves excessively acquiring items and not being able to throw them away, resulting in unmanageable amounts of clutter
People with OCD and severe depression may also have suicidal feelings.
DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
- Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
- Repetitive behaviours (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviours or mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behaviour, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behaviour, as in autism spectrum disorder).
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.
With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.
Tic-related: The individual has a current or past history of a tic disorder.
- F42 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail.
- The 2018 edition of ICD-10-CM F42 became effective on October 1, 2017.
- This is the American ICD-10-CM version of F42 – other international versions of ICD-10 F42 may differ.
Type 2 Excludes – which means that these are considered separate disorders
- obsessive-compulsive personality (disorder) (F60.5)
- obsessive-compulsive symptoms occurring in depression (F32–F33)
- obsessive-compulsive symptoms occurring in schizophrenia (F20.-)
The following code(s) above F42 contain annotation back-references that may be applicable to F42:
Mental, Behavioural and Neurodevelopmental disorders
- Hoarding disorder
- Hoarding disorder co-occurrent with lack of insight and/or delusions
- Hoarding disorder w absent insight or delusional beliefs
- Obsessive compulsive disorder
- A disorder characterized by the presence of persistent and recurrent irrational thoughts (obsessions), resulting in marked anxiety and repetitive excessive behaviours (compulsions) as a way to try to decrease that anxiety.
- An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behaviour which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension.
- An anxiety disorder in which a person has intrusive ideas, thoughts, or images that occur repeatedly, and in which he or she feels driven to perform certain behaviours over and over again. For example, a person may worry all the time about germs and so will wash his or her hands over and over again. Having an obsessive-compulsive disorder may cause a person to have trouble carrying out daily activities.
- Disorder characterized by recurrent obsessions or compulsions that may interfere with the individual’s daily functioning or serve as a source of distress.
- Obsessive-compulsive disorder (ocd) is a type of anxiety disorder. If you have ocd, you have repeated, upsetting thoughts called obsessions. You do the same thing over and over again to try to make the thoughts go away. Those repeated actions are called compulsions. Examples of obsessions are a fear of germs or a fear of being hurt. Compulsions include washing your hands, counting, checking on things or cleaning. Untreated, ocd can take over your life researchers think brain circuits may not work properly in people who have ocd. It tends to run in families. The symptoms often begin in children or teens. Treatments that combine medicines and therapy are often effective.
Causes of OCD
John Greist Clinical Professor of Psychiatry, University of Wisconsin; International OCD Foundation Scientific Advisory Board
Maggie Baudhuin, MLS Coordinator, Madison Institute of Medicine, Inc.
The cause of OCD is complicated and no one really knows what factors might be involved, but here are some of the things that are thought to impact the development of OCD:
- family history – research has shown that you’re more likely to develop OCD if a family member has it, possibly because of your genes but these have been shown to only be partly responsible
- differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
- Research suggests that OCD involves problems in communication between the front part of the brain and deeper structures. These brain structures use a chemical messenger called serotonin. Pictures of the brain at work also show that in some people, the brain circuits involved in OCD become more normal with either serotonin medicines or cognitive behaviour therapy (CBT).
- life events – OCD may be more common in people who’ve experienced bullying, abuse or neglect and it sometimes starts after an important life event, such as childbirth or a bereavement
- personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, as may those who are generally quite anxious or have a very strong sense of responsibility for themselves and others
- time of onset – some experts think that OCD that begins in childhood may be different from the OCD that begins in adults. For example, a recent review of twin studies3 has shown that genes play a larger role when OCD starts in childhood (45-65%) compared to when it starts in adulthood (27-47%).
Studies find that it takes an average of 14 to 17 years from the time OCD begins for people to obtain appropriate treatment.
Stigma and things that reduce people seeking treatment
Some people choose to hide their symptoms, often in fear of embarrassment or stigma. Therefore, many people with OCD do not seek the help of a mental health professional until many years after the onset of symptoms.
- lack of public awareness of OCD, so many people were unaware that their symptoms represented an illness that could be treated.
- Lack of proper training by some health professionals often leads to the wrong diagnosis. Some patients with OCD symptoms will see several doctors and spend several years in treatment before receiving a correct diagnosis.
- Difficulty finding local therapists who can effectively treat OCD.
- Not being able to afford proper treatment if you are in countries that you need to pay or that the NHS has not been able to provide the services you need and you decide to go private.
- The medical profession has often considered OCD bizarre and as such assumed it to be rare. Families are often reluctant to talk about OCD due to the stigma attached to mental illness. Clearly OCD will have an effect on the sufferer, but it can be difficult to understand the effect it can have on their families. OCD is all-encompassing and all family members are inextricably involved with the sufferer’s illness.
In the UK There are two main ways to get help:
- visit your GP – your GP will ask about your symptoms and can refer you to a local psychological therapy service if necessary
- refer yourself directly to a psychological therapy service – search for psychological therapy services near you to see if your local services accept self-referrals
If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they seek help.
Note: OCD is unlikely to get better without proper treatment and support.
The main treatments in the UK are:
- psychological therapy – usually a special type of cognitive behavioural therapy (CBT)
- that helps you face your fears and obsessive thoughts without “putting them right” with compulsions working with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions encouraging you to face your fear and let the obsessive thoughts occur without neutralising them with compulsive behaviours – you start with situations that cause you the least anxiety first, before moving onto more difficult thoughts called – exposure and response prevention https://www.psychguides.com/guides/obsessive-compulsive-disorder-treatment-program-options/
- The treatment is difficult and may sound frightening, but many people find that when they confront their obsessions, the anxiety does eventually improve or go away.
- People with fairly mild OCD usually need about 10 hours of therapist treatment, combined with exercises done at home between sessions. A longer course may be necessary in more severe cases.
- medication if psychological therapy doesn’t help treat your OCD, or if your OCD is fairly severe – usually a type of antidepressant medication called selective serotonin reuptake inhibitors (SSRIs) that can help by increasing the levels of serotonin in your brain
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- You may need to take the medication for 12 weeks before you notice any effect.
- Most people require treatment for at least a year. You may be able to stop if you have few or no troublesome symptoms after this time, although some people need to take medication for many years. Your symptoms may continue to improve for up to two years of treatment.
- Don’t stop taking SSRIs without speaking to your doctor first, as this can cause unpleasant side effects. When treatment is stopped, it will be done gradually to reduce the chance of this happening. Your dose may need to be increased again if your symptoms return.
Possible side effects of SSRIs include:
There’s also a very small chance that SSRIs could cause you to have suicidal thoughts or want to self-harm. Contact your GP or go to your nearest accident and emergency (A&E) department if this happens.
Most side effects improve after a few weeks as your body gets used to the medication, although some can persist.
Further treatment in the UK
Further treatment by a specialist team may sometimes be necessary if you’ve tried the treatments above and your OCD is still not under control.
Some people with severe, long-term and difficult-to-treat OCD may be referred to a national OCD service.
This service offers assessment and treatment to people with OCD who haven’t responded to treatments available from their local and regional OCD services.
To be eligible for this service, you must have been diagnosed as having severe OCD and have received:
- treatment with at least two different SSRIs at recommended doses for at least three months
- at least two attempts at psychological therapy, both in a clinic and at home
- additional treatment with another medication, such as a different type of antidepressant called clomipramine, or an SSRI at a dose higher than normally recommended
Most people’s condition improves after receiving treatment from a national OCD service.
Living with OCD can be difficult. In addition to getting medical help, you might find it helps to contact a support group or other people with OCD for information and advice.
The following sites may be useful sources of support:
OCD Action, OCD-UK and TOP UK can also let you know about any local support groups in your area.
Psychosurgery (only found information about this from America)
Psychosurgery is used to alleviate symptoms of obsessive-compulsive disorder in patients who do not respond to medications or behavioural therapy.
As per the International OCD Foundation, four types of brain surgery have proven effective in treating OCD. They are listed on the OCD UK website but it was unclear if these are offered
anterior cingulotomy. Which involves drilling into the skull and burning an area of the brain called the anterior cingulate cortex with a heated probe. This surgery has provided benefits for 50 percent of those with treatment-resistant OCD.
- anterior capsulotomy
- . This surgery is similar to the anterior cingulotomy surgery, but doctors operate on a different area of the brain called the anterior limb of the internal capsule. The surgery has succeeded in giving relief to 50 to 60 percent of patients with treatment-resistant OCD.
- the gamma knife. This treatment does not involve opening the patient’s skull. Rather, the skull is penetrated by multiple doses of gamma rays. While a single dose of gamma rays will not harm brain tissue, when multiple sources of gamma rays intersect, they create an energy level adequate to destroy targeted brain tissue. The gamma knife procedure has been helpful to about 60 percent of treatment-resistant OCD patients.
- deep brain stimulation (DBS). Although this procedure requires opening the patient’s skull, it does not involve destroying brain tissue. Instead, electrodes are placed at strategic points inside the brain and wired to a pulse generator. The battery-powered generator, also called an implantable neurostimulator, sends pulses to the brain. It works in a similar fashion to a pacemaker. So far, only small studies have been conducted with deep brain stimulation, but the response rate is similar to the other surgeries.
Supporting someone with OCD
Families and OCD Barbara Livingston Van Noppen, PhD Associate Professor, University of Southern California International OCD Foundation Scientific Advisory Board
1. Do not regard OCD as the person’s fault and try not to believe that you or anyone else may have caused it. If the person decides to seek professional help, be supportive of that decision and encourage their determination to recover. Help your family member find the right treatment. The best treatment usually includes medicine, cognitive behaviour therapy, and family education and support.
2. Encourage the person with OCD to persist with their treatment, even when this seems difficult, and show appreciation of any improvement, however small.
3. Learn how to respond if your family member refuses treatment
- Bring books, video tapes, and/or audio tapes on OCD into the house. Offer the information to your family member with OCD or leave it around (strategically) so they can read/listen to it on their own.
- Offer encouragement. Tell the person that through proper treatment most people have a significant decrease in symptoms. Tell them there is help and there are others with the same problems. Suggest that the person with OCD attend support groups with or without you, talk to an OCD buddy through online support groups, or speak to a professional in a local OCD clinic.
- Get support and help yourself. Seek professional advice/support from someone that knows OCD and talk to other family members so you can share your feelings of anger, sadness, guilt, shame, and isolation.
- Attend a support group. Discuss how other families handle the symptoms and get feedback about how you can deal with your family member’s OCD. To find a list of support groups in your area, visit www.ocfoundation.org
4. Remember that symptoms may wax and wane. Some days, the person may be able to deal with symptoms better than others. Each person needs to overcome their problems at their own pace, even though this may be a lengthy process.
5. Learn about OCD Education is the first step, the more you learn, the more you will be able to help. You can:
- Read books on OCD
- Join the International OCD Foundation
- Attend OCD support groups
- Research online
6. Allow the person to explain their problems to you. This will help them to feel less isolated and ashamed of their condition. The symptoms may seem unrealistic and irrational to you, but the fear for the person with OCD, is very real.
7. While supporting the person with OCD, try not to support the obsessions and compulsions. The International OCD Foundations calls this recognising and reducing “Family Accommodation Behaviours” Family Accommodation Behaviours are things families do that enable OCD symptoms. Families are constantly affected by the demands of OCD. Research shows that how a family responds to the OCD may help fuel OCD symptoms. The more that family members can learn about their responses to OCD and the impact they have on the person with OCD, the more the family becomes empowered to make a difference! Here are some examples of these problematic behaviours:
- Participating in the behaviour: You participate in your family member’s OCD behaviour along with them. Example: washing your hands whenever they wash their hands.
- Assisting in avoiding: You help your family member avoid things that upset them. Example: doing their laundry for them so that it is cleaned the “right” way.
- Helping with the behaviour: You do things for your family member that lets them do OCD behaviours. Example: buying large amounts of cleaning products for them.
- Making changes in Family Routine: Example: you change the time of day that you shower, or when you change your clothes.
- Taking on extra responsibilities: Example: going out of your way to drive them places when they could otherwise drive themselves.
- Making changes in leisure activities: Example: your family member gets you to not leave the house without them. This affects your interests in movies, dinners out, time with friends, etc.
- Making changes at your job: Example: you cut back on hours at your job in order to take care of your family member.
Note: The worst thing to do is to give reassurance to the person that their fears are unfounded. If you do this, the person will not learn this for themselves and the disorder will persist. Encourage the person to challenge the obsessions and compulsions.
8. People with OCD are often aware of the humorous aspects of their obsessions and compulsions. This awareness can be used to help them distance themselves from the condition. However, resist mocking the person’s symptoms as this may cause additional stress, shame and embarrassment.
9. At home, people with OCD should be encouraged to maintain as normal a lifestyle as possible. Families should not try to adapt their ways of doing things to accommodate the person’s obsessions and compulsions.
10. Remember that OCD is tough for families to deal with. Continue to communicate with each other. Remember also that the family, friends and carers of people with OCD need help and support themselves. Make sure you continue to do things you enjoy and have people to talk to about your own feelings and concerns.