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.
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.
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.
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:
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.
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:
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.
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:
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.