Psychology /

Obsessive compulsive disorder (OCD)

Nearly everyone has occasionally experienced brief runs of repetitive thoughts, urges, or impulses, (like having to check the door is locked several times, or have doubts that they have washed their hands thoroughly enough after handling something dirty). Usually these can be dispelled easily and so cause little discomfort. For some people, however, these kinds of worries really take a hold, and they find that they get stuck in cycles of doing something over and over again, like washing their hands again and again, counting up to a certain number, or checking something several times to be sure they’ve done it right. When these kinds of behaviours become a persistent problem and interfere with the person’s life, it is know as obsessive-compulsive disorder (or OCD for short).

OCD in children and adolescents

Children of all ages can be affected. For more information about child OCD please visit this website: http://psychology.iop.kcl.ac.uk/ocdkids/

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What is obsessive compulsive disorder?

Obsessive Compulsive Disorder (OCD) is a form of anxiety disorder, which can vary in severity from very mild to severe, and can take many different and novel forms. Some people are bothered by upsetting thoughts that they can’t get rid of no matter how hard they try; other people may find they feel compelled to wash or to check things, even though logically they know there is no need. When people are troubled by their obsessional problems they can experience very high levels of anxiety and distress, and they can find the problem takes up a lot of their time and attention. It can seem that the problem is taking over their life, and that there is little time for anything other than worrying, washing, checking or other obsessional behaviour. It can interfere with a person’s ability to work, with their personal relationships and with almost every aspect of their life.

How common is OCD?

OCD is a very common problem. In the United Kingdom it is thought to affect 1.2% of all adults. This is thought to be an underestimate, as the disorder is often kept secret or hidden from all but the sufferer. They often find it embarrassing or distressing to talk about, and feel guilty or ashamed for having such thoughts and rituals. At the G.P’s surgery 2-3% of visiting patients will have OCD.

Can OCD be treated?

The most effective treatment by far for OCD is cognitive behaviour therapy (CBT), and this should always be the first line treatment, as there is much evidence to support its use. CBT is a short term, structured, problem focused and goal directed form of therapy. It helps the person get a full understanding of how the problem works, introduces new ways of looking at it, and teaches the person the necessary skills to understand and overcome their problem. It aims to enable the person to become their own therapist when therapy ends. In randomised control trials 75% of patients with OCD are significantly helped by this therapy. Some people may also need to take medication. This usually takes the form of antidepressants which act in the Serotonin System (called SSRIs). The best known and most widely used of these is Fluoxetine (Prozac). The biggest problem with this medication is that once it is stopped OCD tends to return very quickly. Treatment should usually involve CBT in the first instance.

Getting help - From consulting your GP to getting treatment

Firstly go to see your GP. Tell them about the symptoms you have been experiencing and that you think this is OCD.
Ask your GP if there are local Cognitive Behaviour Therapy or Psychology services. If so, ask to be directly referred if this is possible. It may be that you will need to be referred via your local Community Mental Health Team (CMHT).
If not ask them to refer you to your local CMHT.
The CMHT should assess your needs. They may have specialist services in-house, or they may need to refer you on to your local psychology, or other specialist service.
If your local area does not have the specialist services you require, and are unable to treat you locally they can refer you direct to our clinic, or any other national OCD services which may be closer to your home.
In order to find out about the referral processes for other services it would be necessary to call them direct and enquire from them.

Referral to Centre for Anxiety Disorders and Trauma National OCD Service

There are various referral routes to our service, but it does depend on your GP’s registered address and the service agreements our hospital has agreed with your local Primary Care Trust (PCT). From a very small amount of areas we can receive a referral direct from your GP. However, for the majority of areas the referral must come to us via your local CMHT to enable us to obtain authorisation to offer you an assessment, and/or treatment.
In certain cases, once we have received the referral we would have to approach your local PCT on an individual basis to request authorisation to offer you our service. This is quite a routine thing to happen, similar to any specialist services that are required on the NHS i.e. you start at your local hospital, but if more specialist expertise is necessary you may be referred on to a more expert specialist in the disorder you have.
At our clinic when the referral is received and authorised this will be discussed by our team. If the team decide that you would be suitable for an assessment, we will write to you and the referrer to advise you that you have been placed on our waiting list and that we will write to you again in due course inviting you to contact the Centre to enable us to offer you a choice of appointment dates.
It should be noted that specialist services such as ours do have rather lengthy waiting lists, but at this service we do endeavour to offer you a choice of appointment within 13 weeks of the date of the authorised referral.
Once you have accepted an appointment you will be sent out some rather lengthy, but very important questionnaires covering different aspects of OCD, anxiety and depression. It is essential that you complete these prior to the assessment and bring them with you. You will also of course receive a map and directions to the Centre. We do expect that if for any reason you are unable to attend on the day you let us know, preferably in advance. If you do not we will write to you assuming you no longer require our help, and will discharge you if we receive no reply. If you miss the appointment, but require another, there may be a lengthy delay as you will go to the back of the list.
When you come for the assessment appointment this is a rather tiring and lengthy process and usually takes at least 3-4 hours, sometimes it can take longer in which case we may need to ask you to come back. You will be asked very detailed questions about your obsessional problems and any other difficulties you may have. It is important that we get a very clear understanding of your problems in order to establish what kind of help you may need. We routinely videotape our assessments, which we think is good practice as it means we can be sure we all carry out our assessments to a good standard and also that other members of the OCD team can be involved in discussion about your care.
We will not make a decision about what is the best way to proceed on the day. We will consider your case and discuss you with the team, and aim to let you know within a couple of weeks.
We will write back to your referrer after we have completed the assessment and made decisions about your care, and we have a policy whereby if you wish to be copied in on letters we are happy to do so with your signed consent.
If we feel we are able to help you with your problems there is normally a wait of 4-6 months before we are able to start your therapy. This is due to the high national demand for this service.
We would offer suggestions to your referrers about your management in the meantime, if this is appropriate.
If, at assessment, we do not feel we are able to help you then we tell you the reasons for this and make suggestions as to what would seem more helpful ways for you to proceed with your problems.

Practical Advice for People with OCD and their families

Find out as much as you can about OCD. Good places to start are OCD Action or OCD-UK, which are great places for support, information and advice. This also gives you the opportunity to talk with other people who either have or know of OCD. Remember that you really are not alone with this problem.

If you feel able and ready to start working on the problem there are a variety of self-help books which may help you get started. If this is not an option you may wish to discuss the problem with your GP, and try to get some professional help. There can often be rather long waits on the NHS for therapy however, if you are in a position to do so, you may be able to seek a therapist privately. The British Association of Behavioural and Cognitive Psychotherapists are a good source for getting help and advice about finding a suitable therapist. They can be contacted via their website: http://www.babcp.com/or by ringing 0161 797 4484.

Are there support groups I could contact?

There are a growing number of organisations providing support for sufferers of OCD. The most well known are:

No Panic
93 Brands Farm Way
Telford
Shropshire
TF3 2JQ
Telephone: 0808 808 0545
http://www.nopanic.org.uk/

OCD Action
Suites 506 - 507
137 - 148 Goswell Rd
London EC17 7ET
Telephone: 0845 390 6232
http://www.ocdaction.org.uk/

OCD-UK
PO Box 8955
Nottingham
NG10 9AU
Telephone: 0845 120 3778
http://www.ocduk.org/

Anxiety UK
Zion Community Resource Centre
339 Stretford Road
Hulme
Manchester
M15 4ZY
Tel: 0870 122 2325
www.anxietyuk.org.uk

Triumph Over Phobia (T.O.P. UK)
PO Box 3760
Bath
BA2 3WY
Telephone: 0845 600 9601
http://www.triumphoverphobia.com/