Obsessive Compulsive Disorder

Obsessional Compulsive Disorder (OCD) is regarded as a common anxiety disorder estimated to affect between 0.05 and 3% of the general population. In its more severe forms it is an extremely debilitating disorder affecting the sufferer in all aspects of their life.

The age of onset varies but is generally between 6 – 15 years for males and 20 – 29 years for females.

Obsessions are persistent intrusive thoughts, impulses, ideas or images which are perceived as inappropriate and cause marked anxiety, distress and/or discomfort.

These obsessions are 'ego-dystonic' which refers to the nature of the intrusions as being not within the person's own control and alien to their usual pattern of thought.

The most common obsessions are related to repetitive intrusive thoughts regarding contamination of self or others, doubts, aggressive and/or horrific impulses and sexual thoughts and/or imagery.

These intrusions are not simply excessive worries about real-life problems, nor are they likely to be related to a real-life problem (see Generalised Anxiety Disorder). Also the sufferer usually attempts to block or control these intrusions or to replace (neutralise) them with some other thought or behaviour.

Formulation

The Cognitive Behavioural Therapist will work with the sufferer to discover the maintaining factors of the presenting problem and collaboratively construct an idiosyncratic formulation of the problem.

Following this an individual treatment regimen will be constructed and guided by the formulation.

Treatment

Depending on the presentation and formulation, a number of techniques will be employed, such as the well-established and evaluated Exposure & Response Prevention (ER/P), which has been shown to produce positive results in up to 70% or more of patients, to a combination of cognitive techniques including; Verbal Reattribution, Detached Mindfulness, Challenging of Fundamental Beliefs and Appraisals regarding responsibility (however one must take care that

this does not become assimilated into the repertoire of safety behaviours), Thought Action/Event Diffusion and Behavioural Experimentation.

Those who improve with treatment are typically able to maintain their gains at follow ups of between 1 to 5 years.

Adrian Wells, 1997 - A Cognitive Model of OCD