Demystifying OCD

“Cast all your anxiety on Him, because He cares for you”.
1 Peter 5:7

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder that affects one in every 50 people. It is common to hear people refer to themselves as “OCD” or obsessive, but these terms are frequently misused and misunderstood. There are two main types of symptoms in OCD: obsessions and compulsions.

Obsessions

Obsessions are unwelcome and intrusive thoughts, images, urges, worries or doubts. They occur in a repetitive fashion and are experienced as distressing; there is often a fear of losing control completely. Examples include an irrational fear of contamination (i.e. not related to the current Covid-19 pandemic per se) or distress caused by items not being kept in an orderly fashion.

Obsessions should not be confused with instances in which people insist that they are ‘obsessional’, which commonly refers to a preoccupation with certain themes that they tend to ruminate on. Although distressing, it is not the same. Similarly, being tidy or paying extra attention to hygiene, particularly in the current climate, does not mean that you have OCD.

Compulsions

Compulsions are behaviours that people undertake to reduce the distress caused by the obsessions. Examples include repetitive hand-washing, checking doors are locked and counting to a specific number or engaging in other rituals to prevent something bad from happening. So-called ‘compulsive’ gambling or eating is not a true compulsion as defined here.

People diagnosed with OCD may have just obsessions, only compulsions or both sets of symptoms. OCD can have a significant impact on a person’s day-to-day activities and in some cases the quality of their relationships e.g. someone who compulsively checks the front door may spend many minutes leaving their house. The embarrassment and distress caused by the symptoms may result in some people becoming socially withdrawn.

For Christians and non-Christians alike, obsessional thinking can cause significant self-doubt. The nature of obsessions, such as the belief that one may harm other people or thoughts that appear to have a blasphemous theme, can cause some Christians to question the strength of their faith. There can be a lot of guilt and shame about the symptoms they experience and some people may form the belief that they are experiencing OCD owing to some unresolved sin.

What causes OCD and how do I know if I have it?

There is no single known cause of OCD. It does occur more commonly in some families, where an existing family member already has this diagnosis. Some research suggests that people with certain personality traits, such as a tendency towards being methodical and with very high standards, may be more likely to develop OCD.

There may also be links to trauma and in clinical practice it is common to see OCD appearing in new or expectant parents, for reasons that remain unclear. It is important to emphasise that the obsessional beliefs and compulsive behaviours do not indicate the presence of any character flaws, but are random and irrational manifestations of this condition.

Anyone concerned that they or someone they know may have a OCD should seek support from their GP in the first instance. They may be referred on to specialist mental health services, where a further assessment can take place.

The past year has been particularly difficult for many people as a result of the pandemic. Anxiety in this context is a normal reaction to challenging times, but if you feel it is unmanageable, it is best to seek support from a healthcare professional sooner rather than later. If in doubt, talk to your GP and if your symptoms are limiting your life, seek out professional help and advice rather than worrying and trying to diagnose yourself.

Treatment for OCD

The mainstay of treatment is psychological therapy, in the form of Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention (ERP), a behavioural therapy that gently exposes people to anxiety-provoking situations under the guidance of a trained therapist.

People with OCD may also benefit from taking antidepressant medication: the neurotransmitter serotonin (a chemical messenger in the brain) appears to be implicated in the onset of several anxiety disorders, including OCD. A number of antidepressants act on this pathway and thus relieve the OCD symptoms.