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Obsessive Compulsive Disorder

Last updated Thursday, 16 July 2009
By Dr Scott Blair-West, Consultant Psychiatrist.

Laura is a 40 year old primary school teacher who has suffered from Obsessive-Compulsive Disorder (OCD) since her early teens.  Initially she described intrusive thoughts of her parents and her brother dying. These thoughts led to her repeating behaviours such as walking through doors, getting dressed and washing, in response to the thoughts.

A year or so later she experienced intrusive thoughts of contamination, particularly at school, and developed a wide range of repeated washing behaviours and associated avoidance of situations or items that made her feel contaminated.  While this was initially related to a fear of germs, developing an infective illness and perhaps passing it to others, she subsequently came to worry more about contracting the AIDS virus, leading to extensive hand washing, lengthy showering and avoidance of any physical contact with people other than her family.

What does it look like? (Symptoms)

Obsessions: recurrent, intrusive, unwanted thoughts, images or impulses causing distress to a person

Compulsions: repeated behaviours or mental actions performed in response to obsessions, often performed in a specific and characteristic manner. These actions, such as hand-washing or checking locks on doors, are an attempt to reduce the anxiety and stress.

Individuals with OCD worry excessively about the nature and consequences of these intrusive thoughts. Compulsive acts are undertaken to reduce high levels of anxiety. This may help in the short-term but the compulsions actually maintain the obsessional thoughts and keep OCD symptoms going.

Common Obsessions
Associated Compulsions
Fears of contamination
Washing and cleaning compulsions
Fears of causing harm, injury or damage
Checking compulsions, such as locking doors, turning off equipment or lights, or requests for assurance
A need for order and symmetry. A need for a feeling of being "just right"
Ordering and re-arranging compulsions, repetition of certain actions and checking. Counting is also a common compulsive action
Thoughts of a sexual or religious nature
A wide variety of actions including checking, requests for assurance, repetitive praying, repeated actions
Fears of loss or need of material goods
Hoarding (keeping numerous things that others easily through away, eg. newspapers, tissues, wrappers)

How can it cause a problem in my life?

For Laura, her obsessive and compulsive behaviours had a significant impact on her relationships with her friends and limited the development of relationships.  These symptoms have continued over the past 10 years to the extent that she washes her hands extremely frequently throughout the day (up to 50 times), often had lengthy showers, washed her clothing very frequently, would wear different clothes outside of home and change and shower extensively after returning home.  She also avoided a number of situations and was extremely limited in her contact with men.  Prior to her attendance at my practice, she developed further intrusive thoughts about being responsible for harm and injury coming to others when she was driving.  This led her to fear that any noise or flash of light or colour indicated that she had hit someone with her car and she would spend hours driving around in circles checking or asking others for reassurance that some terrible accident had not occurred.  She described high levels of anxiety and significant depression associated with these OCD symptoms.

Commonly OCD symptoms cause significant levels of distress and this can affect the person’s capacity to concentrate and attend to important tasks such as work, study and important relationships.  For many, the lengthy performance of compulsions such as washing, checking, ordering and counting can severely limit the time available to perform daily duties. Also, people performing extensive mental compulsions can appear distracted, absent-minded or unable to function “in the moment” or respond appropriately to conversation.

Who else experiences it?

OCD is a common anxiety disorder experienced by between 1-2% of the general population.  A much larger number of people would not have a formal diagnosis yet often have significant symptoms.
  • Male to female ratio appears to be 1 to 1
  • Common age of onset in mid—late teens, worsening to the point of requiring psychiatric or psychological assistance in mid to late 20’s.  There is often a lengthy delay between onset of significant OCD and seeking professional help (around 10 to 12 years), suggesting a degree of stigma and uncertainty in the community and those suffering from OCD about this condition and its treatment.
  • Typically OCD is a chronic condition.  Few people are cured, though successful treatment leads to a massive reduction in symptoms and associated living difficulties.

What can I do about it? How can I manage it?

Effective evidence-based treatments for OCD fall into two categories.
  1. Antidepressant medications acting on the serotonin system, including the SSRI antidepressants and Clomipramine, have been shown in reliable studies to reduce the symptoms by 30% to 50% in approximately two thirds of patients.  Medications often help, but have relatively limited benefit and are best used to reduce symptoms of OCD, anxiety and depression and allow introduction of CBT approaches.
  2. Cognitive Behaviour Therapy (CBT) methods: Exposure and Response Prevention (ERP) tends to be the most effective therapy, giving significant and long-term benefits for up to 80% of those who practice it.  ERP involves the person exposing themselves to situations that provoke their anxiety but not performing their usual compulsive rituals. This allows the anxiety to decline naturally by itself.  Exposure tasks are set, for example, repeated touching of items such as door handles without washing, and gradually leading to exposure of more difficult items such as touching the mail, shaking hands, and eventually touching bins, toilets and related items.  Exposure therapy is successful when the tasks are performed in a slow, gradual manner with consultation and agreement between the person and therapist.  Support groups and self-help books can assist in this process.

What can I expect? What’s the outlook?

The evidence is good for significant improvement in OCD with appropriate, early treatment.   Successful treatment does not lead to a complete elimination of all intrusive thoughts but rather a reduction in the fear and worry that people assign to these thoughts. Compulsions and avoidance, on the other hand, can be eliminated.  Ultimately we aim to help people accept that occasional intrusive thoughts are normal and experienced by others in the community.  For those who do not improve to this extent, ongoing treatment and support are necessary for the individual and family.

What resources are available for help?

Support Groups
ADAVIC Support Group

Anxiety Recovery Centre (Arcvic)

Treatment Centres
A very active OCD treatment centre in Melbourne is the Anxiety and Depression Program (ADP) at the Melbourne Clinic (ph: 9429 4688)
 The American Obsessive Compulsive Foundation  
TV & Movies
The House of Obsessive Compulsives -     a UK documentary recently aired on ABC

As Good As It Gets (1997) starring Jack Nicholson and Helen Hunt.

Matchstick Men
(2003), starring Nicolas Cage.


info.gifThis information was provided by Dr Scott Blair-West, Consultant Psychiatrist (MBBS DPM FRANZCP),
Senior Fellow, Department of Psychiatry, The University of Melbourne Medical Director, Anxiety and Depression Program, The Melbourne Clinic, Richmond.

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