OCD treatment

Obsessive-compulsive disorder, OCD, is a mental disorder with intrusive obsessions, obsessive thoughts, and compulsions, compulsive actions, which disturb daily life to a greater or lesser degree.

Obsessions are unwanted, repeated thoughts, images or urges that create anxiety. Some are afraid of contamination, that is, of being infected with something dangerous themselves or being to blame for others being infected. Others worry about harming others or are plagued by thoughts of being a paedophile. Even though you know the thoughts are irrational, they are hard to let go of and hard not to believe, because the idea of being to blame for harm to others is so extremely terrible for you.

That is no coincidence. Your obsessive thoughts are very often about what you think would be the worst imaginable thing to be to blame for or to have a tendency towards. What they are about is furthest from the person you are, and that is exactly what makes them so frightening.

Compulsions are ritual actions that you perform both to reduce the anxiety from the obsessions and to prevent them becoming reality. You wash your hands constantly or check the lock again and again. The actions give temporary relief, but they are never the solution. In the longer term they maintain and reinforce the anxiety. The causes of OCD are complex and involve both biological and environmental factors. Genetic predisposition, traumatic experiences and an insecure childhood are among the things that can contribute.

OCD can affect people from all walks of life regardless of age, gender and background. The disorder often begins in childhood or adolescence, but it can arise at any age. Some studies point to genetics: if, for example, you have a parent with OCD, your risk is greater. My experience, though, is that the risk is at least as much about what that parent passes on and teaches the child through their actions.

The causes are not fully understood. Biologically, changes in the brain’s chemical balance, especially the neurotransmitter serotonin, may play a role, and researchers are also examining the brain’s structures to understand more.

The most important thing I can say to you is that OCD is not the result of weak willpower or an inability to "think positively". It is a serious, often disabling disorder. But with correct diagnosis and treatment, many achieve relief and return to a normal, well-functioning life.

OCD is a complex disorder that shows itself in many ways, so two people with OCD can have very different symptoms. Here are some of the most common forms. Some have a combination of several, others only one.

Whatever the form, OCD can be disabling. But with the right treatment many achieve a marked improvement and go on to live a well-functioning life.

OCD is first and foremost a mental disorder, but it also affects the body. Some reactions come directly from the compulsions: dry, cracked and irritated skin in those who constantly wash their hands or use sanitiser, sores and scratches from repeated scrubbing, and muscle soreness or strain injuries after hours of repeated movements. Others come from the persistent stress and anxiety that go with it: tiredness and exhaustion, both from the anxiety and from the many hours the rituals take, disturbed sleep, weight changes, stomach pain and digestive problems, tension headaches and in some people raised blood pressure. Not everyone experiences all of this. Talk to your doctor if you have physical symptoms that worry you.

There is a lot of anxiety connected with OCD, and so most people also experience the usual reactions to anxiety. Anxiety is felt in the body, but it is first and foremost a consequence of your thought, your interpretation. It is the thought that triggers the alarm in the amygdala, a small area in the brain’s temporal lobe, which sets the body up to fight, flee or freeze. The alarm system is vital; without it we could not survive. But the amygdala cannot tell the difference between real danger and your own interpretation of danger, and it reacts exactly the same to both. The interpretation and the alarm then set off a particular behaviour. This is what it typically looks like with OCD:

Life with OCD can be deeply challenging. The constant stream of unwanted, intrusive thoughts and the urge to perform the rituals is draining, both physically and mentally, and so having OCD is also very stressful.

Many feel trapped by their own thoughts in a cycle of anxiety, rituals and brief relief. The rituals disrupt routines, work, study and relationships. Perhaps you spend hours checking whether the doors are locked, so you are not to blame for a burglary, or wash your hands again and again to prevent an infection you are afraid of.

On top of that comes constant self-monitoring. When you are constantly watching your own thoughts and actions, you become afraid of what others think, and then many withdraw from situations where the symptoms could become visible. And then there is the emotional burden: guilt, shame and frustration, especially when you know that the worries are irrational, but still cannot stop them.

Despite all that, many with OCD find relief with the right treatment, cognitive therapy and sometimes also medication. Support from family, friends or groups with others who have OCD can make a crucial difference. And in my sessions there is room to say everything out loud, including what feels impossible to say.

OCD can start at any age, but for many it has been there since childhood or adolescence. The early symptoms can be so small that they are dismissed as ordinary childhood rituals or a phase. So there may be obsessive thoughts and compulsions in childhood that only flare up in adolescence or later in adult life, typically in a period when you are under more pressure than usual.

If the OCD is not treated, and you simply carry out the compulsions day after day, you never get to disprove the anxious thought that drives your OCD. So the thought is maintained, the OCD is maintained, and often it intensifies over time. What began as a single worry or a small ritual becomes more time-consuming and disruptive. At first you may have double-checked the door a couple of times; now you check it many times a day.

As the obsessive thoughts dominate more, you may start avoiding certain situations or things to keep the anxiety away, and that limits your activities and your time with others. With the awareness that your worries and rituals may not be "normal" come shame and guilt, and some isolate themselves. When the OCD finally interferes too much with life, many fortunately choose to seek help. It may be triggered by a particularly stressful period, by encouragement from those closest to you or by your own realisation of how much the OCD is in control.

Even with treatment the intensity can fluctuate, and some periods are worse than others, often with increased pressure, stress or major changes in life. But with the right treatment many learn to manage their obsessive thoughts and compulsions effectively. That is what we work towards.

If you have symptoms of OCD, the most important thing is to seek professional help, preferably at the first signs, so you get the most effective treatment. But beyond that there are several things you can do yourself to tackle your OCD:

• Get to know your OCD. The better you understand the disorder, the better equipped you are. Read books and articles, or join a support group where you can learn more and talk to others struggling with the same thing.
• Hold on to an everyday life that is not run by OCD. Regular meals, sleep and exercise give a sense of normality.
• Keep an eye on the pressure. Stress worsens OCD symptoms. What can you do to make your everyday life less pressured? Also cut down on alcohol and caffeine, which worsen anxiety and disturb sleep.
• Challenge your thoughts. When an obsessive thought comes, you can ask: Is it realistic, does it match reality? Is it necessary, how important is it really? And is it productive, does it do anything constructive for you? That way you steer the thought instead of the other way round.
• Keep going. Even when you are feeling better, and even when it is really hard. Continue the treatment, and keep challenging your OCD.
• Share it with those close to you. When family and friends know what you are going through, they can also understand how best to support you.

And remember: it is not necessary to win an argument with every obsessive thought. Repeated analysis and reassurance can themselves become part of the rituals.

Being close to someone with OCD can be hard, but your support can play a crucial role. Start by learning what OCD is. Then it becomes easier to be empathetic, because you understand why the person does as he or she does, and you gain insight into how best to help. Show support, not condemnation. OCD is a real and often overwhelming disorder, and the person needs to feel that you are there to support, not to criticise.

Encourage professional help. Therapy, especially cognitive therapy, is very effective against OCD, and medication can help some. Be patient, because treatment can take time and have ups and downs. Celebrate the small victories, and be there through the setbacks. If the person is comfortable with it, it can be helpful for you to take part in a session or two to learn how to support best.

Set boundaries. It is important to support, but it is just as important not to become part of the rituals, neither by checking for the person nor by giving the reassurances the OCD asks for. Talk to a therapist about how best to help. And seek support for yourself, because living close to OCD is mentally draining. Consider a group for relatives or your own sessions. You cannot cure the other person’s OCD, but your understanding, patience and support can make a considerable difference.