OCD Obsessive Compulsive Disorder

Many people consider OCD to be characterised by checking taps and lights are turned off and being repetitive in behaviours like locking doors. In reality, although these features do exist, especially in low functioning and younger cases, the most commonly seen examples involve obsessive and intrusive thoughts and images.

Modern neurology advances mean that we understand the different pathways that cause anxiety, and now how to disrupt them using methods based on science. OCD is a form of rumination and perception based anxiety, often found along side other anxiety of emotional issues.

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by obsessions and compulsions: 

• Obsessions: These are unwanted, intrusive, and persistent thoughts, urges, or images that cause anxiety or distress. Common obsessions include fears of contamination, harm, unwanted thoughts, or a need for symmetry or order. 
• Compulsions: These are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. Compulsions are aimed at reducing anxiety or preventing a feared outcome, but they are often excessive or not realistically connected to the obsession. Common compulsions include washing, checking, counting, ordering, and mental rituals. 

Key Features of OCD:

• Time-consuming: Obsessions and compulsions can take up a significant amount of time each day, often more than an hour.
• Distressing: OCD causes significant distress and interferes with daily life, work, school, or relationships.
• Ego-dystonic: Most people with OCD recognize that their obsessions and compulsions are excessive or unreasonable, but they feel unable to control them. 
• Cycle of anxiety: Obsessions trigger anxiety, which leads to compulsions to reduce the anxiety. However, this relief is temporary, and the cycle starts again. 

Common Obsessions and Compulsions:

• Contamination: Fear of germs, dirt, or illness; excessive washing and cleaning. 
• Harm: Fear of causing harm to oneself or others; checking behaviors (e.g., repeatedly checking locks, appliances).
• Unwanted thoughts: Intrusive thoughts of a sexual, violent, or blasphemous nature; mental rituals to neutralize these thoughts.
• Symmetry and order: Need for things to be symmetrical, ordered, or perfect; arranging and rearranging objects. 
• Hoarding: Difficulty discarding possessions; accumulating excessive clutter. 

Causes of OCD:

The exact causes of OCD are unknown, but research suggests a combination of factors:

• Genetics: OCD tends to run in families. 
• Brain structure and function: Differences in certain brain regions and neurochemicals may play a role. 
• Environment: Stressful life events or trauma can trigger or worsen OCD symptoms.
• Learning: OCD behaviors can be learned through reinforcement (compulsions temporarily reduce anxiety).

Diagnosis:

OCD is diagnosed based on a clinical evaluation that includes:

• Detailed history: Gathering information about symptoms, their duration, and their impact on daily life.
• Assessment tools: Standardized questionnaires, such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), can help assess the severity of OCD.
• Ruling out other conditions: It’s important to differentiate OCD from other mental health conditions with similar symptoms, such as anxiety disorders or tic disorders.

Treatment:

Effective treatments for OCD are available and often involve a combination of:

• Therapy: Cognitive behavioral therapy (CBT), particularly exposure and response prevention (ERP), is considered the gold standard treatment for OCD. ERP involves gradually confronting feared situations and resisting compulsions. 
• Medication: Certain medications, such as selective serotonin reuptake inhibitors (SSRIs), can help reduce OCD symptoms.
• Other approaches: Mindfulness-based techniques, relaxation training, and support groups can also be helpful.

Neuro-divergent clients, such as those with forms of ASD Autism often have a form of OCD. This however is similar but not the same and should be handled differently by a specialist trained in ASD support.

Intrusive Obsessive Thoughts

By far the most disabling and severe OCD usually seen in practice involves thought processes rather than behaviours.

A crucial point to remember is that the thoughts are driven by severely painful anxiety.  This is the underlying nature of the condition and it decides the nature of the thoughts and images.  The more troubled and anxious the person, the more painful the thoughts and images.

A second crucial point is that the thoughts and images are not literal! How horrible they are correlates to how upset and anxious the person. What happens in the image or thought is not literal, but representative of the level of pain. Therefore if the images show the person hurting a loved one, it does NOT mean a suppressed desire to actually hurt anyone. What it does represent is emotional pain consistent with the level of upset you would experience if your loved one was hurt.

Its a bit like your unconscious saying:

“I’m so hurt and anxious and freaked out, its like someone was hurting your closest friend, its that bad!”

Typical types of OCD intrusive thoughts

OCD intrusive thoughts are usually thoughts about the thing that is the most horrifying alien thing to you personally. People who love pets might have images of hurting their cat or dog. Loving husbands might imagine hurting their wives. People who hate harm to children might imagine hurting a child. People may imagine violence, psychological cruelty or even sexual violence. The content of thoughts or images are not literal, they are symbolic and represent horror.  It is common for sufferers to become terrified that they are secretly likely to carry out the thoughts or images, which is actually incredibly unlikely, since by definition they are whatever horrifies us most.

“I can’t stop thinking about things”
“Bad thoughts keep entering my mind, I can’t get rid of them”
“Awful things I would never do keep playing out in my mind”
“I keep seeing myself hurting myself”
“I keep seeing myself hurting people I love”
“I’m afraid I am going to do something awful / violent / sexually deviant”
“I am afraid people are going to find out I’m actually a terrible person inside”

What causes OCD Obsessive intrusive thoughts and behaviours?

OCD is driven by underlying anxiety related mental health conditions. Typically this would be an anxiety disorder, clinical anxiety, Generalised Anxiety Disorder, or more complex conditions such as Bipolar or borderline personality disorder. Often anxiety conditions may not have been diagnosed.  The anxiety drives the unconscious into producing intrusive thoughts and sometimes obsessive behaviours.

In theory the mind is trying to get our attention, and to galvanise into urgent action to evade some source of anxiety, and it is sometimes thought that this is a function of our civilisation having out grown our responses in complexity. No longer are our lives about immediate survival, but instead tends to be about complex interactions.

Origin is often developmental, complex and or interpersonal relationship based. It is not unusual for the origin to be multiple source, or for other diagnosis to be present or likely.

The actual process involves the thinking part of the brain feeding the anxiety centre of the brain with a stream of anxiety stimulus which spirals with more rumination. This is different to the trigger style pathway (neuroception) that is seen in startle anxiety response.

Treatment for OCD Obsessional Compulsive thoughts and behaviours

OCD is usually treated according to NICE and research related guidance for treating anxiety related disorders. This often involves cognitive behavioural based psychological therapies such as Cognitive Behavioural Therapy, Cognitive Behavioural Analysis including CBASP and mindfulness based therapies including MBSR. (see research and NICE sources quoted on the CBT, CBASP, Mindfulness pages).

It is important to both disrupt the thought processes as much as possible using methods such as CBT and Mindfulness, and to address underlying causes for longer term relief.

Treatment available in Edinburgh, Glasgow, Dublin and Falkirk

Stuart’s main base is Edinburgh. Stuart uses integrative psychotherapy, combining NICE and research evidenced methods with a holistic and multi modal approach to customise for individual need.

Stuart completed the Certified Clinical Anxiety Treatment Professional (CCATP) process, a post graduate and post qualification award available internationally for specialists in anxiety

Key Words
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