What is Obsessive Compulsive Disorder (OCD)?
Obsessive Compulsive Disorder (OCD) is characterised by ‘obsessions’ i.e. the experience of recurrent and persistent thoughts, urges or images that are perceived as intrusive and unwanted. These intrusions are difficult or impossible to ignore due to what the individual believes about their occurrence. People with OCD develop their own appraisal of these thoughts, that in some way the thoughts signal danger (e.g. that something bad is going to happen) or says something bad about the person experiencing them (e.g. that they are dangerous, irresponsible, or bad in some way) which results in anxiety and distress. Therefore, they must do something to reduce the likelihood of something bad happening, engaging in ‘compulsions’ e.g. repetitive behaviours, mental acts or excessive avoidance designed to reduce or prevent the feared consequences. Many people who suffer with OCD recognise that these behaviours are excessive, but in many cases, there is such doubt, uncertainty and perceived risk associated with reducing routines that they feel compelled to repeat them to completion.
For some individuals with OCD, including some young people, some people who also have a neurodevelopmental condition, such as Autism, or people who have lived with OCD for a long time, intrusive thoughts may not be so clearly articulated and the reason for engaging in compulsive routines may be described as an urge to make things feel right.
At greater levels of severity, OCD can have a significant impact on the individual and their families, resulting in an inability to achieve day to day tasks, or live independently.
People who experience OCD may also experience depression and/or other anxiety disorders such as generalised anxiety disorder, panic, emetophobia, or hoarding. There are also high rates of co-morbidity with repetitive disorders including Tics, Autism Spectrum Disorders (ASD) and attention deficit hyperactivity disorder (ADHD).
OCD is estimated to affect between 1 and 4% of the population.
Can treatment help?
The evidence-based psychological treatment for OCD is individual Cognitive Behaviour Therapy (CBT), including Exposure with Response Prevention (ERP) completed with a therapist. Whilst treatment can be highly effective for some people with OCD, beliefs and compulsions can become particularly entrenched, requiring an intensive course CBT with a greater number of home-based sessions.
Aims of treatment
An assessment at OHSPIC will include use of standardised questionnaires that assess the severity of the problem, how it impacts on daily life, what thoughts and beliefs are associated with the problem, and an assessment of other difficulties.
Cognitive Behaviour Therapy (CBT) at OHSPIC includes:
• Developing a shared understanding of the problem
• Collaboratively establishing goals for treatment
• Exploration of beliefs about the nature and content of intrusive thoughts
• Working on developing alternative, less threatening beliefs about the intrusions and the perceived responsibility for preventing or un-doing negative events
• Approaching avoided or difficult situations and finding out what happens when not engaging in the usual behaviours. This will typically involve joint tasks completed with the therapist outside of the clinic, including in the home
• Planning how to maintain progress and work towards longer term goals.
OHPSIC will liaise with local teams to ensure that the work on overcoming OCD can successfully continue, including offering joint work and supervision, as necessary. Home visits or out of office sessions will be included and encouraged as part of joint work with local teams.