Movies and TV shows often portray people with obsessive compulsive disorder (OCD) as quirky and comical individuals.
Professor Michael Kyrios, director of the ANU Research School of Psychology and President of the Australian Psychological Society (APS), says it’s a stereotype that fails to showcase the seriousness of the crippling mental disorder that affects more than 500,000 Australians.
“People will say – ‘I’m so OCD’, but what gets missed in all of that is that there are hundreds of thousands of people who on a daily basis lead their lives as if they’re forced to walk untrained on a tightrope from one high-rise building to another on a windy day,” he says.
“That’s the degree of distress they feel from moment to moment.
“They’re not just perfectionists or people who like things done in a particular way, like the media image, but people who have a serious mental health problem which often coexists with depression and other mental health conditions.”
A life ruled by obsessions and compulsions
People with OCD either have obsessions or compulsions or experience both.
Professor Kyrios says the obsessions are unwanted, intrusive and persistent ideas, thoughts, images or urges that cause the person a lot of distress.
“In order to cope with that distress, what people do is they act out strategies to either get rid of the intrusions that they’re experiencing or to minimise the threat that they see, and these actions are called compulsions,” he says.
“Compulsions can either be obvious behaviours or they can be mental acts.”
One common obsession is irrational concerns about safety, where people with OCD physically and mentally repeatedly check that their appliances have been switched off or that their windows and doors are locked.
Obsessions also include sexual issues, such as unwanted thoughts about engaging in sexual activity, and religious or moral issues, such as a compulsion to pray or seek reassurance that they have not committed an immoral act.
Other obsessions involve cleanliness and a need for order, where people continually wash their hands, clean the house, experience a fear of contamination, and perform tasks or place items in particular places or patterns.
“They may feel that they have some germs on them, which they got from touching a door handle, so then they’ll wash themselves or cleanse the doorknobs compulsively in a particular order,” Professor Kyrios says.
“If they lose sight of the ‘proper’ order, then they start over again and again.
“People can spend hours and hours a day having these thoughts or carrying out these behaviours and, not only do they experience enormously high anxiety levels, but it also compromises their ability to work and have a normal life.”
A common mental disorder, OCD is often caused by a combination of biological and environmental factors, including behaviours learnt in upbringing, while about 75 per cent of people with OCD first experience the early onset of the disorder by their late teenage years.
Evidence shows OCD is treatable and the most successful psychological treatment is Cognitive Behaviour Therapy (CBT). Over 50 per cent of people who complete a course of CBT will recover, while around 80 per cent of people will respond positively.
“CBT is often combined with specific medications but CBT is a necessary part of any management plan for OCD,” Professor Kyrios says.
CBT is a talking therapy that works to manage psychological conditions, such as OCD, by changing the way people think and behave.
Professor Kyrios, who was a lead member of the international Obsessive Compulsive Cognitions Working Group (OCCWG) , says psychological research shows that people with OCD experience intrusions common to most people, but it’s how they respond to those thoughts with actions and what they make of those intrusions that sets them apart from the general population.
“The ‘cognitive’ in CBT refers to thinking, and we know there are certain thinking styles that people with OCD have that’s specific to OCD,” he says.
“We have found strategies, this is the ‘behavioural’ part of CBT, that we can teach people with OCD to then use as alternatives to their compulsions.
“So, rather than checking, rather than washing, we teach people different strategies for dealing with their safety or contamination fears.”
Using CBT, psychologists will teach people anxiety management strategies, such as deep breathing, relaxation and mindfulness exercises, before encouraging them to gradually expose themselves to the situations they fear.
“This is what’s called graded exposure therapy, where we get people to expose themselves to the fears that they have but we never ask them to do that in a way that is overwhelming,” Professor Kyrios says.
“We also teach people that we, as individuals, have the ability to deal not only with the world in a rational way but that actually managing our own emotions and our thoughts is relatively easy once you have the toolkit.
“We morph them from people who have OCD to people who have tendencies like the rest of us but manage our tendencies in a completely different way.
“Our clients then become the experts in managing their OCD.”
How to recover from OCD:
- Get help early. It often takes people with OCD, from the onset of symptoms, 10 years until they seek treatment. Professor Kyrios advises people to seek help when it starts to affect their lives. “Anything between an hour or two hours a day that is spent in thinking about these sorts of things and doing things in response to them is potentially OCD and probably interfering with the quality of your life and your ability to function.”
- Young people need help too. Young people also live with OCD and the onset often occurs at the most important time in their lives, when they’re in Years 11 and 12. “Younger people especially hate feeling different and all of a sudden they have got these thoughts and behaviours that are making them feel different, so you can imagine what that does to their sense of self esteem and their sense of identity,” Professor Kyrios says. “They suffer in silence and are quite often perplexed – they don’t know themselves what they’re experiencing. They require attention and a lot of care and patience, and really good treatment that works.” Check out Curtin University’s online OCD treatment program, OCD? Not Me! for more information.
- Find help. If OCD is in its early stages and just starting to affect the quality of your life, consider accessing an online treatment. Mental Health Online is an evidence-based, user-friendly online resource that Australian psychology researchers have developed and tested. More resources are available at OCD Action and the International OCD Foundation. Most state and territories have their own community-based OCD organisations and support groups.
- Need more assistance? If you can’t get on top of your OCD, visit your GP to get a referral to see a psychologist. You’re able to access 10 sessions of individual treatment and 10 sessions of group treatment in a calendar year with a Medicare rebate. It’s not unusual for people with OCD to require over 18 sessions per year, especially in their first year of treatment.
- Don’t give up hope. Remember, OCD is treatable. “People are happy, can function at work and in their studies, have satisfying lives, and can contribute more positively to their families and their community once they’ve had treatment,” Professor Kyrios says.