Obsessional Compulsive Disorder
The
extent of the problem
About 2% of the population suffer from OCD at some point
in their lives. It is more common that previously thought
and has received a lot of attention in the media. These
reports are not always correct, the terms ‘obsession’ and
‘compulsion’ being applied to various psychological difficulties
such as gambling or overeating which are in fact quite different
from OCD. A number of famous people are thought to have
suffered from the problem such as Charles Darwin and Florence
Nightingale.
What
is OCD?
Obsessions are ideas, thought, images or impulses that are
senseless and ‘get in the way’. They continue even though
a person may try to ignore or forget about them.
Obsessional
compulsive disorder refers to the combination of these obsessions
with fear and guilt, or other unpleasant emotions, which
together drive the sufferer to carry out compulsions to
try and rid themselves of the worry.
Compulsions,
also called rituals, are usually actions that are repeated,
but sometimes are thought patterns that are performed to
rid oneself of a disturbing obsession. Rituals are usually
carried out according to certain rules or in a rigid fashion,
and are clearly excessive. The person recognises that the
rituals are not reasonable but feels unable to control them.
Examples include hand washing, checking or mentally repeating
phrases.
OCD
can take many forms. Some people are bothered by thoughts
of contamination by germs or chemicals; some are preoccupied
by thoughts of causing accidents or injury; others focus
on fears about home security and safety.
Effects
of OCD
The severity of the problem varies a lot. Obsessional problems
can and do take over peoples lives, making regular employment
or family life impossible. People find they have little
or no time for anything other than a pattern of checking
or worrying or washing.
When
troubled by their OCD people experience high levels of discomfort.
Sometimes this anxiety, sometimes this is feeling miserable
or depressed, other times it is just a very unpleasant feeling
that things are not right.
Causes
No single cause has been identified for OCD. Research so
far has failed to come up with any support for the cause
being a chemical imbalance in the brain.
Those
who suffer from OCD vary widely in their personality characteristics
and life circumstances. These is some research evidence
to suggest that certain types of upbringings and family
rules may increase types of upbringings and family rules
may increase the likelihood of OCD.
We also
know that the types of thoughts which trouble people suffering
from obsessions, occur from time-to-time in almost everyone.
For example, it is extremely common for new parents to have
upsetting intrusive thought about harming the new baby.
Research has shown that it isn’t possible to tell the difference
between normal intrusive thought occurring in people without
obsessional problems and the thoughts experienced by OCD
sufferers. What is different is what these thoughts mean
to them. A person who doesn’t have OCD can see an intrusive
thought, however strange, is ‘just a thought’. People experiencing
obsessional problems become upset by the intrusion, and
believe it may make them responsible for harm. This then
effects what they feel they must do. Sufferers feel they
should not ignore the thought but try very hard to ‘push
it away’ or else to ‘put it right’ by some other thought
or action. Unfortunately both these strategies make the
thoughts worse, and so the vicious circle of OCD develops.
Treatment
The most widely accepted form of psychological treatment
for OCD is Behavioural Therapy. This takes the form of a
structured programme of self re-education. Sufferers have
to confront repeatedly what they fear (a process called
‘exposure’) beginning with the easiest situations and progressing
through till all the feared items have been faced. At the
same time, the person must not perform any rituals or checks
(response prevention). In some programmes rituals are reduced
gradually; in others compulsions are prevented altogether.
The therapist does not use force, but relies on the persons
own motivation to overcome the urge to ritualise. Up to
50% of sufferers can be helped by this method. A greater
understanding of the role of cognitions in OCD has lead
to the development of a Cognitive Behavioural approach to
the problem. This provides sufferers with a new framework
for understanding their experiences. Through this they are
helped to change what they understand their obsessional
thoughts to mean, and what it is necessary to do about them.
Medication
of the type which effects the serotonergergic system has
also been proved to be effective for some sufferers. However,
since relapse very often occurs when the drugs are stopped,
they should probably be combined with psychological treatments,
especially for those who are depressed.
What
are Behavioural and Cognitive Psychotherapies?
Behaviour
Therapy, Cognitive Therapy and Cognitive Behaviour Therapy
have some common features. They are based firmly on research
findings and derive from specific theories. The focus is
mainly on the here-and-now, rather than the past, and the
main goal of therapy is to help bring about changes in the
person’s life which are measured and evaluated. Goals for
change may involve:
- A
way of acting eg. being more outgoing
- A
way of feeling
eg. being less scared or less depressed
- A
way a thinking eg. learning to problem solve or get
rid of self defeating thoughts
- A
way of dealing with physical or medical problems eg.
lessening the difficulties associated with back pain.
- A
way of coping eg. training developmentally disabled
people to care for themselves
Cognitive
or Behaviour Therapists may work with individuals, groups
or families, and therapy is time limited. The approaches
can be used to help any person – irrespective of intelligence,
insight or other abilities.
For more information on referring to the clinic please contact us on 01323 430831 or complete our online enquiry form.
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