These are the experiences of 3 people who suffer obsessive-compulsive disorder....

"I'm afraid of catching something from other people, I fear that the germs that they carry may get on to me and I will become infected. I'm afraid I may also "contaminate" my family by passing these germs on to them. I know it is silly but I feel so tense and anxious if I do touch anyone else or any surfaces - such as door handles that they have touched that I have to come home and wash my hands many times, then wash my clothes. That makes me feel a lot better until the next contact with others. All of my own surfaces at home are washed many times each day with bleach to stop the germs. I avoid contact with other people when at all possible. Part of me realises that these fears are daft, but its gone on for so long now I don't know how to stop ... my family are sick of it..."

"I fear that I will harm my partner, I know that I don't want to and I love her but thoughts often come into my head where I can picture myself harming her in some way, with a knife or by strangling her. I am so upset when I have these thoughts that I have to bring into my mind other `good thoughts` such as `I know I love her very much` and I say these to myself many times to get rid of the bad thoughts. I usually feel a bit better after that, until the next time the awful thoughts come into my head. I have hidden away all sharp objects and knives so that there is no risk of me doing it and also seeing these objects brings the horrible thoughts to my mind. I spend hours each day in this mental battle... I think to myself you must be a horrible person to have those thoughts..."

"My whole day is spent checking that nothing will go wrong in the house ... I can't get out because I'm never quite sure that I've turned off the gas, electric appliances, water and locked the windows. However, often I check, my partner has to check them all for me again, before going to bed. I check to see if the gas fire is off, I do this five times and then can sometimes go upstairs, at other times it doesn't feel right and I go through the whole `ritual` again. If I don't check I feel so worried I can't bear it. I know its silly, but I keep thinking if something awful did happen I'd be to blame for being so careless..."

You may have had similar experiences yourself, it is quite common for people to have such thoughts and to carry out checking actions but if it is becoming a major part of your daily life then you may be suffering from Obsessive Compulsive Disorder. We will call it O.C.D. in this leaflet..

What is O.C.D?

Each person who suffers from O.C.D. describes slightly different problems. In general people with O.C.D. experience obsessions. These are thoughts, pictures or impulses that are usually unpleasant and come into mind when we don't want them. Many things can trigger these obsessions, and they usually leave the person feeling very anxious, uncomfortable or frightened. The compulsion is the behaviour performed in order to `put right` the obsession. Sometimes the behaviour performed is quite irrational (and the O.C.D. suffer recognises this) such as counting up in sevens for seven minutes, sometimes the behaviour is more closely related to the obsessional thought such as washing hands many times to avoid thoughts of contamination. Most people with O.C.D. know that their compulsions are unreasonable or `over the top` but they feel unable to control their thoughts or change their behaviour.

Many people experience obsessions and compulsions and are able to live with this without problems. People may think about seeking help when their lives are becoming disrupted by these unwanted thoughts and actions.

What more do we know about O.C.D.?

O.C.D. affects us in a number of ways:

What we think:
  • obsessions
  • guilty thoughts.
 How we feel:
  • tension
  • anxiety
  • agitation
 What we do:
  • compulsion (sometimes described as rituals)
  • avoidance
  • seeking reassurance

These are some of the signs of O.C.D. You may want to tick any symptoms you experience regularly.

  What we think - obsessions   What we do - compulsions
Fearful thoughts or pictures in your mind about being contaminated by dangerous substances, eg germs, dirt, AIDS. Check body for signs of contaminations.
Frightening thoughts/images that some serious harmful events will occur because of your carelessness, for example a gas explosion in the house because the cooker is left on, that the house will be burgled because of doors or windows left unlocked or that you may have knocked someone over in your car. Wash/disinfect frequently.
Avoid going to places or touching objects that you fear may contaminate you.
Pictures or words in your head that suggest you will harm others, especially those you care for and would never want to harm. For example that you may hurt your own child, that you may be unfaithful to your partner. Check feared situations/ appliances or journey route many times.
Avoid being the last person to leave the house.
Pictures come into your mind of your loved ones dead. Avoid responsibility.
Seek reassurance regularly from another person that everything is alright.
Things in your life are not in the correct order or not symmetrical enough or in the right place, eg ornaments are out of alignment and you feel distressed by this. Avoid situations which you feel put you at risk of harming, eg hide kitchen knives.
Blasphemous or unpleasant thoughts/ pictures and doubts about your faith come into your head. Think something to yourself to `put right` the frightening thoughts - neutralising thoughts.
    Think neutralising thoughts to counteract the frightening images.
    Carry out some task that will neutralise the thought, eg counting or saying a special word.
    Seek reassurance from others.
    You put things right or make them symmetrical many times until they `feel` right.
    You avoid contact with things that make you feel like this.
    You pray, seek forgiveness over-frequently.
    Consult religious leader/ seek reassurance.

How do you feel when you experience some of these obsessions?

fearful
guilty
tense		 agitated
depressed
other...		 anxious
disgusted

How do you feel when you have then carried out the compulsive behaviour or thoughts?

relieved
relaxed
other...		 cleansed
less anxious
 calm
disappointed

Most people find a pattern of anxiety or discomfort at having the obsession and relief once they have carried out the compulsive act. This becomes a vicious cycle hat strengthens itself and becomes more likely to happen again.

In addition to this the person who experiences O.C.D. will often feel guilty and that they must be a the terrible person to have such thoughts. This in turn makes thoughts more likely to return because in they are given such negative importance the person's mind.

It is interesting that research tells us that everyone has odd or distressing thoughts and pictures going through their thoughts at some times. Most people dismiss this from their mind as meaningless. Those who feel most guilty, distressed or disturbed by the thoughts, however, may involuntarily bring back these thoughts into their mind because of this distress.

Can O.C.D. be treated?

In the last 20 years the treatment of O.C.D has improved greatly and the majority of people do make a good recovery. The most important treatments are cognitive and behavioural approaches to treatment which will be described later in this booklet, and drug treatment.

What can I do to help myself?

Research has told us that the most successful way to tackle O.C.D is by exposure with response prevention. This literally means that you must gradually face or expose yourself to the things or situations you fear, whilst at the same time preventing yourself from carrying out your usual compulsive behaviour (checking, cleaning etc). This gradual approach means that with each stage you become less afraid of what used to trouble you and you learn by experience that no disaster occurs if you stop your compulsive behaviour.

How can I make facing what I fear easier?

We know that if we can stay in a situation where we feel anxious, gradually the anxiety will reduce - our body becomes used to the situation and we no longer feel fearful. This will help us overcome our obsessions.

For the person with O.C.D., however facing thing we fear may seem very difficult if not impossible.

Because of this it may be helpful to break down into smaller steps the exposure to situations or thoughts we find difficult. Begin by making a list of all situation or thoughts we find difficult. Next make an `anxiety ladder` where those situations that we only fear a little are at the bottom and our worst feared situations are at the top. It may help to look at this example:

Washing and cleaning: Mary has a fear of being contaminated by bacteria which she fears she may pass on to her family. This has resulted in her restricting her lifestyle and spending many hours washing herself and disinfecting her home. She has made up the following anxiety ladder.

Least feared: 1 touching own waste bin with rubber gloves on
2 touching own waste bin without gloves
3 touching objects in friends house
4 eating at friends house
5 going to toilet in friends house
6 touching doors and often objects outside home,
eg at the supermarket
7 going to eat outside the home
Most feared: 8 going to toilet in public toilets

Mary will begin her exposure therapy at step 1 (ie by touching her own waste bin with gloves on) and gradually work towards step 8. She will prevent herself from frequent hand washing at these times - (see Response Prevention below). Are you able to list your own anxiety ladder?

Most people will at first feel greater anxiety when they begin to face the things they fear and feel an urge to perform their compulsion or ritual. The next section may help you deal with this.

Response prevention

How do I stop myself from carrying out the compulsive act? It is important to break the cycle of carrying out the compulsive act or thought following exposure to the thing(s) you fear. There are some tips in attempting this.

How will my progress look?
Your pattern of recovery will look like this if you use exposure and response prevention. Gradually your anxiety will reduce. Exposure to what you fear with response prevention

  1. When you first face what you fear anxiety goes up.
  2. You prevent yourself from performing a ritual and you fell ever more anxious.
  3. Gradually your anxiety reduces (habituates). If you don't break the cycle the following pattern will continue
  OCD without response prevention

  1. Your anxiety is high and you perform a compulsion.
  2. Your anxiety drops because of the compulsion but this reduction is short lived and it soon returns to higher levels. As time goes on the anxiety gradually gets worse.

How can I tackle negative thinking in O.C.D?

Sometimes people get gloomy thoughts when they have O.C.D. especially when they begin to try and break the cycle of obsessions and compulsions by response prevention. Typically these thoughts are criticisms of yourself, for example, "I'm not a caring mother if I don't check things fully" or "I'm letting things get out of control I'm a failure". These thoughts lead to low mood and you feeling unhappy. It is important not to just accept these thoughts, you need to find a more balanced view, try to:

How can I tackle compulsive checking?

The following example may help you understand the method:

Mark had difficulty in leaving the house each day he would check all appliances at least 15 times each. His anxiety ladder looked like this.

Least feared: 1 the taps
2 the lights
3 the gas cooker
4 the windows
Most feared: 5 the doors

He began by step 1, he would check the taps only once before he left the house. At first he felt very anxious about this but gradually his fear lessened - he then moved on to step 2 the lights ......

How can I tackle obsessional thoughts where the compulsion is another thought?

The most important thing when tackling this problem is to break the cycle of having an obsessional thought and `putting it right` with another thought, ie neutralising. Here are some tips!

In summary how can I help myself overcome O.C.D?

Where can I get further help?

We hope you will use the exercises suggested in this leaflet. They may help you overcome O.C.D. and return to normal life. If you feel you are making little progress or the problem is getting worse then seek help in overcoming your problem. Your family doctor is the best person to talk to first. Your GP may suggest a talking treatment of tablets or both. He or she may suggest you see a mental health worker who can offer expert help with your problems. If you feel so distressed that you have thoughts of harming yourself the visit your doctor as soon as possible and explain to him or her how you are feeling.

The following people will also have information about these services:

The following organisations and help lines may also be useful:

Some useful books you may like to borrow or buy from the library: