At times, most people experience an upsetting thought, or feel the need to double-check something they know they have already checked. For example, going back to make sure the stove is turned off or the car is locked.
However, people with obsessive-compulsive disorder (OCD) have these types of experiences repeatedly and they interfere with their day-to-day life. The OCD thoughts and behaviours become very time consuming and distressing.
OCD is characterised by:
- recurring, persistent, and distressing thoughts, images or impulses, known as obsessions
- the need to carry out certain repetitive behaviours, rituals, or mental acts, known as compulsions.
Many people with OCD experience both obsessions and compulsions, whilst others have only one or the other.
Obsessions are not merely worries about everyday concerns, and compulsions are not simply habits. The symptoms of OCD are often upsetting to the individual and can lead to significant avoidance of situations which trigger their OCD thoughts or behaviours.
The repeated behaviours or rituals are generally carried out to reduce anxiety. Sometimes the compulsions (behaviours) are unrelated to the obsessive thoughts. However, the person feels a strong urge to carry out the compulsive behaviour (such as checking or washing) to prevent a feared situation (e.g., a thought that harm may come to someone they care about if they don’t complete the behaviour or ritual).
The sense of temporary relief provided by these behaviours, and the individual's reliance on them to manage anxiety, is part of the OCD cycle. As the worrying thought returns, anxiety or distress increases, and the individual feels the urge to repeat the OCD behaviour to experience the same relief, and the cycle repeats itself.
Symptoms
Common obsessive thoughts include:
- fear of contamination from dirt or germs
- overwhelming concern with personal safety or the safety of others
- needing objects to be organised in a certain way all the time
- thoughts inconsistent with a person's values, such as aggressive, sexual, or blasphemous thoughts.
Common compulsive behaviours include excessive or repeated:
- cleaning, for example, washing hands or scrubbing household surfaces
- checking, for example, whether doors are locked or appliances are switched off
- ordering, for example, placing objects in a particular pattern or making things look symmetrical
- mental acts, for example, reciting phrases in one's head or counting
- hoarding, for example, collecting old newspapers or other things that aren't useful or of value.
Causes
In certain individuals, a major life event such as a relationship breakdown, the loss of a loved one, or the birth of a child may be associated with the onset of OCD, though for others onset can be gradual with no identifiable trigger.
Factors linked to an increased risk of developing OCD include:
- A family history of OCD: People with OCD are more likely to have a family member who has had this condition.
- Personal psychological factors: Unhelpful thinking styles such as perfectionism are thought to increase a person's risk of developing OCD.
- Neurological or biological factors: Brain circuitry related to anxiety responses and the 'turning off' of repeat thoughts may be different between individuals with and without OCD.
Treatment
Cognitive behavioural therapy, specifically exposure and response prevention (ERP), is considered the most effective treatment for OCD. In ERP, a series of goals are developed between the psychologist and the client, based around the situations which trigger obsessions, compulsions or avoidance. With the psychologist's help, the client confronts these situations (exposure), without using their usual OCD behaviours or rituals (response prevention). Through a gradual process the client learns to 'sit with' their anxiety and as they do so, the distress and the obsessions decrease naturally, and more adaptive ways of responding to anxiety develop.
Cognitive therapy (CT) has also been found to help individuals with OCD identify and challenge unhelpful thoughts that contribute to anxiety and their beliefs around the utility of compulsive behaviours.
Managing stress more effectively may also reduce symptoms of OCD. Strategies include problem-solving and addressing sources of stress directly, increasing enjoyable and relaxing activities, maintaining a healthy lifestyle through regular exercise, getting sufficient sleep, maintaining a balanced diet, reducing or eliminating stimulants such as caffeinated beverages and cigarettes, and increasing social supports.
In many cases, psychological approaches alone will be effective in treating OCD. However, some people respond better to a combination of psychological treatment and medication.
Seeking help
Seeing a psychologist
If you are experiencing symptoms of OCD and find that they are affecting your work, school, or home life, a psychologist may be able to help. Psychologists are highly trained and qualified professionals skilled in helping people with a range of mental health and wellbeing concerns, including OCD.
There are a few ways you can access a psychologist. You can:
- Use the Australia-wide Find a Psychologist service or call 1800 333 497
- Ask your GP or another health professional to refer you.
If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate that may assist with the costs of treatment. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.
Additional resources
Head to Health
The Federal Government’s website linking the public to reputable and evidence-based digital mental health services.
www.headtohealth.gov.au
beyondblue
Provides information on anxiety, depression, and related disorders
www.beyondblue.org.au
headspace
Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25
www.headspace.org.au
Lifeline
A 24-hour counselling, suicide prevention and mental health support service
Telephone: 13 11 14
www.lifeline.org.au
References
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- Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., Rapinesi, C., Sani, G., Girardi, P., Kotzalidis, G. D., & Pompili, M. (2019). Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current neuropharmacology, 17(8), 710-736. https://doi.org/10.2174/1570159X16666180813155017
- Destrée, L., Albertella, L., Torres, A. R., Ferrão, Y. A., Shavitt, R. G., Miguel, E. C., & Fontenelle, L. F. (2020). Social losses predict a faster onset and greater severity of obsessive-compulsive disorder. Journal of Psychiatric Research, 130, 187-193. https://doi.org/10.1016/j.jpsychires.2020.07.027
- Dougherty, D. D., Brennan, B. P., Stewart, S. E., Wilhelm, S., Widge, A. S., & Rauch, S. L. (2018). Neuroscientifically informed formulation and treatment planning for patients with obsessive-compulsive disorder: a review. JAMA Psychiatry, 75(10), 1081-1087. doi:10.1001/jamapsychiatry.2018.0930
- Mahjani, B., Bey, K., Boberg, J., & Burton, C. (2021). Genetics of obsessive-compulsive disorder. Psychological Medicine, 51(13), 2247–2259. https://doi.org/10.1017/S0033291721001744
- Miegel, F., Jelinek, L., & Moritz, S. (2019). Dysfunctional beliefs in patients with obsessive-compulsive disorder and depression as assessed with the Beliefs Questionnaire (BQ). Psychiatry Research, 272, 265-274. https://doi.org/10.1016/j.psychres.2018.12.070
- Murayama, K., Nakao, T., Ohno, A., Tsuruta, S., Tomiyama, H., Hasuzawa, S., ... & Kanba, S. (2020). Impacts of stressful life events and traumatic experiences on onset of obsessive-compulsive disorder. Frontiers in Psychiatry, 11, 561266. https://doi.org/10.3389/fpsyt.2020.561266
- Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N. A. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry, 106, 152223. https://doi.org/10.1016/j.comppsych.2021.152223
- World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
- Yusufov, M., Nicoloro-Santa Barbara, J., Grey, N. E., Moyer, A., & Lobel, M. (2019). Meta-analytic evaluation of stress reduction interventions for undergraduate and graduate students. International Journal of Stress Management, 26(2), 132–145. https://doi.org/10.1037/str0000099