THE EXTENT OF THE PROBLEM
About 2% of the population suffer from OCD at some
point in their lives. It is more common than previously thought and has
received a lot of attention in the media. These reports are not always
correct, the terms "obsession" and "compulsion" being applied to various
psychological difficulties such as gambling or overeating which are in
fact quite different from OCD. A number of famous people are
thought to have suffered from the problem such as Charles Darwin and
Florence Nightingale.
WHAT IS OCD ?
Obsessions are ideas, thoughts, images or impulses that
are senseless and "get in the way". They continue even though a person
may try to ignore or forget about them.
Obsessional compulsive disorder refers to the
combination of these obsessions with fear and guilt, or other unpleasant
emotions, which together drive the sufferer to carry out compulsions to
try and rid themselves of the worry.
Compulsions, also called rituals, are usually actions
that are repeated, but sometimes are thought patterns that are performed
to rid oneself of a disturbing obsession. Rituals are usually carried
out according to certain rules or in a rigid fashion, and are clearly
excessive. The person recognises that the rituals are not reasonable but
feels unable to control them. Examples include handwashing, checking, or
mentally repeating phrases.
OCD can take many forms. Some people are
bothered by thoughts of contamination by germs or chemicals; some are
preoccupied by thoughts of causing accidents or injury; others focus on
fears about home security and safety.
EFFECTS OF OCD
The severity of the problem varies a lot. Obsessional
problems can and do take over peoples lives, making regular employment
or family life impossible. People find they have little or no time for
anything other than a pattern of checking or worrying or washing. When
troubled by their OCD people experience high levels of
discomfort. Sometimes this is anxiety, sometimes it is feeling miserable
or depressed, other times it is just a very unpleasant feeling that
things are not right.
CAUSES
No single cause has been identified for OCD.
Research so far has failed to come up with any support for the cause
being a chemical imbalance in the brain.
Those who suffer from OCD vary widely in their
personality characteristics and life circumstances. There is some
research evidence to suggest that certain types of upbringings and
family rules may increase the likelihood of OCD.
We also know that the types of thoughts which trouble
people suffering from obsessions, occur from time to time in almost
everyone. For example, it is extremely common for new parents to have
upsetting intrusive thoughts about harming the new baby. Research has
shown that it isn't possible to tell the difference between normal
intrusive thoughts occurring in people without Obsessional problems and
the thoughts experienced by OCD sufferers. What is different is
what these thoughts mean to them. A person who doesn't have OCD
can see an intrusive thought, however strange, on "just a thought".
People experiencing Obsessional problems become upset by the intrusion,
and believe it may make them responsible for harm. This then effects
what they feel they must do. Sufferers feel they should not ignore the
thought but try very hard to "push it away" or else to "put it right" by
some other thought or action. Unfortunately both these strategies make
the thoughts worse, and so the vicious circle of OCD develops.
TREATMENT
The most widely accepted form of psychological treatment
for OCD is Behaviour Therapy. This takes the form of a structured
programme of self re-education. Sufferers have to confront repeatedly
what they fear (a process called "exposure") beginning with the easiest
situations and progressing through till all the feared items have been
faced. At the same time, the persons must not perform any rituals or
checks (response prevention). In some programmes rituals are reduced
gradually; in others compulsions are prevented altogether. The therapist
does not use force, but relies on the persons own motivation to overcome
the urge to ritualise. Up to 50% of sufferers can be helped by this
method.
A greater understanding of the role of cognitions in
OCD has lead to the development of Cognitive Behavioural approach
to the problem. This provides sufferers with a new framework for
understanding their experiences. Through this they are helped to change
what they understand their Obsessional thoughts to mean, and what it is
necessary to do about them.
Medication of the type which effects the
serotonergergic system has also been proved to be effective for some
sufferers. However, since relapse very often occurs when the drugs are
stopped, they should probably be combined with psychological treatments,
especially for those who are depressed.
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