OCD

Causes

OCD usually starts in the teens or early twenties affecting men and women equally. The severity of symptoms vary over time, and include:

• Recurring thoughts – ‘obsessions’ that make you anxious. These can be unpleasant words, phrases or pictures in your mind.
• Repeating things you do over and over again – ‘compulsions’ that help you feel less anxious. You may try to correct the thoughts by counting, saying a special word, or doing a particular ritual like washing your hands over and over again.

Symptoms

Many factors might play a part in explaining the causes of OCD:

• It can occasionally run in the family.
• Stressful life events bring it on, in about one in three cases.
• Life changes such as puberty, the birth of a child or even a new job.
• An imbalance of a brain chemical called serotonin (also known as 5HT).
• You are a neat, meticulous, methodical person; but these traits begin to dominate your life with obsessive washing, organising or cleaning.

Treatment

Self-help

• Writing or recording your troubling thoughts and going over them helps some people, You need to do this regularly for around half an hour every day, while trying to resist any usual compulsive behaviour.
• Don't use alcohol to control your anxiety.
• If your thoughts conflict with your faith or religion, talk it over with someone you trust who shares your beliefs.

Therapy

Instead of trying to get rid of your thoughts, cognitive behavioural therapy (CBT) helps to change your reactions, targeting unrealistic self-critical thoughts. This is useful if you have obsessional thoughts, but don’t perform any rituals or actions to make yourself feel better.

Exposure and response prevention (which can be used with CBT) helps stop compulsive behaviours and anxieties from strengthening each other. It enables you to gradually face the situation you fear, whilst stopping yourself from completing your usual compulsive rituals, and waiting for your anxiety to go away.

About three out of four people who complete this particular therapy find it helpful but symptoms recur in one in four who will need extra treatment.

Antidepressants can help even if you’re not depressed and can be used alone, or with CBT, for moderate to severe OCD. If treatment has not helped at all after three months, your medication can be changed to something which might suit you better.

About six out of ten people improve with medication and their symptoms reduce roughly by half, preventing OCD returning so long as it ‘s taken, even after several years. Unfortunately, about half of those who stop medication will find their symptoms returning in the months afterwards, although this is less likely when medication is combined with CBT.