Treating OCD

According to OCD Action it is estimated that around 1.2% of the UK population has OCD. This means that approximately 800,000 people are living with the condition. OCD often begins in late childhood, adolescence, or early adulthood. OCD affects men and women fairly equally, although some studies suggest that there is a slightly higher prevalence in women.

What is OCD?

OCD is a chronic mental health disorder which involves a cycle of obsessions and compulsions. These symptoms can significantly interfere with daily life, relationships, and overall well-being.

Obsessions are intrusive and unwanted thoughts, images, or urges that can cause significant distress. Common obsessions may include things like:

• A fear of contamination, for example germs, or dirt.
• A fear of harming yourself or other people.
• Unwanted or intrusive thoughts.
• The need for symmetry or exactness.

Compulsions are repetitive behaviours or mental acts that are performed in order to reduce the anxiety caused by obsessions. Examples may include:

• Excessive handwashing or cleaning.
• Repeated checking, for example locks, or appliances.
• Counting, tapping, or repeating words silently.
• Arranging items in a specific way.

While everyone may experience intrusive thoughts or repetitive behaviours occasionally, people with OCD find these thoughts and actions very time-consuming, distressing, and difficult to control.

Intrusive thoughts can be deeply distressing for several reasons, particularly for people with OCD or other anxiety-related conditions. Intrusive thoughts can often involve themes that are disturbing, taboo, or completely contrary to a person’s values or beliefs. People with OCD often attach significant meaning to intrusive thoughts, believing that having the thought means that:

• They are a bad or dangerous person.
• They might act on the thought, even if they have no plans to do so.
• The thought reflects a hidden truth about themselves.

This misinterpretation of thoughts as meaningful or predictive can lead to guilt, shame, and fear. Intrusive thoughts can create a fear of losing control over your own actions or mind. For example, worrying about acting on the thoughts and hurting someone else or being unable to stop having these thoughts. These fears can lead to heightened anxiety and a sense of helplessness. Intrusive thoughts are involuntary and often feel outside of a person’s control. They can pop up at any given time, even during moments of relaxation or happiness, making them feel particularly intrusive and overwhelming.

The harder someone tries to suppress or avoid these thoughts, the more persistent they often become, creating a cycle of distress. Intrusive thoughts can trigger strong emotional reactions, such as:

• Anxiety – a fear of the consequences of having the thought.
• Guilt – feeling responsible for having the thought.
• Shame – believing the thought reflects something wrong with them.
• Sadness – feeling overwhelmed or hopeless about the thoughts.

Many people with OCD also experience generalised anxiety or other anxiety disorders, such as social anxiety, panic disorder, or specific phobias. The constant worry and fear associated with OCD can contribute to a heightened state of overall anxiety. OCD creates a vicious cycle where obsessions trigger anxiety, and compulsions temporarily reduce the anxiety. However, this relief is often short-lived, and then the obsessions return, continuing the cycle. Over time, this cycle can worsen both the OCD symptoms and the underlying anxiety.

The brain of someone with OCD often has difficulty distinguishing between a thought and a real threat. As a result, intrusive thoughts feel urgent and very real, even though they are usually not based on reality. These emotions can be exhausting, overwhelming and interfere with daily life.

Intrusive thoughts are distressing because they feel uncontrollable, threatening, and often goes against a person’s morals. However, with the right tools and support, it is possible to reduce their impact and regain a sense of control.

Can OCD be cured?

OCD is a chronic condition, meaning there is no cure. However, it can often be effectively managed with the right treatment and support. Many people with OCD can experience a significant improvement in their symptoms and are able to lead fulfilling lives. The goal of treatment is to reduce the severity of obsessions and compulsions, improve daily functioning, and enhance quality of life. An understanding of the condition and being able to identify triggers is also helpful in managing the condition.

Research has shown that people with OCD often have differences in brain structure and function in regions of the brain which are involved in decision-making, error detection, and forming habits. These neurological differences may contribute to the persistent nature of OCD symptoms, as the brain may continue to generate intrusive thoughts and compulsive behaviours and it is how the person learns to manage these that matters.

OCD is associated with dysregulation of serotonin, dopamine, and glutamate, which are neurotransmitters involved in mood regulation and the control of impulses. While medications like SSRIs can help balance these chemicals, they may not fully reset the brain’s natural functioning. Selective Serotonin Reuptake Inhibitors are a class of medications commonly used to treat mental health conditions, including OCD, depression, anxiety disorders, and others. They work by increasing the levels of serotonin, which helps the brain regulate mood, emotions, and behaviour.

OCD is often a lifelong condition, similar to other chronic illnesses like diabetes or hypertension. A chronic illness is a long-term health condition that persists over an extended period of time, typically three months or more, and can often be for a person’s lifetime. Unlike acute illnesses, which are short-term and often curable, chronic illnesses are generally not fully curable and require ongoing management. While symptoms of OCD can often be managed effectively, the underlying predisposition to OCD may remain. OCD symptoms often fluctuate over time. Stress, life changes, or other personal triggers can cause symptoms to worsen, even after periods of remission.

People with OCD often have deeply ingrained thought patterns, such as a heightened sense of responsibility, perfectionism, or intolerance of uncertainty. These cognitive traits can persist even after treatment, making it easier for symptoms to re-emerge. Compulsions are often learned behaviours that provide temporary relief from anxiety. Over time, these behaviours become automatic and deeply ingrained, making them difficult to eliminate entirely. Stressful life events, such as trauma, major life changes, or ongoing stress, can trigger or exacerbate OCD symptoms. Even after successful treatment, these triggers can lead to relapses, beginning the cycle again.

While treatments like CBT and medication can be highly effective, not everyone responds fully to these. Some people may experience only partial relief from symptoms. Even after successful treatment, there is always a risk of relapse. This is why ongoing management and maintenance strategies are important as well as understanding triggers. The severity and complexity of OCD vary widely among different people. Some people may have mild symptoms that are easier to manage, while others may have severe, treatment-resistant OCD.

Many people with OCD also have other mental health conditions, such as depression, anxiety disorders, or tic disorders. These co-occurring conditions can complicate treatment and contribute to the chronic nature of OCD. Co-occurring mental health problems, also known as comorbidities or dual diagnosis, can be challenging to treat for several reasons. When two or more mental health conditions occur together, they often interact in complex ways, making diagnosis and treatment more difficult. Symptoms of different mental health conditions can overlap, making it hard to distinguish between them and one condition can make the symptoms of the other worse.

While some people may be able to achieve long-term remission, others may experience periods of relapse, especially during times of stress. Ongoing management and support are often necessary in order to maintain progress.

Common ways of treating OCD

Many people with OCD experience significant delays in diagnosis, often waiting 10-15 years from the onset of symptoms to receiving a proper diagnosis. This delay can have significant consequences, as early intervention is important for treatment to be effective.

Many people, including healthcare professionals, have a limited or inaccurate understanding of OCD. It is often stereotyped as being about cleanliness or organisation, which overlooks the wide range of obsessions and compulsions that can occur. Some other reasons for delayed diagnosis include:

• Hidden symptoms – people with OCD may hide their symptoms due to shame, embarrassment, or fear of judgment. This can make it difficult for others, including doctors, to recognise the condition.
• Fear of judgment – the intrusive thoughts associated with OCD can often be disturbing or taboo. People may fear being judged or misunderstood if they disclose these thoughts.
• Self-stigma – many people with OCD blame themselves for their symptoms. This can prevent them from seeking help.
• Misdiagnosis – OCD symptoms can overlap with those of other mental health conditions, such as anxiety disorders, depression, or eating disorders. This can lead to misdiagnosis or incomplete diagnosis.
• Focus on physical symptoms – some people with OCD present with physical symptoms, such as skin damage from excessive washing or gastrointestinal issues from stress. Doctors may focus on treating these physical symptoms without recognising the underlying OCD.
• Minimising symptoms – people with OCD may downplay their symptoms, believing that their thoughts and behaviours are just a part of their personality or a phase they will outgrow.
• Cultural or familial norms – in some cultures or families, certain compulsive behaviours may be seen as normal or even virtuous, delaying recognition of a problem.
• Lack of access to mental health services – in some areas, access to mental health professionals who specialise in OCD is limited. This can result in long wait times or inadequate care. The cost of therapy or medication may prevent people from seeking help, especially if they are unaware that OCD is a treatable condition.
• Gradual onset – OCD symptoms often develop gradually, making it difficult for people to recognise when their thoughts and behaviours have become problematic.
• Hope for self-resolution – many people hope that their symptoms will go away on their own, leading them to delay seeking professional help.
• Healthcare provider barriers – some healthcare providers may not have sufficient training in recognising and diagnosing OCD, especially in its less common or more complex forms.
• Time constraints – in busy clinical settings, doctors may not have enough time to thoroughly assess for OCD, particularly if the patient does not explicitly mention their symptoms.
• Cultural stigma – in some cultures, mental health issues are highly stigmatised, discouraging people from seeking help.
• Gender differences – men may be less likely to seek help for mental health issues due to societal expectations around masculinity, while women may be misdiagnosed with anxiety or depression instead of OCD.

Delays in diagnosing OCD can have serious consequences, including worsening symptoms and the development of co-occurring conditions. Getting accurately diagnosed and receiving the right treatment for OCD is vital.

Treatment for OCD typically involves a combination of therapy, medication, and lifestyle changes. The most effective treatments are evidence-based and tailored to the individual’s needs.

• Cognitive Behavioural Therapy (CBT) – CBT is the gold standard for treating OCD. It focuses on identifying and challenging irrational thoughts and behaviours. A specific form of CBT, called Exposure and Response Prevention (ERP), is particularly effective for OCD.
• Medication – Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medications for OCD. They help regulate serotonin levels in the brain, reducing symptoms. Examples include fluoxetine, sertraline, and fluvoxamine. In some cases, other medications, such as tricyclic antidepressants may be prescribed.
• Lifestyle changes – regular exercise, a balanced diet, and adequate sleep can help manage stress and improve overall mental health. Mindfulness and relaxation techniques, such as meditation or yoga, may also reduce anxiety. Lifestyle changes can help manage OCD by reducing stress, improving brain health, and creating a supportive environment for recovery. While they are not a standalone treatment, they can significantly enhance the effectiveness of traditional therapies and medications. Adopting healthy habits can empower people with OCD to take control of their symptoms and improve their overall quality of life.
• Support groups – joining a support group can provide a sense of community and reduce feelings of isolation. These groups provide a safe and understanding environment where people can share their experiences, learn from others, and access valuable resources. OCD can be an isolating condition, as people may feel ashamed or misunderstood due to their intrusive thoughts and compulsions. Support groups bring together people who have similar experiences, helping participants realise they are not alone. Hearing others share similar struggles can validate one’s own experiences, reducing feelings of guilt, shame, or self-blame.

How to stop intrusive thoughts

Trying to stop intrusive thoughts in OCD is generally not helpful and can often make symptoms worse. This is because intrusive thoughts are a core feature of OCD, and attempting to suppress or eliminate them can increase their frequency and intensity. Instead, the goal is to change your relationship with these thoughts and reduce their power over you.

Research shows that trying to suppress thoughts often leads to a rebound effect, where the thoughts return more frequently and intensely. This is because the brain keeps checking to see if the thought is gone, which reinforces its presence. Struggling to stop intrusive thoughts can create more anxiety and frustration, as it reinforces the idea that the thoughts are dangerous or unacceptable.

Intrusive thoughts are a hallmark of OCD, but there are strategies to manage and reduce their impact:

• Acknowledge the thoughts – recognise that intrusive thoughts are a symptom of OCD and do not reflect your true desires or character. Avoid engaging with or trying to suppress the thoughts, as this can make them more persistent.
• Practice mindfulness – mindfulness involves observing thoughts without judgment. By accepting intrusive thoughts as temporary mental events, you can reduce their power over you.
• Challenge negative beliefs – use CBT techniques to question the validity of intrusive thoughts. Ask yourself, is this thought realistic? Or what evidence do I have for this fear?
• Distract yourself – engage in positive activities that require focus, such as reading, exercising, or solving puzzles, to redirect your attention away from intrusive thoughts.
• Seek professional help – if intrusive thoughts are overwhelming, a therapist can help you develop personalised strategies in order to manage them.

Exposure and response prevention

ERP is a highly effective form of CBT specifically designed for OCD. It involves gradually exposing individuals to their fears, or obsessions while preventing the accompanying compulsive behaviours.

It works by exposing the individual to situations, objects, or thoughts that trigger their obsessions. For example, someone with a fear of contamination might touch a doorknob. The person resists the urge to perform compulsive behaviours. For example, they avoid washing their hands after touching the doorknob. Over time, repeated exposure to triggers without engaging in compulsions helps reduce the anxiety associated with obsessions. ERP works by:

• Disrupting the cycle of obsessions and compulsions, leading to long-term symptom improvement.
• Helps people regain control over their thoughts and behaviours.

In order for ERP to be successful, it is important to:

• Work with a trained therapist to develop a structured ERP plan.
• Start with less anxiety-provoking situations and gradually progress to more challenging ones.
• Practice regularly and be patient, as progress may take time.

OCD is a challenging condition, but with the right treatment and support, people can manage their symptoms and lead fulfilling lives. Cognitive Behavioural Therapy, particularly ERP, is the most effective treatment for OCD, while medication and lifestyle changes can provide additional support. Managing intrusive thoughts and breaking the cycle of compulsions are key steps in overcoming OCD.

If you or someone you know is struggling with OCD, reaching out to a mental health professional or support organisation is an important first step toward recovery. Organisations like OCD Action and Anxiety UK offer resources and support for people with OCD.