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Treating obsessive compulsive disorder

obsessive compulsive disorder
Posted by Dr Mortons 1 Comment

Written by Dr Tim Cantopher Consultant Psychiatrist and adviser to Dr Morton’s – the medical helpline

See Dr Morton’s understanding for mental illness

Obsessive compulsive disorder (abbreviated to OCD) is one of the most underdiagnosed conditions in psychiatry, mainly because it is often hidden by sufferers and their families through shame and fear. This is sad, as it is eminently treatable.

It isn’t difficult to understand why OCD happens. In my view it is much harder to explain why it doesn’t happen to everyone who is severely anxious. The brain is designed to make patterns out of things, to make sense of an apparently meaningless environment. It’s one of the reasons why we are a successful species; we organise our surroundings. Anxiety is defined as fear in the absence of a fearful object; it has no meaning, it’s just fear. The brain doesn’t like that, so it sometimes forms anxiety into spurious patterns, one form being OCD. So OCD is no more strange than anxiety organised.

Forms of OCD

OCD can take several forms. It may manifest as obsessions, ie repetitive thoughts which the sufferer feels compelled to think over and over, realising that they are false, resisting them, but suffering mounting anxiety which can only be assuaged by giving in to the thought. Typical obsessional thoughts include certain numbers, words, tunes or scenarios repeated a set number of times. Alternatively there may be compulsions, ie apparently meaningless actions which have to be performed a certain way, or number of times.

OCD usually includes an element of magical thinking, such as “unless I do this action/think this thought, something awful will happen to a loved one and I’ll never forgive myself.” One form involves obsessional doubting, in which the sufferer can’t decide between A or B. If I say “Go for A” he’ll go for B, then think “I should have gone for A” and end up oscillating indecisively for ages. He can be difficult to live with. Another common type has the person afflicted by the most horrible, repugnant and shocking thoughts she can imagine, such as “What if I murder someone I love?” Of course she would never act on these thoughts; their only meaning is that they are the most shocking thoughts her brain could create. Understandably, the ‘shocking’ type of obsessional thought tends to cause enormous distress and fear, and like other forms of OCD, feeds itself, the symptom creating more fear and therefore more OCD.

The first crucial principle in dealing with OCD is to realise that it means nothing, other than that you are too anxious. The disaster isn’t going to happen and you aren’t going to turn into a heinous criminal. Evil people don’t worry about being evil; if you suffer from OCD you’re not one of them.

Don’t hide the problem; you aren’t mad, it’s nothing to be ashamed of and it can be treated.

Treatment

Treatment for OCD can be very effective, though you have to be patient and stick to it for the long haul; it can take a while to resolve and may pop up in another form later on, but if you keep at it, you can win in the end. The mainstay of treatment is cognitive behavioural therapy (CBT), often incorporating mindfulness (these treatments are outlined in others of my online articles). Some medications, particularly SSRI antidepressants also have proven efficacy.

The first and most important step is to go to your GP. Don’t hide the problem; you aren’t mad, it’s nothing to be ashamed of and it can be treated.

 

Confidential online cognitive behavioural therapy (CBT) is available through our partnership with Thinkwell

thinkwell CBT service Dr Morton's referral

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Tags: cognitive behavioural therapy, OCD

One Response

  • john says:
    March 8, 2015 at 9:39 PM

    Thanks for this. I think this is the problem my sister has. I’ll see if I can get her some help

    Reply

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