Obsessive-compulsive disorder (or OCD) is a distressing condition which affects around 1 in 100 people over the age of 16 in England at any one time. Although some degree of thinking things over or personal idiosyncratic behaviours or habits are normal, symptoms of OCD must be a source of distress to an individual and interfere with their functioning. There are two elements of the condition – obsessions and compulsions – which show certain key characteristics. Either obsessions or compulsions, or both, must have been present for most days in a two-week period in order to make a diagnosis.
Obsessions are thoughts. In OCD, they are recognised as an individual's own thoughts and not coming from an external source. They are unpleasantly repetitive thoughts. The person experiencing the thoughts may try to resist them or fight them off, but at least one of the thoughts must be unable to be resisted.
The thought of carrying out the act should not in itself be pleasurable. Examples include obsessive ruminations (debating things in one's mind over and over again without reaching any conclusion) and obsessive doubts over actions (for example, turning the gas off or closing the doors and windows).
Compulsions are behaviours and are often manifestations of obsessive thoughts. They are purposeful acts which must be carried out within a set of rules. They are not an end in themselves but are designed to bring about some other outcome (for example, avoiding some kind of disaster). There must be a disconnection between the act and the outcome it is trying to achieve and the individual must show some sort of magical thinking around these two elements. Examples include checking, washing and counting.
There is a strong association between OCD and anxiety. Obsessions cause anxiety whereas acting on compulsions can relieve anxiety.
Certain risk factors, such as a similar type of illness in family members or having a personality which lead to having abnormally high expectations of unpleasant outcomes,may indicate why someone might have developed OCD but cannot be changed. There are other risk factors, such as chemical abnormalities in the brain and learned abnormal behaviour (triggers leading to obsessional thoughts and subsequently using compulsions to lower anxiety), which maintain the presence of OCD symptoms but which are capable of being changed and offer good targets for treatment.
The treatment of choice for OCD is cognitive-behavioural therapy, which has been shown to be as effective, if not more effective, than medication for the condition; the majority of people undergoing this therapy for OCD show some improvement and reduction in symptoms. Antidepressant medication is best used in combination with psychological therapy; if symptoms improve on medication alone, they are likely to return when medication is stopped if the individual has not had a course of CBT as well.
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