Obsessive compulsive disorder

Most people do recover from OCD. The most commonly used treatments are Cognitive Behavioural Therapy (CBT) and medication.

Medication may be prescribed by a psychiatrist or by your GP. The medication that is most commonly prescribed for OCD is anti-depressant medication. These can be effective, even if you do not think that you are depressed. They do usually take a few weeks before people feel the benefit from them; but they are not addictive and have few side effects. It is important that you continue with the treatment in the early days even if you do not feel that it is helping you.

Cognitive Behaviour Therapy (CBT) helps you to identify the thoughts (cognitions) or images and learn about how they trigger the changes in how you feel, what you do and how you behave. You can access this treatment through your local NHS Talking Therapies service, which you can self-refer to or be referred to by your GP.

Below is a table which summarises some examples of obsessions and compulsions.

OCD affects us in several ways including what we think, how we think and what we do.

How does your obsession make you feel? It may make you feel:

• anxious
• distressed
• worried
• scared
• uneasy

How do you feel when you have done the ritual? 

• relieved
• calm
• less anxious
• more settled
• less distressed
• less worried

If you identify with a few of the above, you may have an OCD. Most people that have OCD find there is a pattern to what they experience. They will have the thought or image that will trigger the anxiety, which then decrease when they have done their compulsive act.

Exposure Response Prevention (ERP) is a form of cognitive behavioural therapy. This means exposing youself to, or gradually facing the things that you fear, without responding with the ritual behaviour that you would have done previously.

For example, if your obsession is not believing that the door is locked then the compulsion may be to check the door handle three times before you can comfortably walk away. With ERP you would only check the door once and then walk away. Even though the anxiety would rise and possibly feel unbearable, it is important not to go back and check the door.

By doing this you are providing evidence that even though you did not respond in your usual way and go back and check the door, nothing bad happened.

Please note, not all the examples on this page will be exactly like your experiences. Do not worry — use the parts that apply to you.

For many people with OCD, facing your fears can seem like an impossible task. The anxiety and distress that is triggered may feel unmanageable which will put you off trying ERP treatment.

Therefore, it is more helpful to make a list of all the things you find you do and think to reduce your distress, and then start with the easiest to tackle.

For example, Edward has a fear that he is full of germs and may contaminate his family. As a result of this, he has started carrying hand sanitiser around, using it every time he touches anything, and he has been avoiding any physical contact with his children.

Edward listed his fears from 1 (most feared) to 6 (least feared):

1. Cuddling his children after they have had a bath
2. Cuddling his children before they have a bath
3. Holding his children’s hands
4. Preparing a meal for his children
5. Shaking another person’s hand
6. Passing a pen to another person

Edward will focus on his least feared problem and will address this with exposure therapy. For example, he will pass a pen to a colleague several times a day, but will resist the urge to clean his hands with hand sanitiser before he passes the pen.

Edward may feel extremely anxious and uncomfortable but needs to allow the anxiety to reduce. It will reduce.

It is difficult to stop yourself from carrying out the compulsive act; however it is a necessary stage in overcoming OCD. Below are some tips that may help you:

Not to seek reassurance: If people offer reassurance this may stop or lessen the anxiety but it will stop you from completely facing your fear.

Give praise: Remember to compliment yourself when you have not completed a ritual/compulsive act. This is a big step forward in breaking the vicious cycle!

Keep a diary: You can track your progress this way. You will find the more that you respond without using the compulsive acts the anxiety will lessen and you will feel uncomfortable for shorter periods of time.

Watch out!: If you find you have started this compulsive act without realising it, stop as soon as you notice.

When you start to tackle the OCD behaviours, you may notice some negative thoughts.

These thoughts may be criticisms of you. For example: “It would be irresponsible of me to cuddle my children without cleaning my hands” or “If I spread germs to my children that would make me a bad father”. These thoughts will affect your mood. It is important that you do not accept these thoughts as facts. You need to find a more balanced view point.

Firstly, write down what these thoughts are. Then try following these steps:

• Try to argue against this thought
• Ask yourself ‘How do I know this?’
• Remember your good points, not just the bad.

For example, Cyril has a thought about hurting his wife. This thought left him anxious and distressed.
Here are some tips for Cyril:

• Don’t try to get rid of the thought. This will only mean you focus on it more
• Accept it as just a thought. It is not an indication of what you want to do, and we all get odd thoughts at times
• Trying to stop the thought would only lead to him paying it more attention, which would then cause him more distress.
• He needs to stop trying to neutralise the thought because again this only leads to him paying a lot of attention to it.
• He needs to accept it as just a thought and then let it fade, not to be afraid of the thought.