Obsessive compulsive disorder (OCD) is characterised by obsessions and compulsions.
Obsessions are unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore. Examples of this are an overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind.
Compulsions are repetitive actions the person feels they must do, generating anxiety if they are not done. Often, these compulsions are a way for the person to handle their obsessions. For example, they check that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down. Although this behaviour can be normal and appropriate, a person with OCD may check every plug in the house ten times before being reassured.
The obsessions and compulsions are present daily and are not something the person will enjoy or do willingly. They impact other areas of life, such as their social life or other interests.
The OCD Cycle
There is a cycle in OCD involving:
- Obsessions
- Anxiety
- Compulsion
- Temporary relief
The obsessions lead to anxiety, which leads to compulsive behaviours, which leads to a temporary improvement in the anxiety. Shortly after the temporary improvement in anxiety, the obsession reappears, and the cycle reoccurs. Each time, the cycle gets more ingrained in the person’s behaviour. Without completing the compulsions, the person feels no relief from their anxiety about the obsessions.
Diagnosis
Diagnosis is based on criteria from either:
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
- International Classification of Diseases (ICD-11)
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) can be used to assess the severity of symptoms.
Management
Mild OCD may be managed with education and self-help resources.
More significant OCD may require:
- Cognitive behavioural therapy (CBT) with exposure and response prevention (ERP)
- SSRIs
- Clomipramine (a tricyclic antidepressant)
Exposure and response prevention involves gradually facing the obsessive thoughts and anxiety without completing the compulsions.
Last updated June 2024
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