The world is a stressful place right now. The World Health Organisation (WHO) lists obsessive-compulsive disorder (OCD) in its top 10 most disabling conditions as measured by lost income and decreased quality of life.
What is OCD?
‘Obsessions’ and ‘compulsions’ are commonly used terms, like ‘I’m obsessed with my shoes’ or ‘He is a compulsive liar’, but they have a different, and a very specific meaning for mental health professionals.
An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease. These have to be recognised as one’s own thoughts and the person is unable to resist them.
A compulsion is a repetitive behaviour or mental act that you feel you need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought (these often are excessive hand washing, cleaning or checking something repeatedly). They have to be repeated again and again and are not inherently enjoyable or purposeful.
The WHO’s International Classification of Diseases specifies that for a diagnosis of OCD to be made obsessions, compulsions or both need to be present for at least 2 weeks and be a source of distress or interfere with the person’s activities. In addition, it also divides it into more specific categories: one with ‘predominant obsessional thoughts or ruminations’, one with ‘predominantly compulsive acts’ and what would probably be most common and recognised as OCD – ‘mixed obsessional thoughts and acts’.
Diagnosis and treatment
OCD is identified by taking a detailed history of symptoms and other elements of person’s history. To exclude other causes and decide on the best treatment this is best done by a trained doctor or other mental health professional.
What should you do if you are concerned that you/someone you know have OCD?
People with OCD often delay seeking help because they feel ashamed or embarrassed or are afraid someone will say they are ‘mad’. You should encourage them to either speak to their GP or in a lot of places they can refer themselves directly to a psychological therapies service. Unfortunately, mental health services are under a lot of strain and often a period on the waiting lists can also discourage many from accessing the help.
Seeking help should be encouraged as there are treatments that are effective for most sufferers. Typically, this would start from a course of psychological therapy called CBT (cognitive behavioural therapy) where you would look into your thoughts, feelings and behaviours in more detail with the help of the therapist and would typically have exercises to do at home.
If one does not respond to the psychological treatment or when the symptoms are more severe a prescription of an antidepressant might be indicated.
It is also worth connecting with other people, who have similar experiences to find the things that work for them and OCD support groups are available in many locations as well as online.
Managing OCD during the current pandemic
Whilst to most it is seen as necessary public health advice to wash hands frequently, for those with OCD this may cause increased anxiety. Indeed some sufferers may have spent years trying not to wash their hands (possibly as part of treatment). To then be told they must repetitively wash their hands to prevent infection from a virus that kills (adding the ritual of singing the happy birthday song) could very likely exacerbate this condition.
There are a number of things you can do to manage your OCD during the pandemic:
Relaxation using apps, breathing exercises, distraction techniques, and mindfulness exercises.
Taking a break from the news. Limit the time spent listening to or reading the news. Avoid scrolling social media sites for news which may be misleading.
Following official advice on hand-washing, but only cleaning your hands for the recommended amount of time.
Most importantly, making sure you maintain social contact with friends and family by phone or video call.
Dr Wiktor Kulik MRCPsych