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Obsessive Compulsive Disorder
By Deborah Condon, Irishhealth.com

Imagine you are walking somewhere with a pen in your mouth. A thought may enter your head - 'what if I were to fall, what damage could this pen do?' You might shudder at the thought and remove the pen from your mouth, you might even laugh that such a notion entered your head in the first place. Or you may simply carry on as you were.

However to some people, that thought may cause such stress that they literally become obsessed with it. This is one of the symptoms of OCD (obsessive compulsive disorder).

"The 'pen in the mouth' analogy is a good way of explaining OCD. Where we can laugh it off, the person with OCD can get so caught up with the thought that something bad is going to happen, they have to create a ritual to make that thought go away", explained Leslie Shoemaker, a counselling psychologist who specialises in this area.

The exact cause of OCD is unknown, however it is widely considered to be a disorder of the brain. While it is not known how many Irish people are affected, international research suggests that 2 - 3% of the population has it - that is one in every 33 - 50 people.

"Many of those affected have mild OCD. However it can be severe. I have dealt with people who are unable to work and whose relationships with family and friends are impaired as a result of the disorder", Ms Shoemaker told irishhealth.com.

While OCD has been highlighted in films such as The Aviator and As Good As It Gets, the condition can be difficult to explain and understand, even among health professionals. In fact, American research indicates that those affected see, on average, three to four doctors over a nine year period, before they receive a correct diagnosis. Obtaining appropriate treatment can take even longer.

So what exactly are obsessions and compulsions and how do these 'work' in relation to OCD?

Obsessions are generally regarded as unwanted and intrusive thoughts, images and urges that can cause a person anxiety when they occur. The person with an obsession may see it as senseless, upsetting and difficult to discuss. The difficulty with OCD is that once an obsession has occurred, it brings about feelings of discomfort, anxiety and an urge 'to put things right'. When the person acts on this urge, this is known as a compulsion.

In other words, the compulsive behaviour is carried out to make the thought (obsession) go away, which reduces the anxiety and discomfort being experienced by the person affected. A simple example of this could be a person who has an obsession with contamination and has to wash their hands five times after touching a particular object.

There are a range of topics that people can becomes obsessed with, including:

  • Health/contamination, e.g. germs, illnesses.
  • Morals/religion, e.g. excessive concerns about right and wrong.
  • Symmetry/order, e.g. items on a shelf must be placed in an exact place and order.
  • Checking behaviours, e.g. repeatedly checking that doors are locked or that appliances such as ovens and irons are switched off.
  • Hoarding/collecting, e.g. not being able to throw away items such as old newspapers or having to minutely inspect rubbish bags to ensure nothing valuable has been thrown out.
Meanwhile compulsions, i.e. the act that is carried out to lesson feelings of anxiety, can be done in the head, such as counting, or they may be more obvious, such as continually checking that the oven is off.

One of the most obvious signs of OCD is the lack of rationality associated with it, according to Ms Shoemaker.

"When it comes to something like hoarding, many people may have problems throwing certain things out. People may not want to throw clothes out in the hope that some day they may fit back into them! However the person with OCD literally cannot throw items out. This is very irrational", she explained.

Another sign, she pointed out, is the 'ritualism' with which people carry out their compulsions.

"Compulsions can be very ritualised, very mechanised. A person with OCD, for example, may have a particular routine they follow when they are going to bed. Many of us have routines, but if we are interrupted, we don't notice and carry on or we do things in a different order. If a person with OCD has their routine interrupted, they have to start the entire ritual again", she said

As with most health problems in Ireland, a person seeking help for OCD will generally approach their GP first. People may choose to go to the doctor themselves or may be encouraged to do so by concerned family or friends.

The GP may deal with the disorder or refer the patient to a consultant psychiatrist. Ms Shoemaker emphasised that whether you are seeing a GP or psychiatrist, you should be comfortable that they are familiar with the condition and are in a position to treat it.

"I always advise patients to get as much information as they can about OCD and bring it with them to the GP or psychiatrist. Ask them if this is an area that they know about and if it is not, go elsewhere. It is also essential that you feel comfortable with your doctor", she said.

People with OCD may be treated with drugs, specifically SSRIs (selective serotonin re-uptake inhibitors), which are a type of antidepressant. Another typical form of treatment is cognitive behavioural therapy (CBT). It is widely accepted that this is the best type of therapy when it comes to treating OCD.

According to Ms Shoemaker, who works in the field of CBT, the aim of it is to give a person with OCD the tools to manage the disorder. This is done using a technique known as ERP (exposure response prevention), which involves exposing the person to their fear. For example, a person obsessed with germs or contamination may be brought into a public bathroom. The person will be helped to face their obsession, without having to use a compulsion to reduce their anxiety.

"CBT can work quickly or may take some time - every case is different. Unless it is a particularly urgent case, I will see a patient usually once a fortnight. Some of these meetings will take place outside of the therapy room for the purposes of ERP", she explained.

However apart from the fact that the disorder can be misdiagnosed or missed altogether, the lack of cognitive behavioural therapists is also a major cause for concern when it comes to OCD treatment, Ms Shoemaker points out.

These therapists mostly work on a private basis and many have waiting lists. The situation in the public arena is even worse. Some Health Service Executive (HSE) areas have no cognitive behavioural therapists for public patients at all and those that do have long waiting lists.

"You can be weeks to months waiting to see a cognitive behavioural therapist. More are definitely needed. It is also difficult to find a place to train if you want to work in this area, so more courses are needed", Ms Shoemaker added.

For more information on OCD, including support group details, see
http://www.ocdireland.org.
 

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