Problems with intrusive thoughts, obsessional
worry or doubt and compulsive checking behaviours, are normally strong clinical
indicators for Obsessive Compulsive Disorder (OCD).
In spite of the confusing
and often contradictory information available on the web, the recommended treatment
of choice for OCD spectrum related problems is Cognitive Behavioural Therapy
(CBT).
In addition to mainstream CBT, special forms
of Cognitive Behavioural Therapy known as Acceptance and Commitment Therapy
(ACT), Metacognitive Therapy and Inference Based Therapy have been found to be
particularly effective in the treatment of OCD. Exposure Response and
Prevention (ERP) also forms an integral part of the CBT treatment process,
providing a well established behavioural strategy for reducing OCD compulsions.
We specialise in Obsessive Compulsive
Disorder and all recognised OCD subtypes. This includes contamination OCD, harm
and checking OCD, primarily obsessional OCD, Orderliness and symmetry OCD and
the related problem of compulsive hoarding.
We are fully qualified and professionally
accredited by the British Association for Behavioural and Cognitive
Psychotherapy - BABCP, which is the recognised UK professional body for
Cognitive Behavioural Therapy. To talk
to one of our OCD specialists, email
Obsessive Compulsive Disorder – OCD is a
clinically recognised psychological disorder in which individuals experience
intrusive thoughts, images or
sensations, obsessional worries or doubts and compulsive checking, neutralising
or reassurance seeking behaviours.
Obsessions are defined as unwanted or intrusive thoughts, urges, feelings
or images, that lead to significant anxiety, distress, discomfort, disgust, as
well as other evaluative feelings including shame, guilt, embarrassment and insecurity.
More recently, another feeling of
“Incompleteness” has been identified. This is an emotional sense that things
are not “just right” or “just so”, leaving an unaddressed sense of disorder, indefiniteness,
uncertainty or agitation. This is linked to “Just So” OCD which is described in
more detail below.
The word “Obsession” is derived from the Latin “Obsidere” which means to besiege
or occupy. In our clinical experience working with Obsessive Compulsive
Disorder over many years, this term accurately describes the overwhelming and besieging
feelings experienced by OCD sufferers.
Compulsions are repetitive behaviours or routines that are performed in
an attempt to avoid, neutralise, control or prevent the feared consequences of
the obsession. Whilst compulsions can become automatic over time, they are
generally voluntary actions taken in response to the obsessional doubt or the associated
distress.
Compulsions are normally classified as external and internal. External behaviours sometimes referred to as “Overt” compulsions.
These typically include physical acts such as touching objects, excessive cleaning,
repetitive checking of switches or locks and organising items in a particular order
or sequence.
Internal compulsions, sometimes referred to as “Covert” compulsions
usually involve internal mental acts, rituals or routines. These can include
repeating words or numbers, thought stopping or control, using words or phrases
to neutralise or cancel out fears, excessive praying and repetitive memory
checking.
For a clinical diagnosis of OCD to be present, the individual would
normally experience obsessions and compulsions for at least one hour per day, leading
to significant emotional distress.
Whilst the research demonstrates that the different forms of Obsessive Compulsive Disorder follow a common psychological pattern, there are specific characteristics relevant to different OCD presentations. These different forms of OCD are not diagnostically unique, however the content and focus of OCD can vary depending on the individual's history, perceived vulnerabilities and situation. We have outlined ten common OCD themes below, however it should be noted that the content and focus of obsessions and compulsions can shift like an “OCD Carousel".
Contamination based OCD involving obsessional worry about germs and other forms of physical or mental contamination. This can be linked to health obsessions and frequently leads to superstitious or magical thinking, excessive checking and cleaning behaviours.
Harm based OCD involving intrusive or disturbing thoughts about causing or being responsible for preventing harm to others. This frequently involves highly distressing worry, self-doubt and patterns of avoidance and reassurance seeking behaviours. This can also include specific worry about harm or danger to children.
Primarily Obsessional OCD, also referred to as Pure “O”. This is mainly an internal mentalised form of OCD involving excessive worry, rumination and self-doubt. Whilst it is commonly assumed that this form of OCD does not involve compulsions, Pure “O” also includes internal attempts to stop, avoid, neutralise or control obsessional thoughts. The OCD compulsions still exist, but in an internalised form.
Relationship OCD involves excessive worry and doubt about relationship commitment and compatibility. Like other . OCD presentations, the individual’s attachment experiences and irrational beliefs about relationships can profoundly influence ROCD obsessions and compulsive behaviours. ROCD frequently leads to relationship difficulties and breakups, causing significant distress for the sufferer and their partner.
Real event OCD has more recently been used to describe obsessional worry and rumination about past events or memories. This can involve an obsessional fixation with past mistakes, or continuous attempts to replay, interrogate or test memories. In addition to high levels of anxiety, real-event OCD can be linked to guild or shame and significantly influenced by early maladaptive schema or personal rules and beliefs.
Sensorimotor and hyperawareness OCD are a physicalised form of Obsessive Compulsive Disorder. Sensorimotor typically involves an obsessional focus on body sensations or physiological functions and hyperawareness OCD is linked to testing external senses such as sounds, visual stimuli or smells. Hyperawareness OCD can also be confused with hyperacusis and Misophonia, so it’s important to obtain an accurate diagnosis and treatment.
Scrupulosity OCD involves obsessional worry about sins and violations of religious or moral rules. As worry is focused on faith or ethical issues, the obsessions are impossible to test or disprove , leading to excessive praying, mental or physical purification, reassurance seeking and acts of self-sacrifice to neutralise the worry.
Sexuality OCD involves worry and self-doubt about one’s sexuality or attraction to others outside the individual’s known sexual preferences. This frequently involves self-checking and worry about arrousal.
· Orderliness and Symmetry OCD, also known as “Just So” OCD involves anxiety and discomfort when things are out of sequence, symmetry or balance. This is characterised by intrusive and obsessional thoughts about disorder and compulsive arranging, organising or visual alignment behaviours.
Existential OCD is similar in nature to Scrupulosity OCD and involves obsessional thoughts about theoretical, hypothetical or philosophical questions that cannot possibly be answered. This frequently involves attempts to disprove or figure out doubts about consciousness, life, meaning or existence itself.
Magical Thinking OCD involves intrusive and obsessional thoughts about superstitious or fatalistic worries and compulsive behaviours in an attempt to prevent or neutralise future possible harm, negative events or bad luck.
Pedophilia OCD also known as POCD, involves obsessional worry avoidance, checking and reassurance seeking behaviours relating to worries about being attracted to children. This is a highly distressing form of OCD linked to repugnant intrusive doubts about the shame and stigma of opposite and inappropriate attraction.
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