Obsessive-Compulsive Disorder (OCD)
The reports of suicide in the news in recent months has brought my attention back to mental health problems and I picked OCD (Obsessive Compulsive Disorder) as one of the common but less well-publicised mental health problems which is associated with an increased risk of suicide.
The worldwide prevalence of obsessive-compulsive disorder (OCD) is approximately 2% of the general population. It is thought that 1-3 in 100 people have some form of OCD behaviours or traits.
What is OCD?
A disorder is defined as an illness that disrupts normal physical or mental functions. Obsessive-compulsive disorder (OCD) is a common mental health problem. Symptoms typically include recurring thoughts and repetitive actions in response to the recurring thoughts.
What are Obsessions?
Obsessions are unpleasant thoughts, images or urges that keep coming into your mind. Common obsessions include:
- Fears about contamination with dirt, germs, viruses (for example, HIV), etc
- Worries about doors being unlocked, fires left on, causing harm to someone, etc
- Intrusive thoughts or images of swearing, blasphemy, sex, someone harmed, etc.
- Fear of making a mistake or behaving badly.
- A need for exactness in how you order or arrange things.
Obsessions can be about all sorts of things. Obsessive thoughts can make you feel disgusted, anxious or depressed. You normally try to ignore or suppress obsessive thoughts.
What are Compulsions?
Compulsions are thoughts or actions that you feel you must do or repeat. Usually, the compulsive act is in response to an obsession. A compulsion is a way of trying to deal with the distress or anxiety caused by an obsession.
For example, you may wash your hands every few minutes in response to an obsessional fear about germs. Another example is you may keep on checking that doors are locked, in response to the obsession about doors being unlocked. Other compulsions include repeated cleaning, counting, touching, saying words silently, arranging and organising – but there are others.
The Impact of OCD
In popular culture and frequently within the media OCD is mistakenly portrayed as a positive trait and personality quirk, but in reality – for those that suffer from Obsessive-Compulsive Disorder (OCD), it has a devastating impact on their life. The obsessions that you have with OCD can make you feel really anxious and distressed.
The severity of OCD can range from some life disruption to causing severe distress. You know that the obsessions and compulsions are excessive or unreasonable. However, you find it difficult or impossible to resist them.
OCD affects people in different ways. For example, some people spend hours carrying out compulsions and, as a consequence, cannot get on with normal activities.
Some people do their compulsions over and over again in secret (like rituals). Other people may seem to cope with normal activities but are distressed by their recurring obsessive thoughts. OCD can affect your work (or schoolwork in children), relationships, social life and quality of life.
OCD can be so severe that it can seriously impact on some or all areas of a person’s life, sometimes disrupting or completely ruining: Education, Employment, Career development, Relationships with partners, parents, siblings and friends, Starting a family.
Also, some of the behaviours that people do to cope with OCD (including compulsions) can also have devastating effects, for example, Substance abuse (self-medicating with alcohol or other substances or harmful drugs)
Who gets OCD and why?
The cause of OCD is not clear. Anyone at any age can develop OCD but it usually first develops between the ages of 18 and 30. Up to 2 in 100 children are also thought to have OCD. If you are concerned that you may have OCD, you should see your doctor and explain your concerns. Is there any thought that keeps bothering you that you would like to get rid of but cannot? Do these thoughts interfere to the extent that you respond to them with some compulsory actions so much so that it interferes with your daily activities by taking a long time to finish them or not even being able to perform your daily activities or function?
A detailed assessment is needed for OCD to be diagnosed. This may either be carried out by your doctor or by a specialist mental health team. The assessment will look at any obsessional thoughts and compulsions that you have and how they affect you and your daily life. Children with OCD may be referred to a specialist mental health team which is experienced in assessing and treating children with OCD.
What is the treatment for OCD?
The usual treatment for OCD is:
- Cognitive behavioural therapy (CBT); or
- Medication, usually with a selective serotonin reuptake inhibitor (SSRI) antidepressant medicine; or
- A combination of CBT plus an SSRI antidepressant medicine.
Cognitive behavioural therapy is a type of therapy that deals with your current thought processes and/or behaviours and aims to change them by creating strategies to overcome negative patterns, which may help you to manage OCD more effectively.
Recent studies suggest that people with OCD are 10 times more likely to die by suicide than the general population. Actively thinking about suicide (sometimes called suicidal ideation) also appears to be relatively common among people affected by OCD. This risk can be further heightened when an OCD sufferer develops depression because he or she is unable to relieve themselves of the disabling symptoms of OCD.
The take-home message is to seek help early when suffering from symptoms of OCD or indeed any mental health problems. We all have a role to play in reducing the suicide rates in our community. Being aware and supportive of people with mental health difficulties goes a long way to relieve their distress and prevent the rising rates of suicide.
OCD UK, WHO, VeryWell mind, Time to change.org.uk, NHS Self Help therapies. NHS Cognitive behavioural therapies.
Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review. (PMID:29929465)