Obsessive compulsive disorder (OCD) is a disabling disorder where you have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), and behaviours which drive you to do something over and over (compulsions). Often you carry out the behaviours to get rid of the obsessive thoughts. In this disorder, if you fail to do the behaviour, there is a dramatic increase in anxiety. The behaviour provides a short-lived sense of relief. These thoughts and behaviours occupy much of your time and cause considerable distress. The illness dramatically impacts on functioning and relationships. Whilst, at times, these thoughts or behaviours may be recognized as being irrational, you are unable to control your thoughts and behaviours. Examples include germ/ hygiene obsession and repeated handwashing, counting, checking.
Treatment usually requires both medication and psychotherapeutic intervention. In the initial assessment we will explore your thoughts and habits as well as assess for a level of impairment and distress. In addition, it is important to exclude comorbid psychiatric disorders such as depression, generalized anxiety, substance use disorders and autism spectrum disorders. Medication generally involves serotonin promoting agents such a selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and selective serotonin and noradrenaline reuptake inhibitors (SNRIs) but may require the addition of antipsychotics to dampen down the dopamine-mediated ‘reward’ pathway to the behaviour. Psychotherapeutic interventions involve psycho-education, family support and gold-standard cognitive behavioural therapy which works on distress tolerance to intrusive thoughts and more positive behavioural techniques to cope with the associated anxiety brought on by these thoughts.