Obsessive Compulsive Disorder (OCD) is a mental health condition where a child, teenager or adult has reoccurring thoughts and negative behaviours which they cannot control. There are many misconceptions about OCD and frequently, people will refer to themselves as having OCD when they do not. Whilst frequently a throw away comment ‘I’m a bit OCD’, OCD is not a need for neatness or a preference for hand washing. OCD is incredibly distressing for the person who experiences it and the compulsions which they experience can be extremely devastating to an individual’s life.
OCD is a distressing and persistent condition which takes up significant periods of someone’s life and frequently disrupts life or prevents people from being able to engage in activities. Rituals of OCD may take minutes to hours a day.
Around 50% of those with OCD find that their symptoms present in childhood and adolescence. The average time taken between first symptoms and diagnosis is 7-11 years. This is often delayed because the person is reluctant to seek help, has hidden their behaviours, is embarrassed or due to family having made adjustments around their obsessions and compulsions which have allowed them to continue to function to some degree.
Types of OCD
There are 4 types of OCD:
- Symmetry and ordering
- Rumination and intrusive thoughts
Checking – Checking is a compulsion driven by an excessive fear that if they do not ‘check’ something terrible might happen. This can include a need to check doors, locks, windows, plug sockets, tapes, seek reassurance, emails, text messages….. Checking is generally carried out multiple times and may be associated with key numbers. Checking can take minutes to hours.
Contamination – Contamination drives an obsessive fear that they (or those that they love) may get dirty, ill, infected and therefore steps need to be taken to keep things safe and clean. This can include a fear of touching things, shaking hands, touching bannisters, public doors or people. It can include personal hygiene routines and cleaning spaces before they are used. Like checking, cleaning rituals are completed multiple times and not finished until the person feels clean. It can also include avoidance of places which may lead to contamination.
Symmetry and Ordering – Symmetry is the compulsive need to have things in order, lines, symmetrical or ‘just right’. Those affected by symmetry and order will spend great deals of time putting items, toys, belongings into the right positions and may return to them repeatedly to check and adjust. This can include pictures, toys, books, CDs, Tinned items, or the home.
Rumination and intrusive thoughts – Rumination occurs when a person has obsessional thoughts which are prolonged, cannot be escaped and are intrusive. These thoughts may be disturbing or horrific to the person. They may ruminate that they have done or said something to others, or that they will cause harm to others and are deeply upsetting. Whilst many people will have intrusive thoughts in their lifetime, OCD based intrusive thoughts are repetitive, continuous and cause extreme distress. The concept of having the thoughts is equally upsetting. Thoughts can be sexual, religious, violent, relationship focussed and body focussed.
Obsessions and Compulsions
OCD compromises three core elements:
In some cases, individuals will only have the obsessions and emotions, but in many cases, they have all aspects.
Obsessions are unwanted thoughts These are frequently unpleasant and may be thoughts, images or urges.
Emotions – The obsession results in a feeling of intense anxiety, distress or discomfort.
Compulsions are behaviours or mental activities that people have to repeat to relieve the obsessive thoughts. The compulsion is perceived to relieve the obsession and bring peace, however this is only temporary.
Common obsessions include:
- Worries about germs or dirt
- Worries about illness
- Fear of saying something offensive
- Fear of hurting themselves
- Fear of hurting others
- Fear of harming other people by mistake
- Fear of contamination
- Fear of infection
- Fear of throwing things away
- Worries about their own or family’s safety
- Needing symmetry
- Needing things to be in a particular order
- Thoughts which are violent
- Thoughts of a sexual nature
Therapy and Treatment
Many people with OCD require therapeutic support to help them break the need to complete the cycle and relieve anxiety. This cannot be relieved with talking alone. Some people will also require a course of SSRIs (Selective serotonin reuptake inhibitors) which are antidepressant medications.
Untreated OCD can become chronic and without treatment remission rates are low. There are also associations between untreated OCD in childhood and adolescence and chronic disease.
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Obsessions are unwanted thoughts These are frequently unpleasant and may be thoughts, images or urges. The obsession repeatedly occurs and causes uncomfortable, anxious or disgusting feelings. Obsessions are dominating thoughts and their presence interrupts other things and activities. They may prevent someone from living their life.
Emotions – The obsession results in a feeling of intense anxiety, distress or discomfort
Compulsions are behaviours or mental activities that people have to repeat to relieve the obsessive thoughts. The compulsion is perceived to relieve the obsession and bring peace, however this is only temporary. The repetitive nature means that they bring a large amount of distress. Compulsions are often excessive and not realistic. Those with OCD often recognise their compulsions are irrational, however they carry a sensation that if they do not perform them then something bad will happen.