Obsessive-Compulsive Disorder (OCD) is unfortunately the type of mental health condition that laypeople abuse to some extent, as OCD is often used in a loose, cut-off-the-cuff way that decreases the severity of the condition in people’s minds. Yet OCD can be immensely distressing to the person with the condition as those around them. At the moment, I live with someone with OCD and before we started an intervention, their OCD was negatively impacting our lives in a number of ways. Therefore, in this clinical psychology podcast episode, you’re going to be learning what is OCD, what are the symptoms of Obsessive Compulsive Disorder, how is OCD treated and more. If you enjoy learning about mental health conditions, clinical psychology and more then this is going to be a great episode for you.
Today’s psychology podcast episode has been sponsored by Introduction To Psychotherapies: A Clinical Psychology Introduction To Types of Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What Is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorder is a mental health condition where someone experiences repeated, unwanted thoughts, images, feelings and/ or sensations (obsessions) and they engage in mental acts or behaviours (compulsions) in response. It is typical for someone with Obsessive Compulsive Disorder to carry out their compulsions to temporarily eliminate or reduce the impact of their obsessions, as well as if a person does not perform these compulsions then this causes them additional distress.
In addition, similar to other mental health conditions, Obsessive Compulsive Disorder varies in its severity but if a person doesn’t receive treatment for the condition then it can limit their ability to function at home, school or work.
Some examples of compulsions and obsessions can distressing thoughts round the idea of food going back so the person seals the food in a very particular way and if there is a mistake then they believe they are going to die. Or if a person holds distressing beliefs round their family going to get hurt by someone breaking into their house then they might check that their doors are locked over and over. Leading them to be late to work.
I didn’t use typical examples because I want you to understand that OCD is way more than handwashing and obsessions about being clean.
Moreover, in the United States, Obsessive Compulsive Disorder is estimated to impact around 2% of the population and it is often co-occurring with other mental health conditions. For instance, depression, anxiety disorders as well as eating disorders. With the condition typically manifesting for the first time in childhood, adolescence or early adulthood. As well as up to 30% of people with OCD have a tic disorder according to the DSM-5.
Personally, as an aspiring clinical psychologist, I am always interested when mental health conditions tend to occur together because it raises important therapeutic questions. For example, is the OCD maintaining the eating disorder or could the anxiety disorders be causing the OCD or vice versa. These are important factors to think about when treating someone with Obsessive Compulsive Disorder and another mental health condition.
What Are The Symptoms Of Obsessive Compulsive Disorder?
As much as I passionately dislike the DSM-5 for a whole host of reasons that I have explained in other places, when it comes to Obsessive Compulsive Disorder, the diagnostic criteria says that compulsions and/ or obsessions have to be present.
Firstly, the DSM-5 defines Obsessions as recurring urges, thoughts or images that are experienced as unwanted and intrusive, and for most people, they are distressing or induce anxiety. Then the person tries to suppress, ignore or neutralise them with a different action or thought.
Secondly, the DSM-5 defines compulsions as repetitive mental acts or behaviours that a person feels compelled to do because of their obsession or strict rules around something. The idea behind these compulsions is to counter anxiety, distress or to prevent a feared situation or event. Even though the reality is these compulsions are not realistically connected to the outcome, or the compulsions are excessive.
For example, it is reasonable to assume that milk that is two or three days past the Best Before date might be off, so you need to check it. It is excessive to throw away milk the night before the Best Before day because you truly believe that you are going to die if you drink the milk tomorrow.
In addition, the DSM-5 includes other information in the diagnostic criteria. For example, the obsessions or compulsions take up more than one hour a day, cause impairment for the person and/ or they cause clinically significant levels of distress. Then there is the typical DSM-5 caveat that Obsessive Compulsive Disorder needs to be the best explanation for what the client is experiencing and their symptoms cannot be better explained by another mental health or medical condition or a substance.
When it comes to the obsessions themselves, the specific details of them can vary wildly between different people with Obsessive Compulsive Disorder. They can include thoughts round contamination, a desire for order or they can be taboo thoughts around harm to themselves or others, sex and/ or religion.
Again, OCD in the real world is so much more than washing hands.
Furthermore, it is worth noting that compulsions aren’t always observable to other people. Like people with OCD might not always rearrange or count objects, check their concerns or wash things. In fact, some compulsions cannot be seen by others because the whole point of compulsions is they ideally offer someone temporary relief from their intense feelings caused by their obsession.
People with the condition could avoid certain places, things or people that trigger their obsessions and compulsions. As well as they can often have dysfunctional beliefs that can include an intolerance of uncertainty, a heightened sense of responsibility, perfectionism or an exaggerated view of the importance of troubling thoughts.
Personally, one of the many ways how OCD has impacted my life as someone with lives with a person with the condition is round cleaning, food preparation and whatnot. Since I am not allowed to do the cleaning in our kitchen, I am only allowed to clean my things because I do not clean in the very specific way that my housemate’s obsessions and compulsions allow.
Even though after their OCD, relationship and other things came to a head last week, after I write this blog post, I’m going to help clean other people’s things.
Also, it’s a very tragic thing to say but my housemate’s OCD was a core factor in why my anorexia has gotten this bad. Due to my housemate needing their food prepared in a very, very specific way, them getting extremely distressed round eating to the point where I was scared to go into the kitchen in case I made a mistake and the evening became so unpleasant for me. Granted, I was still dealing with rape trauma, PTSD and my own mental health at the time but I didn’t need the added stress of the OCD and getting scared to cause my friend so much intense distress.
This is why OCD can definitely impact other people and if I take a systemic approach for a moment then I can see how the OCD has caused disruptions and negatively impacted our household unit.
Going back to the content, people with OCD vary in their insight into their own condition. Some people with OCD have good insight because they recognise their OCD-related beliefs are not actually true. For instance, these people can understand that wrapping up opened ham in tin foil in a very specific way will not help them not die from contamination. Whereas other people with OCD do not have such good insight so they believe their compulsions and obsessions are true.
Finally, like other mental health conditions, the severity of OCD symptoms can vary over time, but the condition can persist for years or decades if it is not treated.
What Causes Obsessive Compulsive Disorder?
Briefly, whilst the causes of OCD are not fully understood, we know there are both genetic and environmental factors. For example, people that have family members with Obsessive Compulsive Disorder are more likely to have it themselves, and twin studies show there is a genetic influence in the development of OCD. As well as sexual or physical violence and other forms of trauma are associated with greater risk.
How Is Obsessive Compulsive Disorder Treated?
In the next week’s podcast episode, I’m going to be focusing more on how a person’s support system can support the individual with OCD but professionally Obsessive Compulsive Disorder can be treated in several ways. It can be treated using psychological or medical interventions, and sometimes these approaches are combined.
For example, Cognitive Behavioural Therapy can be used in a very specific way in a programme called Exposure and Response Prevention. In Exposure and Response Prevention, a person with OCD is guided by a therapist and exposed to things, situations or thoughts that produce anxiety or lead to obsessions as well as compulsions. Then over time the person learns not to engage in these habitual compulsions.
Ultimately, Exposure and Response Prevention aims to over time reduce the anxiety that these obsessions produce once triggered by certain people and situations. Then this allows the person to better manage their OCD symptoms.
Medically, OCD can be treated using Serotonin Reuptake Inhibitors or Selective Serotonin Reuptake Inhibitors. Like clomipramine and more recently developed drugs like fluoxetine, sertraline as well as fluvoxamine. This is believed to help treat OCD because it increases the neurotransmitter serotonin in the brain and it is commonly used to treat depression and anxiety disorders.
It typically takes 12 weeks to produce an improvement in symptoms when used to treat OCD.
Yet I always recommend reading Read and Moncrieff (2022) because they show how useless anti-depressants are at treating depression and how there is no science behind them by modern standards.
Personally, I think the idea of using SSRIs to treat OCD is ridiculous because compulsions and obsessions are psychological elements. There are no biological basis here. Obsessions and compulsions are not cancer cells that you can target, they are not a virus, they are inside a person’s head. Therefore, you need to target the person’s mind through psychological interventions. Also, if SSRIs work so well, why do they actually need 12 weeks to cause an improvement. Of course, psychological therapy can take 12 weeks but it can be done by that time and by the end of the 12 weeks, you can actually arm a client to have enough adaptive coping mechanisms that they are set for life. SSRIs you need to keep taking for life.
Finally, one of my friends with OCD (not the one I live with), he’s going through CBT for OCD at the moment and he’s almost done. We were talking and I started to see improvements in him after 4 weeks. That is a lot shorter than 12 weeks.
Just saying.
Clinical Psychology Conclusion
I know what it is like to live with someone with OCD. I hate seeing my friend so distressed, having so much anxiety and struggling with their functioning. Also, I was surprised how much OCD can impact the lives of other people, including friends, housemates and loved ones. Therefore, I am glad that I now have a deeper understanding of OCD because it helps me be more understanding and it helps me to learn and put myself in their shoes. I am far from perfect but I want to try and understand my friend.
As a result, at the end of this psychology podcast episode, we understand that OCD is a mental health condition where someone experiences repeated, unwanted thoughts, images, feelings and/ or sensations (obsessions) and they engage in mental acts or behaviours (compulsions) in response. It is typical for someone with Obsessive Compulsive Disorder to carry out their compulsions to temporarily eliminate or reduce the impact of their obsessions, as well as if a person does not perform these compulsions then this causes them additional distress.
Finally, if you are guilty of this then it is okay because you are human and we can all change. Yet please stop saying “you’re a little OCD” unless you actually have the condition. By saying these things, you are minimising the intense distress and anxiety that people with real OCD experience on a daily basis and if we continue to minimise it then people don’t treat OCD as the serious condition that it is and a condition that we need to treat.
All so people with OCD can decrease their anxiety and psychological distress, improve their lives and develop more adaptive coping mechanisms.
This is the lifeblood of clinical psychology and that is why we must stop minimising a terrifying condition that causes so much distress to people every day of their life.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Introduction To Psychotherapies: A Clinical Psychology Introduction To Types of Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References and Further Reading
Chakraborty, A., & Karmakar, S. (2020). Impact of COVID-19 on obsessive compulsive disorder (OCD). Iranian journal of psychiatry, 15(3), 256.
Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., ... & Pompili, M. (2019). Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current neuropharmacology, 17(8), 710-736.
https://www.psychologytoday.com/us/conditions/obsessive-compulsive-disorder
Mahjani, B., Bey, K., Boberg, J., & Burton, C. (2021). Genetics of obsessive-compulsive disorder. Psychological Medicine, 51(13), 2247-2259.
Robbins, T. W., Vaghi, M. M., & Banca, P. (2019). Obsessive-compulsive disorder: puzzles and prospects. Neuron, 102(1), 27-47.
Spencer, S. D., Stiede, J. T., Wiese, A. D., Goodman, W. K., Guzick, A. G., & Storch, E. A. (2022). Cognitive-behavioral therapy for obsessive-compulsive disorder. The Psychiatric clinics of North America, 46(1), 167.
Stein, D. J., Costa, D. L., Lochner, C., Miguel, E. C., Reddy, Y. J., Shavitt, R. G., ... & Simpson, H. B. (2019). Obsessive–compulsive disorder. Nature reviews Disease primers, 5(1), 52.
Uhre, C. F., Uhre, V. F., Lønfeldt, N. N., Pretzmann, L., Vangkilde, S., Plessen, K. J., ... & Pagsberg, A. K. (2020). Systematic review and meta-analysis: cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 59(1), 64-77.
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