You’re about to settle down to sleep one night when you get a niggling feeling that you haven’t locked your car. You know it’s probably locked, you’ve never returned to see it open. You try to rationalise why you should stay in the warm comfort of your bed but the niggling feeling just won’t go away. So you get up, go outside and press the key fob. The lights appear with no clicking sound, it’s already locked! But a small uneasy feeling remains so you unlock and lock the car just to hear that reassuring clicking sound.
If you’ve had a similar experience, there’s no need to worry, it’s very common and not a sign of Obsessive Compulsive Disorder (OCD). However, it may provide a brief glimpse into the world of those with OCD. Now imagine that after you check your car, you have to check each door, each window and each electrical switch of your house multiple times. Rationally you know your house is safe, but that uneasy feeling just won’t go away unless you’ve checked the house five times. This ‘not just right’ feeling can be a common experience in OCD and can cause a person to repeat a behaviour over and over.
So what exactly is OCD and how is it diagnosed? OCD is characterised by recurrent, anxiety-provoking thoughts (obsessions) and repetitive acts or rituals aimed at removing anxiety (compulsions). These symptoms are typically time consuming (> 1 hour per day), cause distress and interfere with a person’s life. As such, OCD is more than a personality trait and can cause as much distress and impairment as other mental health disorders (e.g., difficulty maintaining relationships, employment). Approximately 2-3% of the population will meet the full criteria for OCD.
Contamination, Checking & Immoral Thoughts
OCD is characterised by a diversity of symptoms and each presentation can vary greatly. Attempts have been made to categorise OCD symptoms and the most common symptom clusters are presented below:
- Thoughts about being contaminated or dirty and engaging in excessive washing.
- Engaging in repetitive checking of locks/switches or certain rituals to prevent bad events (e.g., touching objects in a certain order).
- Unpleasant and unwanted thoughts about engaging in immoral or aggressive acts.
- An excessive need for symmetry, order and balance.
While there is some awareness of the washing, checking and ordering symptoms of OCD, the more obsessional symptoms are often hidden, such as distressing immoral thoughts. As an example, a person with OCD could have a recurrent thought about pushing others into traffic. Because of this thought they may avoid crossing at a junction with other people. They have no intention of ever committing the act, but rather the thought is powerful because they are so distressed by it and try to suppress it.
What causes OCD?
The biological basis of OCD has yet to be established, although recent neuroscientific research has begun to shed light. Such research has identified certain brain regions involved in OCD, particularly an overactivity in the orbitofrontal cortex. One theory proposes that in OCD, these neural circuits do not adequately signal to the person that they have successfully completed a task. As such, they may be left with an internal feeling of incompleteness and motivational anxiety, even though they have successfully completed the task (e.g., continuing to feel dirty after washing).
Psychological theories have examined the factors which can contribute to the development of OCD. For example, individuals with OCD can have excessive feelings of responsibility and guilt. As such, they may feel that an inappropriate thought could cause harm to others or that they must engage in a certain ritual to prevent bad events. Heightened feelings of disgust can also be common in OCD and washing compulsions may be a way to reduce either physical or moral feelings of disgust (e.g., Lady Macbeth effect).
Do I have OCD and how can I seek help?
Many of us will experience OCD-like thoughts or behaviours from time to time or have obsessional personality traits that we are comfortable with. However, you should consider seeking help when such obsessions or compulsions cause you distress (e.g., irritability, anxiety) or significantly interfere with your life (e.g., impact your work or relationships). You can first contact your GP who will conduct an initial screening and may recommend referral to a mental health professional. Further information on the assessment and treatment of OCD is provided on the HSE website. The OCD Ireland website also provides information on support groups.
Treatment of OCD
Cognitive behaviour therapy (CBT) is recommended as a psychological intervention for OCD. CBT will typically involve exposure and response prevention whereby the person is gradually exposed to the situations that cause their anxiety and compulsions. Instead to reacting to the distressing feeling with a compulsion, they learn to cope with the feeling and allow the compulsion urge to subside. Medication or a combination of CBT and medication may also be indicated for moderate to severe forms of OCD.