What is obsessive compulsive disorder (OCD)?

OCD is a mental health condition characterised by a pattern of obsessive thoughts and compulsive behaviour. The obsession is typically a fear of something unpleasant, such as getting ill, or committing violence, and the compulsive behaviour is an effort to protect against the fear. While the compulsive response to the fear provides temporary relief from feelings of anxiety, it reinforces the cyclical behaviour. OCD can be successfully treated with counselling and/or medication.

Symptoms of OCD

OCD symptoms can range from mild to severe. Some people with OCD may spend an hour or so a day engaged in obsessive-compulsive thinking and behaviour, but for others the condition can completely take over their life. Children and teens are as susceptible to OCD as adults.

Common subjects for obsessive thoughts include:

fear of deliberately harming yourself or others
fear of harming yourself or others by mistake or accident
fear of attack by outsiders
fear of contamination by disease, infection or an unpleasant substance
a need for symmetry or orderliness

Common behaviours for those affected by OCD include:

cleaning and hand washing
checking – such as checking doors are locked, or that the gas or a tap is off
counting
ordering and arranging
hoarding
asking for reassurance
repeating words silently
extensively "overthinking" to ensure the feared consequence of the obsession does not occur
thinking "neutralising" thoughts to counter the obsessive thoughts

Another symptom of OCD that is less spoken about is intrusive thoughts. Here therapist Nicola Williams explains what these are:

What are intrusive thoughts?

We experience thousands of thoughts per day, and often we are not even consciously aware of their content. Intrusive thoughts however are those thoughts (and images) that unexpectedly pop into our minds and are distressing enough for us to take notice of them.

Although particularly common in anxiety disorders, OCD and PTSD, most people will experience them at some time, even without any other symptoms of poor mental health. In fact, studies have shown that up to 94% of the population have these thoughts at some point.

When do intrusive thoughts become a problem?

Intrusive thoughts are harmless; however, they can feel distressing if we attribute meaning or significance to them, particularly if their content is at odds with our personal beliefs or values. A religious person who has blasphemous thoughts and then believes this makes them a ‘bad person’ will have a tendency to experience more guilt and shame than a non-religious person, or a religious person who understands that these thoughts are meaningless and hold no value. They can therefore become problematic if we believe the thoughts say something about us as a person, we become overly focused on them, and change our behaviour as a result.

An example of this may be a new mother who suddenly has an intrusive thought of harming her child. This can trigger a perception of herself as a bad mother, fear that having the thought may mean she will act on it (even though she can think of nothing worse), and subsequent avoidance (perhaps refusing to spend time alone with her baby, or not picking her up in case she drops her).

Unfortunately, most of the time we keep these thoughts to ourselves. Many people fear that they will be judged, perceived as ‘odd’, or even dangerous. Lack of communication then perpetuates the belief that intrusive thoughts are uncommon, and that other people will not understand. There is often the concern that ‘thinking it’ must mean that deep down we must either want to do it, or that we are at risk of doing it, triggering feelings of confusion, anxiety, or shame, and the unspoken cycle continues. This is particularly true if the thoughts are of a sexual or violent nature.

What are the causes of OCD?

Research has not yet revealed exactly what are the causes of OCD. However, the following factors are believed to play a part:

genetic inheritance, if there is a family member with the condition
lack of the brain chemical serotonin, which regulates body functions like mood, memory and sleep
a history of upsetting life events, such as bereavement, abuse, neglect or bullying
a neat and meticulous personality may sometimes be more predisposed to develop into OCD behaviour

What can I do to help myself?

OCD can be successfully treated, so you should see your GP to talk about your treatment options: counselling and medication (anti-depressants such as SSRIs) are both options
talk to trusted friends and family so they understand how OCD makes you feel
make contacts with support groups and other organisations (see below) if you feel that might help too

How can counselling help with OCD?

People with mild and medium levels of OCD are usually treated with a short course of behavioural cognitive therapy (CBT) sometimes involving exposure and response prevention (ERP). Working with an OCD therapist, you break down your problems into their separate parts, such as your thoughts, physical feelings and actions. ERP encourages you to face your fear and let the obsessive thoughts occur without "putting them right" which will make you feel anxious. As you repeat the exercises and become more used to them, you will find that the anxious feelings slowly start to go away. Once you have overcome one exposure task, you can move to another, until you move beyond all the things that trigger your OCD.

While behavioural therapy is the most common recommendation for those with OCD, as always it will depend on what works best for you, and what your OCD relates too. It's possible that there may be things from your past experiences that you need to unpack in order to recover from OCD.

People with mild cases may find that up 10 sessions of counselling will be sufficient; those with more serious OCD may need up to 20 OCD therapist sessions.