Integrity CBT

Obsessive-Compulsive Disorder (OCD)

OCD hand washing A clinical perspective on Obsessive-Compulsive Disorder (OCD):

Obsessions can be described as being those distressing thoughts, ideas, images, or impulses that seem to repeatedly and involuntarily enter the mind of the person with OCD.
People with this condition often describe them as being repugnant, they are often recognised as being excessive or senseless and seem to occur against their will.  These are described as being intrusive and inappropriate, and cause marked anxiety or distress.  In order for a clinical diagnosis to be applied, these need to be  recognized as the product of one’s own mind and  not simply excessive worries about real life problems, and are accompanied by efforts to ignore, suppress, or neutralize the thoughts.

Compulsions are described as those behaviours or mental acts that the person with OCD feels driven to perfom repeatedly in response to an obsession, according to rigid rules , although they may be recognized as being senseless or not realistically connected to the obsessive fear, and excessive.  As they are aimed at preventing or reducing distress or preventing some dreaded event or situation from happening, it may be extremely difficult to resist doing them. There is frequently increased levels of anxiety that does not diminsh until the behaviour is completed.

Common Compulsions

  • Checking
  • Washing and Cleaning
  • Repetition of Normal Activities
  • Ordering or Arranging
  • Saving or Collecting
  • Mental Compulsions
  • Special words, images, and numbers recreated mentally to reduce anxiety
  • Repetition of special prayers
  • Mental counting
  • Mental list making
  • Mental reviewing

Common Obsessions

  • Contamination: Dirt, germs, bodily waste, chemicals
  • Mistakes: Locks, appliances, paperwork, decisions
  • Impulses: Violent, sexual, religious, embarrassing
  • Order: Neatness, symmetry, numbers

Compulsions are intended to prevent harm, however all they do in reality is reduce discomfort, and tend to be performed automatically without purpose.

Obsessions cause anxiety, causing the sufferer to engage in compulsions in an attempt to aleviate the distress caused by the obsessions. Carrying out these compulsions, or rituals, does not result in any permanent change, and in fact, worsens the OCD symptoms.

OCD is Reinforced by Learning Theory

  • Obsessions give rise to anxiety or distress
  • Compulsions reduce obsessional anxiety
  • Performance of compulsions prevents the extinction of obsessional anxiety
  • Compulsions are negatively reinforced by the brief reduction in anxiety they engender

Obsessions and compulsions cause distress, are time consuming, and significantly interfere with functioning.

  • OCD has a one-month prevalence of 1.3%
  • OCD has a lifetime prevalence of 2.5%

Incidence of Comorbid Conditions

  • Depression: 30%
  • Simple Phobia: 30%
  • Social Phobia: 20%
  • Panic Disorder: 15%
  • Tourette’s Syndrome: 36-52%
  • Sleep Disorder: 40%
  • Eating Disorders: 10%
  • Bulimia: 33%

There is a wealth of evidence to suggest CBT can be an effective treatment for OCD – Information from NICE can be downloaded here