Expert Focus: Obsessive Compulsive Disorder (OCD)

10 November 2014

"Whilst OCD has become a well-used term, its stereotypes do pose the risks of misunderstanding and minimisation of the degree of distress and debilitation that suffers often bare" - Clinical Psychologist, Libby Watson.

Our specialists have answered some frequently asked questions about OCD below.

Is it common for people with OCD to not realise they have it? 

Helen Page, Clinical Psychologist

"Peoples experiences vary, some people seek treatment having recognised their difficulty with OCD through reading about it, seeing it on TV or discussing it with friends and professionals. Other people seek help because they are noticing its impact on various areas of their life, for example difficulties in their relationships, at work or in their social lives.

"The problem might be stopping them from doing things which they value. However, the individual might not consider themselves to have OCD. Difficulties with OCD can also develop over time, so it can often be difficult for people to be aware that their concerns or behaviour have become a problem."

Is it common for them to internalise the problem?  

Laura Cole, Psychological Wellbeing Practitioner

"Someone with OCD can appear to function day to day despite experiencing distress or discomfort.

"Although OCD is considered to be the fourth most common mental disorder, people may feel very much alone with their difficulties and internalise the problem.  People may feel ashamed, a sense of guilt or too afraid to seek support.

"If the profile of OCD is raised it may help those who do not recognise the condition and give them the choice to access evidence-based treatments."

Are there common stereotypes associated with OCD?

 Helen Page, Clinical Psychologist

"There often is a stereotype that sufferers will be keeping things orderly or washing their hands excessively, however OCD can present in many different ways.

"People might have obsessional concerns about harm coming to themselves or others, for example worrying that they will catch germs from touching things or that the house will catch fire if they didn't check the oven.

"These are quite normal worries, but for people with OCD it becomes difficult not to think about constantly. People therefore find themselves taking excessive precautions such as constantly checking, seeking reassurance or avoiding things all together.

"OCD also often presents as intrusive thoughts which the person feels very worried about. They might be thoughts the person doesn't want to have or act on, for example thoughts of harming someone, which they then try to avoid or control. 

"It might not always be obvious that someone has OCD as they might have a lot of rituals that they do in their mind, for example thinking 'good' thoughts."

What advice would you give people trying to cope with OCD?

Helen Page, Clinical Psychologist

"I would recommend seeking help from your GP or a psychology service as there are very effective treatments which can help. It can be useful to speak with friends and family in order to gain support from people who understand you. Treatment can be a challenging process so it is helpful to have people supporting you.

"Often OCD suffers feel isolated or embarrassed and speaking to other people, whether it be friend or your GP, can really help you to feel less alone with the problem.

"Reading about the problem can also be a good starting point and there is a lot of helpful information online. Self-help books are also very valuable."

What treatment is used for those with OCD?

Cognitive Behavioural Therapy (CBT) is one of the most effective types of treatment for OCD. Generally, CBT helps you to identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones. CBT teaches you new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.

Libby Watson, Clinical Psychologist

"Cognitive Behaviour Therapy (CBT) is an active and structured therapy, where therapist and client work collaboratively in making sense of the client's presenting difficulties in the 'here and now' (there is less focus on the client's past compared to other therapies). The aim is to help the client to become their own therapist, equipping them with tools and techniques (practised both in and between-sessions), to both understand and challenge unhelpful thoughts and behaviours that may be maintaining the problem.

"Assessment will help determine whether CBT 'fits' with a person's difficulties and willingness to work on the problem. Therapy will begin by developing a shared understanding between client and therapist of 'the problem': from where it may have stemmed; its onset and course; things that make it better or worse - with a particular focus beliefs and coping strategies that in the short-term may reduce distress (e.g. repeated hand-washing to 'prevent' contamination), but in the long-term may actually be maintaining the distress.

"The therapist will then devise with the client experiments to help 'test out' unhelpful beliefs and feared predictions, and encourage the person to face their fears in a graded manner (in OCD this tends to take the form of Exposure and Response Prevention; e.g. 'exposing' oneself to something believed to be contaminated and preventing the ritual hand-washing). New understandings and beliefs from experiments are recorded and reinforced, and problem-solving is applied to any difficulties that may arise during the therapy. Before therapy ends, time is spent summarising and consolidating the work that has taken place with a plan for managing any future challenges."

What services within C&I are available to people with OCD.  

Camden and Islington iCope Psychological Therapies Service offers evidence-based psychological therapies as recommended by the National Institute for Health and Clinical Excellence (NICE). iCope offers therapies for adults of all ages, from young to old. We can help you learn ways to help yourself so that you feel more able to cope with your problems.

Find out more about how iCope can help you.

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