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Author: Dr Muffazal RawalaConsultant Adult Psychiatrist

Commonly misunderstood and often well hidden, OCD affects an astonishing 1 in 100 people in the UK.


What is OCD?

Sadly half of those with OCD will suffer with severe OCD symptoms, which can severely limit their ability to partake in certain activities and lead to depression.

Though we might all have our ‘quirks’ and be particular about certain things, (like the way the cupboards are ordered or things we need to check before leaving the house), those with OCD are often crippled by their fears and live an exhausting round of upsetting thoughts and behaviours they simply cannot control.

People with OCD report of feeling trapped in a prison and may feel like they are going crazy. The World Health Organisation has listed OCD as one of the top ten debilitating illnesses in terms of the impact it has on the individual’s quality of life.

The onset of OCD is normally in late adolescence or early adulthood


OCD explained

  1. Obsessions – these are thoughts, images and fears that are intrusive, persistent and most important, uncontrollable. Obsessional thoughts can take a variety of forms from fears that something or someone is contaminated, to horrific fears of hurting someone physically or sexually as well as fears of causing an accident or behaving inappropriately in public.
  2. Compulsions – these are physical or mental actions and rituals performed by the individual, often in a very structured and rigid manner. By performing the physical action or mental ritual someone with OCD believes they will be able to prevent whatever they fear most from happening (their obsessions). Performing the ritual also gives momentary relief from the intense discomfort that the obsessions can result in.

2/3 of people respond positively to antidepressant treatment for OCD


Symptoms of OCD

It’s a common misconception that OCD symptoms have to be visible – whilst there are stereotypically ‘overt’ or visible compulsions often represented on TV or the press – there are often invisible compulsions that can be just as distressing and disabling.

Common ‘overt’ symptoms of OCD

  1. Excessive hand washing / changing of clothes
  2. Aligning objects so they are ‘just right’
  3. Ritualistic cleaning routines that can last for hours
  4. Turning lights on and off a certain number of times
  5. Hand washing in a certain way

There are also some more ‘covert’ or invisible compulsions, which can be equally as distressing, powerful and exhausting:

  1. Counting to a certain number or repeating a certain phrase silently or quietly.
  2. Avoiding objects that could cause harm, such as locking kitchen knives away.
  3. Avoiding certain places or people for fear of causing them harm, for instance train stations.

The above lists are by no means comprehensive and the sad truth is that many people with OCD feel huge shame and embarrassment so will hide or disguise their behaviours from others. OCD requires expert understanding and treatment but can be successfully managed.


OCD – the vicious circle

OCD is a vicious circle for many. The more someone worries about something, the more they carry out their compulsions and the more prominent it is in their minds.

As their deepest fears do not come about, this pattern is then reinforced in their minds. It is important to note that people with OCD often know that their fears are irrational but are unable to control them.

It is not unusual for the obsessions and compulsions to change over time and to intensify during times of stress.

My OCD had become the most powerful thing in my life, every waking moment felt like I was in hell, constantly second guessing myself and checking – endless checking. I was diagnosed with OCD and depression and the treatment I have had has really helped – once my low mood lifted I was able to engage in the CBT much more effectively and I saw a brilliant psychologist. Finally I feel like I have got my life back.

Izzu, London


Treating OCD

OCD is treatable and as with many other mental health conditions – the earlier it is dealt with the easier it is to make a recovery. Often people with OCD will hide their symptoms due to fear, shame or just feeling their symptoms ‘aren’t that bad’.

Because OCD can have such a huge impact on a person’s life, it is common for other mental health conditions like depression to develop as well.

The development of a condition like depression can have a significant impact on the best treatment course – sometimes it is necessary to get the depression dealt with before you can start to tackle the OCD – partly so the individual has the motivation and energy needed to engage in therapy but also so they can develop some self-esteem which will help them tackle their OCD behaviours.

OCD can, in its most severe forms, be one of the most disabling conditions you can experience. Effective treatments are available, and I have seen them give people their lives back.
MBBS, MSc, MRCPsych

Consultant Adult Psychiatrist
London

Dr Muffazal Rawala is an experienced NHS Consultant Psychiatrist, currently working for East London NHS Foundation Trust. He has a Medical Degree, a Masters in Transcultural Mental Health, has a postgraduate certificate in Psychopharmacology and is a...

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