Obsessive Compulsive Disorder: Do you know the facts?

OCD image

Most people have probably heard the of term ‘OCD’ and know that it stands for ‘obsessive compulsive disorder’.  But few people actually know what OCD is and even fewer recognise how debilitating it can really be.  In this weeks blog we look at the signs and symptoms of OCD and  explore how it can be linked to disordered eating.

What is obsessive-compulsive disorder?

OCD has two characteristic elements:

1. obsessions (undesirable, recurrent, intrusive, distressing thoughts and worries)

2. compulsions (repetitive or ritualized physical or mental behaviors).

Most people with OCD will experience both obsessions and compulsions.  A smaller number of people experience obsessions without compulsions and an even smaller number of people will perform compulsions without an awareness of their feared or obsessional thoughts.

OCD usually starts in childhood or teenage years.  At its most severe a person with OCD might spend all day performing ‘compulsions’ such that they are unable to leave the hose, hold down a job or maintain relationships.  OCD tends to get worse with time so it is always worth seeking help as early as possible and as soon as the OCD start to become a problem.

What is the link between obsessions and compulsions?

In OCD obsessions and compulsions do not happen independently.  The compulsions usually happen to stop the obsessions from happening, to reduce anxiety or distress resulting from the obsession, or to prevent an obsessional thought from becoming a reality. Examples of this might be someone who hand washes to prevent an obsessional fear of germs.

Obsessions and compulsions are in fact not uncommon among most people – almost all of us will experience an intrusive unwanted thought from time to time.  There are also many things that people do in a particular or repetitive way.  To meet criteria for OCD, obsessions and impulsions must evoke significant distress, must be time consuming, and must interfere with a persons normal functioning.

Understanding obsessions

94% of the population will experience unwanted intrusive thoughts.  These are thoughts or images that seem to come from nowhere that people usually would not want to admit to having.  In OCD these intrusive thoughts or images  occur repeatedly (much more frequently than in someone without OCD) and are experienced as being outside of a persons control. The thoughts or images are unwanted and they evoke significant distress in the individual when they do occur.  Overtime, these obsessions start to occur more and more frequently such that they start to interfere with normal activities like socialising or working.  Common obsessional thoughts include:

  • Contamination (thoughts about germs and disease, dirt, chemical contamination, fear of getting a physical illness or disease)
  • Losing control (fear of acting on a urge to harm oneself or another person, fear of stealing things or yelling out insults)
  • Perfectionism (extreme desire for things to be even or exact, concern with a need to know or remember something important, inability to decide whether to keep or discard things)
  • Harm (fear of being responsible for something horrible happening or of not protecting others through not being careful enough)
  • Unwanted sexual thoughts (forbidden or unwanted sexual thoughts or images)
  • Religious obsessions (concern with offending god, superstitious ideas about lucky or unlucky numbers or colours)

We don’t really know why obsessions occur in some people more than others although a number of different theories have been proposed.  We will cover these theories in a separate blog post.

Understanding compulsions

An example of a ‘normal’ compulsion might be a bedtime or cleaning routine –  doing something in the ‘same’ way repetitively.  In OCD compulsions ‘have’ to be performed.  The thought of not performing the compulsion evokes extreme anxiety usually because the person fears that not performing it will result in a disastrous consequence.   Common compulsions in OCD might include:

  • Washing and cleaning (hand washing; excessive cleaning or washing to remove or prevent contamination)
  • Checking (checking that you didn’t harm someone, make a mistake, that nothing terrible has happened or checking a part of your body)
  • Repeating (rereading or rewriting; repeating routine activities; repeating body movements e.g. tapping, touching, blinking; repeating activities in multiples of the same number)
  • Mental compulsions (praying, counting, mentally reviewing events to ensure you did things ‘right’ or didn’t do wrong)
  • Avoiding (situations that may trigger obsessions or certain words or numbers that might be ‘unlucky’)
  • Order / symmetry (putting things in order or in a certain place so that it feel ‘right’)

Over time, both obsessions and compulsions usually occur more frequently as the person works harder either to stop themselves from having the intrusive thought, or to prevent the intrusive thought from becoming a feared reality.

OCD and Eating Disorders

Whilst OCD and eating disorders are different disorders, they can be related and often coexist.  Some of the ways in which OCD and eating disorders can be related include:

  • OCD may result in an ‘eating disorder’.  For example when a person becomes unable to eat either through fear of contamination by food or because their compulsions become so time consuming.  It might look as though someone is suffering from an eating disorder when actually they have a severe form of OCD.
  • OCD may be caused by low weight – as weight drops behaviours tend to become more obsessive and ritualised – this is a result of the brain being starved.  In these instances, OCD type behaviours tend to resolve with weight gain.
  • The OCD might overlap with an eating disorder – obsessions may be specifically about becoming fat or gaining weight, and compulsions may be about restrictive eating or exercise
  • An eating disorder may be used to ‘resolve’ OCD – occasionally low weight or a focus on food and weight may temporarily distract someone aware from their OCD obsessions.  This means that an eating disorder might be used as a way or reducing distress caused by the OCD.  In these circumstances, as the eating disorder is resolved, OCD behaviours may increase unless they are also effectively treated.

What treatment is available?

Treatment for OCD is highly effective in people who want to stop the compulsions.  CBT is the treatment with the best evidence base and this is often used in combination with education to reduce anxiety.  Around 75% of people will make a full recovery from OCD with appropriate and specialist treatment.

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