Have you ever heard someone say, “I’m a bit OCD”?*

When most people think of obsessive compulsive disorder (OCD), they think of being tidy, organised, colour-coding items, and cleaning. However, OCD is an extremely complex and debilitating mental health condition, and very different from simply being neat and conscientious.

“Although many with OCD worry about cleanliness, symmetry, arranging, and perfectionism, OCD is a complex disorder that can manifest itself in a variety of symptom dimensions, including unacceptable or taboo thoughts and ruminations about morality.”

Williams et al. 2017

OCD is so common that the World Health Organisation classifies it as the fourth most common mental health illness worldwide. However, while the disorder has many globally recognised traits, some studies have found that certain localised components of OCD exist, along with very different ways of diagnosing and treating the condition. As a result, the figures on the condition may vary depending on culture and geographical region.

“Culture can have profound effects on the manifestation of psychopathology, particularly with a disorder as multi‐faceted as OCD.”

Williams et al. 2017

When we look at the prevalence within the UK, we can see that an estimated 12 out of every 1000 experience OCD. This equates to at least 750,000 people who are living with this mental health condition.

What is OCD?

Obsessive compulsive disorder is a mental illness characterised by obsessive thoughts and compulsive behaviours. Obsessions are defined as anxious thoughts, desires, or mental images that occur repeatedly. Compulsions, on the other hand, are repetitive behaviours that a person experiencing OCD feels compelled to perform in order to help diffuse the anxiety triggered by an obsessive thought.

Obsessions might present themselves in the following ways:

• Concern about germs or contamination.
• Worries that people in your family are going to die unless you do something to stop it.
• Having everything in perfect symmetry or order.

Compulsions can manifest itself in a variety of ways, including:

• Excessively cleaning and/or washing yourself or items around you.
• Ordering and arranging objects in a specific way.
• Repeatedly checking whether the door is locked or if the oven is turned off.

Please keep in mind that not all habits are compulsions. Many people will occasionally double-check themselves, but it moves into the realm of disorder when the person is:

• Unable to regulate their thoughts or behaviours to the point of impacting upon their day-to-day activities.
• Spending a lot of time thinking about or acting on these thoughts or behaviours, and / or
• Seeking to use certain behaviours as a way to relieve the tension and anxiety triggered by their thoughts.

In addition to the above symptoms, those living with OCD may develop motor and/or vocal tics. Motor tics are movements that are sudden, short, and repetitive, such as eye blinking and other eye movements, face grimacing, shoulder shrugging, and head on shoulder jerks. Vocal tics are repeated sounds such as throat clearing, sniffing, or grunting.

Due to the nature of the disorder, OCD-derived behaviours (whether repeated acts or thoughts) end up worsening the internal, unpleasant sensation they were intended to alleviate. This is because, not only might the ‘diffusing’ behaviour itself cause distress, but the behaviour also acts as a temporary sticking plaster, failing to remove the trigger and underlying cause of the anxiety, leading to a repeat of events later on.

*Note on language: we always recommend that – as a society – we learn to drop OCD from your vocabulary, unless when talking about the condition itself. If someone living with OCD hears you casually/jokingly referring to yourself or someone else as ‘a bit OCD’, it can cause hurt and shame and prevent someone from seeking support and starting their recovery journey.

“It’s like you have two brains, a rational brain and an irrational brain. And they’re constantly fighting. “

Emilie Ford

What causes OCD?

While the leading cause of OCD is not yet fully understood, there are a variety of risk factors to consider. Let’s look at three key factors.  They are:

1) Genetics

According to research, those who have close family members (parent, sibling) with a diagnosis of OCD have a higher chance of also receiving a diagnosis of OCD. However, this does also bring into consideration the nature vs. nurture debate.

2) Brain Structure and Functioning

New research suggests that those living with OCD have significant variations in the frontal cortex and subcortical areas of the brain. However, whilst it’s true to say that sometimes people with OCD are  found to have different patterns of brain activity, it could be argued this is the result of OCD due to the learnt behaviours impacting upon the ‘wiring’ of the brain – rather than being the cause of OCD.  

There is also research highlighting the imbalance of chemicals, in particular serotonin, however, more studies are being conducted into understanding the true relationship between brain structure, hormones and OCD.

3) Trauma / Life Experiences

As with many mental health conditions, studies suggest that those who have experienced childhood trauma may be predisposed to experiencing OCD. This can include traumatic childhood experiences such as being bullied, abused, or mistreated, but also significant life experiences within adulthood, such as childbirth or grief.

How to get support for OCD

First and foremost, it is key to understand that a diagnosis of OCD does not carry any shame. 

Just because you have received a mental health diagnosis, it doesn’t mean that you cannot live a full and varied life.

If properly detected and managed, it is absolutely possible to access the right support; and of course – the earlier the better, as with all mental health conditions. 

Treatment for OCD is usually in the form of:

1) Therapy

There are many routes into therapy, but the two main entry points tend to be either self-referral or via your doctor. 

The most common therapy used for OCD is a form of cognitive behavioural therapy (CBT), known as exposure and response prevention (ERP) therapy. 

“The exposure component of ERP refers to practising confronting the thoughts, images, objects, and situations that make you anxious and/or provoke your obsessions. The response prevention part of ERP refers to making a choice not to do a compulsive behaviour once the anxiety or obsessions have been “triggered.”

International OCD Foundation

From our experience in the field of mental health, many people often experience a reluctance towards therapy. However, if we can give you just one bit of reassurance in your journey, please remember that not every single therapist you meet will be the perfect match for you, and not every style of therapy will suit your needs. And that’s okay.

Sometimes what we need is to simply try a few therapists with a few different styles until we find the one who we connect with the most.

That said, whichever therapist or therapy you choose, please remember that the process of exposure therapy detailed above must be practised under the safe guidance of a professional. 

“All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your own ERP exercises to help manage your symptoms. Over time, the treatment will “retrain your brain” to no longer see the object of the obsession as a threat.”

International OCD Foundation

2) Medication

The second treatment that is often offered to those living with OCD is a type of antidepressant medication known as selective serotonin re-uptake inhibitors (SSRIs). This form of medication is thought to alter the balance of chemicals in the brain, helping to alleviate symptoms in some people. 

Important note: choosing whether to take medication is a very personal choice and that choice must be owned by the person experiencing the condition.  Medication works well for some more than others, but the key is to establish the right care and support that is right for you. All mental health support and services must be considered at a person-centred level.

3) Support groups

Finally, another key route to accessing support is via community groups.

When someone receives a mental health diagnosis, it is natural for that person to feel scared and alone in their experience, and as a result, withdraw from social situations. 

However, research has shown that joining others who are going through similar experiences can help to offer reassurance, as well as learn what coping strategies have worked for others. 

Some examples of charities who offer OCD-specific support groups include OCD Action, OCD-UK and TOP UK. You can also find a wide-range of discussion forums and educational workshops available in your local communities, countrywide and internationally.

With the appropriate diagnosis and treatment, a person with OCD can absolutely lead a happy and full life, just as many other people are living well with a wide-range of different health conditions across the world, whether it is physical or mental. 

Recovery, whether symptom-free or not, is absolutely completely possible.