What is OCD?

Obsessive-compulsive disorder (OCD) is a treatable anxiety disorder. It affects more than 500,000 people in Australia. It usually starts in late childhood or the early teenage years.

Most people have irrational thoughts and impulses from time to time, such as feeling you can jump from a high place. But People with OCD tend to ‘hold onto’ these thoughts and behaviours more tightly and are unable to control or limit them. This can lead to feelings of embarrassment and shame.

These feelings can cause you to suffer in secret, and present ‘normally’ to those around you. This costs a lot of:

• time
• energy
• stress
• effort

If you have OCD, getting support and effective treatment can help improve your life.

OCD is not the same as obsessive-compulsive personality disorder (OCPD). which is when people are rigidly preoccupied with:

• order
• perfection
• control

What are the symptoms of OCD?

OCD can have different symptoms in different people, but often they follow certain common themes.

As the name suggests, there are 2 main kinds of symptoms:

1. obsessions — unwanted thoughts, images or urges that repeatedly come to mind and cause distress
2. compulsions — behaviours or rituals that you repeatedly carried out to reduce anxiety associated with the obsessions

Obsessions can lead to compulsions. Compulsions can take considerable time, as they are difficult or impossible to resist doing. They can affect your normal day-to-day activities. Often compulsions are triggered by the fear ‘something’ bad will happen e.g. I will die/someone I love will die if I don’t pray in an exact way, if I step on the cracks, if I don’t wash my hands for 3 minutes in a specific way

For example, you may need to check the iron is turned off exactly 20 times.

You may have OCD if you have obsessive thoughts and compulsive behaviours that:

• take up a lot of time — more than 1 hour a day
• are excessive and unreasonable
• cause you significant distress
• interfere with your normal life and relationships such as make you late for work or school

CTA: If you need to talk to someone about your mental health, call Beyond Blue on 1300 22 4636.

Obsessions (thoughts)

Common obsessions include:

• fear of germs or illness for fear it will be catastrophic (I/they will die from the germs)
• fear of hurting others — such as your own children or a passenger in your car

• having things in order or following certain patterns
• sexual or pornographic thoughts or images
• worrying you have forgotten to lock doors or turn off appliances
• preoccupation with religious or moral issues
• thoughts of harming yourself or others

Compulsions (behaviours)

Common compulsions include:

• excessive hand washing, showering or cleaning due to fear of germs
• the need to continually check things, like taps, locks or light switches, for fear of harm or to maintain order
• counting items or objects such as paving stones on a walk
• hair pulling and hair loss
• skin picking
• hoarding random objects, such as junk mail and old newspapers
• praying excessively
• constantly seeking reassurance from others

Compulsions can impact your health. For example, excessive cleaning may lead to dermatitis on your hands.

Some behaviours not listed here may still be OCD symptoms. It’s the obsessive nature of the behaviour that’s important in diagnosing OCD, rather than the behaviour itself.

Other conditions can be closely related to OCD, such as:

• body dysmorphic disorder — excessive concern about your body, believing it is abnormal in some way
• trichotillomania — compulsive hair pulling
• hypochondriasis — fear and preoccupation with developing a physical illness
• compulsive hoarding
• anorexia nervosa or other eating disorders

What causes OCD?

It’s not clear why some people develop OCD.

Like many mental health disorders, it’s thought to develop due to a combination of factors.

Genetics

Your genes likely play a part in OCD, as it appears to run in families.

Biology

Research does suggest that people with OCD have different brain structure or functioning to people who don’t have OCD.

OCD has also been linked to irregular levels of serotonin — a chemical that sends messages to the brain.

Environment and personality

OCD behaviours may:

• develop following traumatic or stressful events
• originate from social learning

When should I see my doctor?

OCD symptoms can feel embarrassing or shameful. You may find it difficult, but it’s important to get help.

The sooner treatment starts, the sooner you will feel better. Speak to those close to you — they can help you get the support you need. Remember, most people have obsessions or compulsions at some stage in their life.

Don’t delay a visit to the doctor if you or someone you know has obsessions or compulsions that:

• are unreasonable, irrational and distressing
• impact their life in an negative way

How is OCD diagnosed?

There is no single test for OCD. The first step is to see a doctor.

They can make a diagnosis based on your:

• behaviours
• thoughts
• feelings
• level of distress and impact on functioning

They may refer you to a:

• psychologist or psychiatrist
• occupational therapist

The doctor will rule out other conditions that may be causing your symptoms such as:

• depression
• schizophrenia
• anxiety disorders

Diagnosis can sometimes take time. But beginning the assessment process is a positive step towards recovery.

How is OCD treated?

OCD can be a lifelong condition. But, there are treatments that can help you manage intrusive symptoms and significant distress, and stop them controlling your life.

The best results may come from a combination of treatments.

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is guided by a mental health professional. It’s a way to learn new and more positive ways to cope with your symptoms. You will be gently encouraged to:

• Understand the nature of OCD
• resist your compulsive behaviours
• find other ways to reduce your anxiety

Exposure and Response Prevention (ERP) is a type of CBT. During ERP, you make a list of what makes you less anxious to most anxious, such as:

• images
• thoughts
• objects

ERP helps you to work your way through the list and confront your anxieties while avoiding and reducing your compulsions.

Over time, this can help you learn to manage and reduce your symptoms.

Medicine

Antidepressants are used to treat OCD in Australia and can be very effective. They can help restore normal chemical levels in your brain.

Your doctor or psychiatrist can prescribe medicines for OCD. They can take 8-12 weeks to work.

Community support and recovery programs

People who have OCD may isolate themselves.

If you have OCD, you and your family can benefit from therapy or a support group. In these groups, people can:

• share coping strategies
• develop a support network

Can OCD be prevented?

The cause of OCD is not completely understood and can’t be prevented. But treatment can help manage anxiety and other symptoms of OCD.

Complications of OCD

If not treated, OCD can become chronic and cause significant impact to your functioning and quality of life. This may mean that you become housebound and can’t attend work or school.

People who have OCD are also more likely to develop:

• depression
• other anxiety disorders, such as panic disorder or social anxiety

Resources and support

You can contact one of the services below to speak with someone or to chat online:

• OCD Stop! Program (an online program for understanding and managing OCD)
• OCD? Not Me! (online OCD treatment program).
• Kids Helpline (telephone and online counselling for ages 5-25) — call 1800 55 1800.
• Mensline Australia (online counselling and forum for men) — call 1300 78 99 78.
• Lifeline (anyone having a personal crisis) — call 13 11 14.
• Suicide Call Back Service (anyone thinking about suicide) — call 1300 659 467.

You can call Medicare Mental Health on 1800 595 212 for advice and to get connected to local mental health services. Check the operating times. You can also visit the Medicare Mental Health website for information on obsessive-compulsive and related disorders.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.