Guardian featured Harley Street IBS & Autoimmune Clinic addresses the underlying issues, not just the symptoms in OCD treatment.
OCD Treatment: Obsessive Compulsive Disorder (OCD) affects as many as 1 out of every 100 adults. The disorder is characterised by intrusive obsessions and all-consuming compulsions, and its impact on the lives of those who have it can be devastating. Even when OCD is managed with therapy or medication, it can have far-reaching consequences on a patient’s career, social life, and personal relationships.
The essential features of adult OCD are recurrent, unwanted obsessions or compulsions that are severe enough to be time consuming; that is, they take more than one hour a day — or they cause marked distress or significant impairment in your daily life.
There are many different types of obsessions and many people with OCD will have more than 1 type of obsession. Some examples of common obsessions are:
FEAR OF CONTAMINATION
This obsession involves a fear of coming into contact with germs, getting sick or making others sick from touching “dirty” or “contaminated” items, sticky substances or chemicals. For example, “I will be contaminated by germs if I pick up this pen off the floor” or “I can be poisoned by lead if I come into contact with paint.”
THOUGHTS OF DOUBT
This obsession involves constant doubt about whether you’ve done something wrong or made a mistake. For example, “Did I turn off the stove?”; “I think I made a spelling error on the email I just sent.”; “I think I threw away something important”; or “I might not have answered that question clearly and precisely enough.”
FEAR OF ACCIDENTALLY HARMING SELF OR OTHERS
Adults with these obsessions are afraid of harming themselves or others through carelessness. For example, “If I don’t make sure that the door is locked at night, the apartment might get broken into and I might be robbed and murdered”, “If I don’t immediately change out of my work clothes and wash them with bleach, I might bring outside germs home and cause my whole family to be sick.”
NEED FOR SYMMETRY/EXACTNESS
Adults with this obsession feel a need to have objects placed in a certain order or position or tasks or events to be completed in a set way. For example, “I need to sort all my clothes by colour and have them face the same direction. Otherwise, it just does not feel right!”; “I just scratched my right arm twice and now I need to balance it out by scratching my left arm twice.”
Repugnant means disgusting. These kinds of obsessions include unwanted thoughts, images, or impulses of doing something horrible to a loved one (e.g. throwing your baby off a balcony, kicking your elderly grandmother; jumping off a bridge); sexual obsessions (e.g. thoughts of touching someone sexually against his/her will, images of molesting one’s baby, doubts about one’s sexuality); and obsessions that violate religious beliefs (e.g. swearing in temple/church, images of having sex with a priest). Repugnant obsessions can also take the form of doubts, for example; “Did I run over someone without realising?”; “Did I become sexually aroused while bathing my baby?”; or “Did I sin but forget to repent?
These kinds of obsessions are particularly unwanted and people who experience them would never want to act on them. Having them DOES NOT mean you are crazy, dangerous or evil deep down inside.
What do “Compulsions” Look Like?
These behaviours are performed in an attempt to stop something bad from happening. However, repeated checking often makes people feel even less sure that they have successfully prevented the bad event from happening. Some examples include:
- WASHING/CLEANING COMPULSIONS
This category of compulsion involves excessive washing and cleaning behaviour. For example, you may wash your hands excessively, follow intricate rituals and rules for cleaning the bathroom or kitchen, or follow rituals with regards to grooming, tooth brushing, or showering. Rituals may including having a specific order you have to follow (e.g. washing a specific part of your body first or brushing your teeth in a particular order).
- CHECKING COMPULSIONS
This category involves behaviours aimed at ensuring something is done properly, everyone is safe or mistakes have not been made. For example, you may repeatedly check to make sure doors are locked, stoves are turned off, or electrical outlets are unplugged. Other examples may also include checking to make sure everyone is okay and not harmed (e.g. Contacting family members repeatedly to “check” if they are safe). Checking can also include making sure that you haven’t made any mistakes (e.g. re-reading emails over and over to “check” for spelling/grammar mistakes or visually checking the environment to make sure that you have not left anything important behind).
- ORDERING/ARRANGING COMPULSIONS
This category of compulsion involves arranging items in specific ways, such as clothes, books, shoes, etc. For example, you might line up all the clothes in the wardrobe so that they are arranged according to colour, with all the hangers facing in the same direction. Adults with this compulsion will sometimes arrange things until it “feels right”. Some will do it to prevent bad things from happening; for example, “If I don’t arrange all the books and magazines in the house so that they face east, then someone in my family will die.”
- MENTAL RITUALS
These are compulsions that are performed in your head. For example, you might mentally repeat a prayer whenever you have thoughts about something bad happening, or you might replace a “bad” thought (e.g. mum dying) with a “good” one (e.g. mum smiling and in good health).
- NEED TO ASK OR CONFESS
Some adults with OCD are afraid that they have done or thought something “bad”, and therefore feel a strong urge to confess all of their thoughts to friends or family (for example, telling a loved one that “I just had a thought about pushing someone into the street”). Most people who feel the need to confess will also seek repeated reassurance that everything is okay (for example, asking a loved one, “Do you still love me even though I had a bad thought?”).
Some adults with OCD have a very hard time throwing away things that seem to others useless or of limited value. Hoarding can lead to excessive clutter in the home and interfere with daily life. For example, some people are not able to throw away any receipts, financial documents, or old newspapers.
*Tip: Over time, OCD symptoms can change. For example, you might start off with washing your hands compulsively but later develop excessive checking behaviours and actually stop compulsive washing altogether.
Using neuro-imaging technologies in which pictures of the brain and its functioning are taken, researchers have been able to demonstrate that certain areas of the brain function differently in people with OCD compared with those who don’t. Research findings suggest that OCD symptoms may involve communication errors among different parts of the brain, including the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus (deeper parts of the brain). Abnormalities in neurotransmitter systems – chemicals such serotonin, dopamine, glutamate (and possibly others) that send messages between brain cells – are also involved in the disorder.
Although it has been established that OCD has a neurobiological basis, research has been unable to point to any definitive cause or causes of OCD. It is believed that OCD likely is the result of a combination of neurobiological, genetic, behavioural, cognitive, and environmental factors that trigger the disorder in a specific individual at a particular point in time.
Treatment will be multi-faceted dependent on the root physical and emotional causes. Each patient is unique, so all factors will be taken into consideration so that a tailored plan for OCD treatment can be formulated, based on the results of carefully selected functional medicine tests. All treatment, using non pharmaceutical medicine, is tailored to each patient’s unique needs. We do not have a one size fits all approach.
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