Living with
Obsessive Compulsive Disorder (OCD)

What is obsessive compulsive disorder (OCD)?

Obsessive Compulsive Disorder (OCD) is a chronic, debilitating medical condition characterised by obsessions and compulsions.

Obsessions are unwanted, distressing ideas, images or impulses, which repeatedly enter a person’s mind. Compulsions are repetitive thoughts or behaviour that the person feels obliged to perform in an attempt to reduce the distress created by the obsessions.

How do you know you have OCD?

Symptoms usually involve obsessions about contamination, doubt, or possible harm. The most common compulsions include the following excessive behaviours:

• Checking
• Washing and cleaning
• Counting
• Ordering
• Arranging
• Hoarding.

Patients are often embarrassed by their symptoms. They may also be afraid that others will think they are crazy. They therefore often try to hide their illness from family and professionals. Therefore, OCD is also commonly known as the “secretive illness”.

What is the link between OCD and personality?

Positive ‘exactness,’ which relates to high standards of performance in work or recreation, should not be confused with the obsessive perfectionism of some OCD sufferers.

A person with perfectionistic or obsessive-compulsive personality traits believes that everyone should conform to his or her high standards; while the OCD sufferer realises that his or her obsessions and/or compulsions are senseless and exaggerated and would like to get rid of them.

What is the link between OCD and depression?

Patients with OCD often become extremely demoralised about their symptoms and about 70-80 % of people with OCD will develop depression.

What causes OCD?

The South African Depression and Anxiety Group (SADAG), state that while OCD was once considered a rare disorder, it is now recognised to be a common problem affecting some 2-3 % of the general population.

There is no single, proven cause of OCD.
It is likely that genetic, neurobiological and environmental factors are all involved. Studies have shown that people with OCD have different activity patterns in some brain areas compared to those with other psychiatric disorders or healthy individuals.
It is also believed that an insufficient level of serotonin, a neurotransmitter, is prominently involved in OCD.
Genetic links are still being studied worldwide, and there is already significant evidence to suggest that the risk of developing OCD is higher in some families, while identical twins have a 70 % chance of sharing the disorder.

One-third to one-half of adults with OCD report that their illness started in childhood. There seems to be no clear association between OCD predisposition and female and male sex.

The common risk factors for developing OCD include:

• Genetics/having a family history: Having a family member, especially a parent or sibling, with the disorder might mean you have an increased risk of developing OCD too.
• Stressful life events or trauma: If you have experienced traumatic or stressful past life events, your risk for OCD may also increase. Such events can trigger the intrusive thoughts and the emotional distress characteristised by OCD.
• Other mental health disorders: OCD may be related to other mental health disorders, such as anxiety disorders, depression or substance abuse.

Can OCD be prevented?

At present there is no known prevention for OCD. However, early diagnosis and correct treatment can help people avoid the complications associated with the condition and lessen the risk of developing other problems, such as depression or relationship and work difficulties.

How is OCD diagnosed?

If you think you experience obsessive thoughts or compulsions and are worried that these are interfering in your daily life, then contact your doctor or a mental health professional for help. The earlier you get help, the easier your OCD will be to treat and manage, so be open and honest with your doctor or mental health professional.

Your doctor may diagnose you with OCD through one or more of the following ways:

• Physical examination and history taking: Your doctor can look for physical signs of underlying medical conditions that can cause OCD-like symptoms, such as the repetitive behaviours associated with tic of Tourette’s syndrome, eating disorders and the tremor of Parkinson’s disease that can mimic tics.
  Compulsive skin picking may be associated with OCD, but is usually a sign of common skin conditions like eczema or allergies.
  Additionally, people with OCD may present to their doctor or healthcare provider with stress symptoms like migraine headaches or stomach ulcers. Some chronic conditions, such as heart disease, hypertension and thyroid disease, are also associated with a higher risk of developing OCD.
• Psychiatric exam: A psychiatrist or psychologist will talk with you about your thoughts, feelings and mood. They may use a questionnaire to help them.
  They will also determine whether you have any other mental health condition, like depression or anxiety disorders, that are associated with OCD. They may also want to talk to your family or people you live with to determine your everyday functioning.
• DSM-5: Your doctor or mental health professional may use the criteria for OCD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (these are the symptoms listed earlier).

Living and managing

Coping with OCD can be challenging as medications can have unwanted side-effects and you may feel embarrassed or angry about your symptoms.
Here are some ways to help cope with OCD:

• Stick to your treatment plan: Work with your doctor or mental health professional to identify techniques and skills that help manage symptoms, and practice these regularly even if they are challenging or upsetting.
  Always take your medications as directed, even if you think your OCD is better. Do not skip your medications because OCD symptoms are likely to return or worsen. Also check with your doctor first before taking other medications, including any over-the-counter medications, vitamins, herbal remedies or other supplements, as these may cause unwanted interactions with your OCD medication.
• Pay attention to triggers and warning signs: Work with your doctor or mental health professional to identify any issues or situations that can trigger your OCD symptoms. Make a plan so that you know what to do if symptoms return or worsen, including contacting your healthcare provider.
• Learn about OCD and join a support group: This can empower and motivate you to stick to your treatment plan. Get more resources to help you cope and to reduce any negative feelings or stigma you may feel about having OCD.
  Find out more about OCD on Let’s Talk. You can find resources that you may find useful in helping to manage stress and stay positive. You can also find out about where to get help if you are struggling to cope and need someone to talk to.
• Stay generally healthy, including staying involved in regular activities and hobbies, and practising relaxation and stress management techniques: It is important that you exercise regularly, eat a healthy diet and get adequate sleep to help manage your mental health condition successfully.
  Explore healthy ways to channel your energy, such as hobbies and recreational activities. Do not let OCD get in the way of you enjoying your normal life and try to continue normal daily activities, like going to see friends or family.
  Additionally, try out stress management techniques such as meditation, visualization, muscle relaxation, massage, deep breathing, yoga or tai chi that may help ease stress and anxiety.

What treatment is available for OCD?

Combining antidepressant medication and cognitive-behavioural therapy (CBT) has been found to be the most effective treatment for OCD.

People with OCD often benefit from antidepressant medications that increase serotonin levels, making more of this neurotransmitter available to transmit messages in the brain. The main medications that do this are known as selective serotonin reuptake inhibitors (SSRIs). For those who have tried several SSRIs without benefit, there are other medications that may help.
In some cases, other types of antidepressants are more effective. In others, a second drug is given in addition to an SSRI.

CBT (including exposure and response prevention) employs specific techniques to decrease OCD symptoms. Patients are encouraged to come into contact with feared stimuli (for example, placing their hands into dirt) and to not engage in their usual response (for example, not washing the dirt off straight away). With time, the anxiety and distress associated with the obsession should decrease.

Treatment of OCD is a long-term commitment. Both kinds of treatment may take several months to be effective, but a good response is often seen in time.
The patient’s commitment and active participation in treatment, together with the support of his/her family, and a good trusting relationship with a therapist, are of the utmost importance in recovery.

What are the complications associated with OCD?

OCD symptoms often create problems in daily living and relationships

In extreme cases, people become totally disabled and cannot leave home because they spend their time engaged in obsessive thoughts or rituals.

Without treatment, the disorder may last a lifetime, becoming less severe from time to time, but rarely resolving completely. In some people, OCD occurs in episodes, with years free of symptoms before a relapse.

Even with treatment, however, OCD can come and go many times during a lifetime. Although OCD is completely curable in some individuals, most people achieve relief with comprehensive treatment.

When to see your doctor if you have OCD?

• When you suspect you or a family member may be developing symptoms of OCD.
• You or a family member experience worsening OCD symptoms that are not relieved by strategies you learnt in CBT.
• You or a family member experience changes in OCD medication side-effects.
• You or a family member have new symptoms that may indicate development of another disorder (such as panic attacks or depression).
• You or a family member are going through a life crisis that might worsen your/their OCD.

Get help if you are struggling to cope and need someone to talk to.