How is OCD Diagnosed and Treated?

OCD is not an easy condition to diagnose as the ways in which it affects individuals can vary greatly. Healthcare professionals will take into account how distressing the symptoms are that the individual is experiencing and will also assess how much of their life is being affected by those symptoms.

The National Institute for Health and Care Excellence (NICE) provides official guidelines about the diagnoses of OCD, which states that for a diagnosis to be made, the following should be taken into account:

• The thoughts and impulses that are occurring are from the individual’s mind and are not imposed by someone else.
• One obsession or compulsion being experienced should be acknowledged as excessive or unreasonable.
• Obsessions or compulsions should cause marked distress to the individual.

What are the treatments for OCD?

There are two main types of treatment for OCD – Medication and Therapy.

Medication

Medication is likely to be one of the options that are given to the person who has OCD when they have visited their GP. He or she will be able to discuss what type of medication may work the best for the individual based on their symptoms.

These options may include SSRIs (selective serotonin reuptake inhibitors), which help by lifting a person’s mood and making them feel less anxious and then less compelled to carry out rituals. SSRIs do not work instantly though and it can take up to a year before their effects are fully experienced. There are some side effects to this type of medication but, unlike some other types of medication to treat mental illness, these are not addictive and so can be used long-term.

Therapy

CBT (cognitive behavioural therapy) is very effective in treating OCD because its fundamental aim is to help individuals to amend their thinking patterns. Since dysfunctional thinking is a large part of OCD, then CBT often proves useful, especially when used alongside other methods of condition management.

CBT – Cognitive behavioural therapy works by enabling the individual to look a their thinking patterns and readjust them so that they do not automatically fear the worst and can self-question in times where they may fear that they are going to cause harm. For example, and individual who is prone to OCD may hear a car brake loudly and suddenly and instantly fear that they have caused that accident to happen. A CBT therapist will enable them to see how extremely unlikely this is so that, in future, they do not always automatically assume that they are responsible for potential harm.

Person centered counselling – This style of counselling enables the individual to find their own solutions to their issues with the counsellor simply acting as a guide. Counselling takes place in a non-judgmental atmosphere where the counsellor will encourage the individuals to be open and honest about how they are feeling.

The counsellor will show empathy and hopefully help them to see that she is not alone in how they think and behave. Simply the act of sitting and speaking with someone for an hour a week can have a massively positive effect on alleviating the symptoms of OCD because someone feels validated and reassured that they are not going mad but are simply experiencing the symptoms of a mental illness that can be successfully managed.

Resources for OCD

Community Mental Health Teams (CMHTs) employ a wide range of health professionals who will be able to support and advise any individual who is referred to their services. This may mean that the individual is monitored to check that progress with therapy or medication is being made and that they are not experiencing any setbacks, which may cause their condition to worsen.

Examples of people who are employed by CMHTs include:

• Psychiatrists.
• Mental health nurses.
• Psychologists.
• Social workers.
• Occupational therapists.

A care plan will be put together by the individual and as many of the CMHT as is deemed necessary in order for the individual to be able to manage their condition successfully. Care in this team will continue until it has been mutually decided that the individual is capable of managing their care by themselves, although a GP may want the individual to present themselves for a check up at some point in the future.

Individuals will not be left to fend for themselves after they have been discharged, they will be offered advice about where they can find support in the future and assured that they can be re-referred to a CMHT if they experience any form of relapse in their mental health condition; something, which most individuals will find very reassuring at what will be a difficult time in their life.

Health centres often have walk-in appointments where individuals can attend to discuss any problems that they are having with mental health problems. Professionals will be on hand to assist in giving advice about the issue, possibly pointing them in the direction of a GP appointment or towards ways in which they can reduce their stress levels, which may account for some of the symptoms that OCD causes. Many health centres are able to offer discounted memberships at local gyms where individuals can attend to improve their confidence and self-esteem or possibly partake in lessons such as yoga and Pilates, which are known to be beneficial at reducing levels of stress and anxiety.

Support groups are very common for mental health problems and organisations such as mental health charity MIND offer them in many towns. It is said that the people who experience the issue are the biggest experts about it and joining a support group can be rewarding on many levels. Individuals feel understood and accepted when they are speaking with others who have gone through or are going through the same thing that they are. Helping someone else is also good for an individual’s self-esteem and confidence, and it can also be very rewarding.

Online forums provide exactly the same kinds of support as community groups but are better for individuals who cannot currently face the prospect of meeting with other people. To someone who has never experienced a mental illness, it may be difficult for them to understand how, simply going out and speaking to people can cause such issues, but for those people who do have these conditions, even the most simple of day-to-day tasks can sometimes feel insurmountable so any kind of help to keep them in contact with other people will be beneficial.

There are many online sources of support that are tailored specifically to the needs of people who experience OCD and can be very reassuring for individuals to read and discover that what they believe they are experiencing on their own, is actually common top more people than they would have ever imagined.

Examples of these sources include:

• OCD Action – which is an online community where individuals can be supported by forums or via Skype.
• OCDUK – also has an online community where individuals can discuss their issues with other people.
• MIND – have a supportive online community known as Elefriends.

Support for children with OCD

Child and Adolescent Mental Health Services (CAMHS) offer support to individuals who are under 18 years old and they provide care both in medical settings and in the individual’s home or school as well so that they are supported in as many ways as possible.

CAMHS teams are made up of many different professionals who work together to ensure that children and adolescents are support during times of mental ill health so that their quality of life is impacted as little as possible by their illness.

Professionals who work within a CAMHS team include:

• Nurses.
• Therapists.
• Psychologists.
• Support workers.
• Social workers.

As well as helping the child or adolescent, CAMHS are able to support parents and carers so that all aspects of the young person’s health are taken into account.

Self-support for OCD

As there is currently no cure for OCD, this remains a condition where an individual will have to live with throughout their lives.

However, the reality for most people is that the condition can be managed and there are several ways in which this can happen:

• Acknowledging and understanding the causes and triggers.
• Medication.
• Therapy.
• Counselling.
• Exercising.
• Eating properly.
• Sleeping properly.
• Not avoiding fears.
• Get a hobby to refocus and distract.
• Creating a ‘worry period’ every day.
• Creating a support network of family and friends.

Acknowledging and understanding the causes and triggers of OCD may be the first way in which an individual is able to manage their condition. When this happens, it will enable the individual to see why they are experiencing dysfunctional thoughts and obsessions and what they may be able to do in order to relive some of the anxiety that this causes. For example, if someone’s OCD symptoms seem to occur when they are feeling stressed at work, they can take steps to avoid that stress and hopefully reduce the effect that the OCD has as a result of this.

More importantly, however, an acknowledgement of the condition may encourage someone to seek help from a professional who will be able to advise many other ways of managing the condition that the individual may not have been previously aware. Even the fact that they have spoken to someone about their behaviour may help them to feel less anxious because they have seen that no one thinks that they are going mad and that they have not been ‘locked up’ for admitting to dysfunctional thoughts.

Exercising, eating properly and sleeping properly are interlinked and when an individual can manage to do all three, this can have a positive effect on their overall well being, which may help them to manage their condition so that it does not interfere with their daily life. For example, exercise can act as a distraction but it also helps the body to release ‘feel good’ hormones such as serotonin, which appear to be lacking in the brain chemistry of individuals who have OCD.

When someone has exercised, they are more likely to be tired and will therefore fall asleep more naturally. Eating properly also helps to make someone feel better because their energy levels will be higher and this may stop someone from slipping into a routine where they are too tired to leave their house or go about their daily routines.

Not avoiding the source of a fear can be useful because it means that the individual does not become subject to avoidance techniques and is therefore more able to stick to a routine. For example, if someone had a fear of walking near a school because they had a dysfunctional thought that they were going to kidnap a child, then avoiding the school would not help because it did not address the problem.

As part of CBT ‘homework’ individuals will be asked to face their fears slowly so that they can see that the fear associated with them is very unlikely to make them carry out their feared thought. In this case, this might mean that the individual passed the school on the other side of the road at first before they were able to walk straight past it or that someone walked with them past the school before they were able to do so alone.

A new hobby or activity can provide a very good distraction away from rituals and dysfunctional thoughts, although this may be something that individuals are not able to do straight after a diagnosis, as they may need to be lead into a change in their obsessional routine slowly.

For example, someone may take up jogging and could start by simply jogging around the block to take them away from their house for just a few minutes. Once they are comfortable with this, they can go further away until, eventually the individual may realise that nothing bad has happened whilst they were taking part in their new activity and that they may not have to continue with certain rituals.

The creation of a ‘worry period’ during someone’s day may not initially sound like a good idea because it is encouraging people to dwell on things that cause them anxiety. However, a slot during each day when the individual allows themselves time to worry may mean that they do not worry all day instead and can wait until the worry period to think about whatever is bothering them.

Finally, a support network of family and friends can be invaluable to someone with OCD, or any mental illness so that they know that they can go and speak with others if they need to and not be judged because of their condition. Maintaining this kind of contact also reduces the chances of isolation and more severe mental illnesses, which, will likely only service to make the OCD worse.

How other people can support someone with OCD

Being patient and understanding of the condition is the most important thing that anyone who knows a person with OCD can be. OCD can cause considerable distress to those who experience it and having people around them who are still accepting of them despite what the condition may cause their behaviour to become is essential in enabling them to feel as ‘normal’ as they possibly can.

In order to be understanding, it is helpful if other people can be educated about what OCD is and why it happens. This may mean that family members or friends attend doctor’s appointments and possibly even therapy sessions if this is what the individual needs.

Other people can also find out more information about OCD by encouraging the individual to talk about their issues so that they are able to be more empathetic towards them, which means that others will be able to understand better how the individual feels. OCD should be discussed as a manageable condition, not one that someone will experience to the point where their quality of life completely disappears, as some others may believe to be the case.

Some of the behaviours of the individual may be appear very strange but it is essential that other people don’t judge them as this may lead them to feeling embarrassed or ashamed of their condition and lessens the likelihood that they will seek treatment if they have not already done so. Encouraging them to seek help is another key factor in enabling someone to take back control of their life so that their overall well being, as well as their OCD symptoms can be improved.

Trying to work together with the individual can help them to stay motivated and it is vital that when working together that others do not reinforce the negative behaviours. For example, if someone has a hand washing compulsion then other people should not encourage them to do this continually just because it provides some initial, temporary relief from anxiety. They should, instead, motivate them by praising improvements and reminding individuals, when they appear to be slipping back into old habits of how much they have improved their life since they started to manage their symptoms effectively.

Finally, many individuals will be encouraged to mange their condition if they, and the people around them, can find some humour in the events that take place. This can be done in a way that does not mock the individual or disrespect them but helps them to appreciate that what they are doing is not the end of the world and that it can be seen as what it is – a symptom of a mental illness. Being able to laugh about a ritual or a compulsion may actually help it to become less of a focus for the individual and this may play a big part in their ability to manage their condition more successfully.