OCD - Obsessive Compulsive Disorder

What is it?

Imagine being so worried about cleanliness that simply popping out to the shop means having to wash your hands again and again before leaving your house. And immediately after you leave, having to go back to wash them again because you touched the door handle and may have picked up some microscopic germ.

Or only being able to settle down in the evening once every item in your kitchen was lined up in its correct position (and that includes every knife, fork and spoon in the cutlery drawer, every packet in every cupboard, and even every biscuit in every tin). Life would rapidly grind to a standstill, and that is exactly what happens for many people with OCD.

Obsessions and compulsions

An obsession usually develops in the form of thoughts or impulses that occur over and over again. These obsessions may be about almost anything, although common ones revolve around dirt, germs, being ill, and harming someone you love.

The obsessions are generally traumatic for the person who feels out of control and may be associated with other symptoms such as fear, panic, disgust, and doubt.

Compulsions are small acts or rituals that a person performs over and over again in a desperate bid to make the obsessions go away. They may have to be performed in an certain way, to set rules, and can drive the person crazy, but they have little choice but to do it.

Common compulsions include:
~grooming rituals
~cleaning
~tidying
~checking switches and locks
~counting and arranging
~collecting objects
~repeating the same action over and over until it feels just right

OCD can start at any age, although usually before mid-life - in as many as 1 in 3 cases it starts in childhood. The exact cause is not fully understood, but there is a genetic or inherited tendency. Biological changes seem to occur in the brain, particularly in the way information is handled - in other words, OCD is not just made up or "all in the mind".

Research suggests that in OCD, communication between the front part of the brain and deeper structures is faulty. Serotonin is the major chemical messenger involved in this area, and insufficient levels are thought to play an important part in OCD.

Occasionally, there may be clues to a physical cause. One unusual example is when the problem begins suddenly in childhood, after a bad throat infection (with the streptococcus bacteria). An autoimmune mechanism may be to blame, and it is worth trying a course of antibiotics as these may help.

Psychological treatments

In recent years, great claims have been made for a treatment called cognitive behavioural therapy (CBT), which includes learning about the condition and learning to adapt behaviour to cope with obsessive feelings. The therapy can help prevent other problems associated with OCD such as depression, or more simply, unemployment.

Other psychological techniques may be incorporated in this treatment. Those who complete a course of CBT (usually about a dozen sessions) can expect a 60 to 80 per cent reduction in symptoms.

In the US, a 12-step programme adapted from that used successfully with alcoholics, has helped some people with OCD. More information can be found at: www.emotionsanonymous.org
Drugs that increase the brain concentration of serotonin may also help improve symptoms. These are known as selective serotonin reuptake inhibitors (SSRIs), and include well-known treatments such as Prozac (fluoxetine).

Talking to others can help people with OCD share their burden. The Obsessive Compulsive Foundation has a lively chat room, among many other good resources: www.ocfoundation.org

This article was last medically reviewed by Dr Rob Hicks in December 2005.
Webite source: bbc.co.uk health

Notation: I, too, suffer from OCD in the form of checking. It has become a huge problem within my daily life, as I check, which has just been checked, and check again… For me, medications were unsuccessful.