Obsessive Compulsive Disorder (OCD)
What is OCD:Obsessive Compulsive Disorder (OCD) is a mental health condition that affects about 1 in 100 people. OCD is characterised by obsessions (intrusive, unwanted and distressing thoughts, images or urges), and compulsions (repetitive behaviours or mental acts performed to reduce the anxiety caused by obsessions or to prevent a feared event). Obsessions in OCD are not just everyday worries, but rather are experienced as intrusive, distressing, and hard to control.
There are many different types of OCD, including, but not limited to:
Contamination OCDo Obsessions: Fears of germs, dirt, viruses, chemicals, illness, or spiritual contamination.o Compulsions: Excessive washing, cleaning, avoiding “contaminated” places or people.
Checking OCDo Obsessions: Fear of harm due to one’s own negligence (e.g., forgetting to turn the stove off).o Compulsions: Repeatedly checking locks, appliances, emails, physical symptoms.
Harm OCDo Obsessions: Fear of causing harm to oneself or others (intentionally or accidentally). May include fear of harming children sexually. o Compulsions: Mental review, reassurance-seeking, avoiding sharp objects or vulnerable people.
Sexual OCDo Obsessions: Unwanted intrusive sexual thoughts (e.g., about children, same-sex attraction, family members). o Compulsions: Avoidance, mental neutralising, checking arousal, reassurance seeking.
Religious / Scrupulosity OCDo Obsessions: Fear of offending god, sinning, blasphemous thoughts, or moral failure o Compulsions: Excessive praying, confessing, reassurance from religious leaders, avoiding sacred texts or symbols.
Symmetry / “Just right” OCDo Obsessions: Need for things to feel or look “just right” or symmetrical; fear of discomfort or “bad luck.”o Compulsions: Arranging, ordering, tapping, repeating until it “feels right.”
Relationship OCDo Obsessions: Doubts about one’s romantic partner or feelings (e.g., “Do I really love them?”o Compulsions: Mental reviewing, comparing, checking for feelings, asking for reassurance.
Health anxietyo Obsessions: Fear of having or getting a serious illnesso Compulsions: Body checking, researching symptoms online, excessive doctor visits
Talking Therapy for OCD:
Psychoeducation
A crucial part of OCD therapy, regardless of the type, is psychoeducation. Psychoeducation will help you to understand how OCD can develop, including what keeps OCD going. People living with OCD often have strong beliefs that their intrusive thoughts are genuine signs of danger, which can motivate them to act in ways that prevent such danger occurring. People living with OCD may also have a strong sense of responsibility for preventing harm, which can become a problem when this sense of responsibility feels overwhelming and out of proportion to reality. OCD can also cause worries that are difficult to stay with, which can lead to patterns of avoidance to be able to reduce worries. Individuals may also find they are prone to engaging in compusions or neutralising behaviours, to reduce the feared outcome from occurring. Psychoeducation helps individuals in therapy to consider what keeps their OCD going, including behaviours that may reduce anxiety in the short term, but may be harmful in thpe long-term.
Exposure and Response Prevention
Exposure and Response Prevention (ERP) is a form of Cognitive Behavioural Therapy that is a considered a gold standard treatment for OCD. In this therapy, clients are supported to identify their intrusive thoughts, and compulsions, and to resist the urge to engage in compulsions, rituals, or avoidance behaviours that are usually relied upon to reduce anxiety in the short term. The rationale for this, is that intrusive thoughts become somewhat of a ‘faulty alarm’ for people with OCD, that goes off too often, and demands too much of our attention. Clients have learned to listen to this alarm, even though there may be situations where it is faulty. Through ERP, the client is able to learn over time to allow the alarm to go off, but to resist responding to it, and to learn that they can be safe regardless. Overtime clients often find that this way, the alarm reduces in frequency and intensity. ERP works by breaking the cycle of fear and avoidance, and leads to lasting change. Importantly, ERP exercises are client-led - designed in collaboration with clients, unique to your type of fears and anxieties, and at a pace you are ready for.
When is it important to seek help?
Seeing a therapist if you think you have OCD is important as OCD doesn’t typically go away on it’s own. If you notice increased fears, longer rituals, and more distress, it might be time to see someone for support. OCD also can co-occur alongside other mental health problems, including anxiety disorders, depressive disorders, and tic disorders. Some of these co-occuring conditions can lower motivation to seek support for OCD, so if you feel low motivation to seek help, that may be a sign that it is important to take the first step. A qualified clinician, such as a Clinical Psychologist, trained in assessment and diagnosis of OCD may also be able to support you to determine if medication may be of assistance, and to support you in connecting with your GP to ask further questions about medication if this is of relevance to you. The good news is, research has consistently shown high success rates and clinically meaningful improvements for OCD treatment, particularly through ERP therapy when it is delivered correctly. Further, improvements often last, particularly when clients are committed to continuing to practice exposure tasks, reduce safety behaviours, and learn to accept uncertainty.