It's often thought of as having a fixation with cleanliness or being paranoid about leaving the oven on, but obsessive compulsive disorder (OCD) is a serious condition that is as common as diabetes.
Beyond Blue estimates that OCD affects around 3 per cent of Australians in their lifetime — more than 500,000 people — however, psychologists say it's still majorly misunderstood.
What is obsessive compulsive disorder?
OCD is characterised by having recurring, intrusive thoughts, urges and impulses, or repeating actions or behaviours, that are distressing and time-consuming.
"Obsessive compulsive disorder is primarily an anxiety condition, characterised by intrusive thoughts, urges and impulses that come into a person's head that tend to be quite left-field," clinical psychologist Dr Emily O'Leary says.
"People get a bit of a shock when they get [those thoughts], because they don't make sense.
"And, because of that, they get distressed, they feel anxious, and they have to engage in a number of behaviours which we call compulsions."
Dr O'Leary says those behaviours are designed to neutralise or decrease the anxiety a person is experiencing by trying to control them, and can be physical or mental compulsions.
"The issue is though, the solution becomes the problem, because the behaviours become a problem," she says.
"Sometimes, OCD is seen as a rather strange or bizarre disorder that people don't really understand.
"It'd be nice if people saw people with OCD with a little bit more compassion, rather than as those people [who] wash their hands a lot."
What are the symptoms?
OCD symptoms differ from person to person, but there are some common thought patterns and behaviours.
Some common obsessive thoughts can include:
- fear of contamination from germ, dirt and other illnesses
- needing things to be organised in a particular way at all times
- being preoccupied with having things follow a certain pattern
- worrying that appliances haven't been turned off or doors haven't been locked
- overwhelming concerns about personal safety or the safety of others.
Some common compulsions can look like:
- excessive cleaning, hand washing or showering
- continually checking things, like taps or locks out of fear of damage, or to maintain order and symmetry
- counting items or objects, like steps or pavement blocks when walking
- seeking constant reassurance from others
- hoarding and collecting items that have no use or value.
However, Dr O'Leary says thoughts aren't always linked to actions, so people with a contamination fear will not always repetitively wash their hands in response.
"That might not be what we call contact contamination, it might be like mental contamination, which is the sense of pollution," she says.
"It might be linked with a compulsion, like a check-in compulsion"
The above, however, isn't an exhaustive list of behaviours and thoughts, so having a preference for how your spices are stored in your pantry isn't necessarily a symptom.
It is the obsessive nature of the behaviour that is important when it comes to OCD, not the behaviour itself.
Are there different forms of OCD?
The International OCD Foundation recognises several subsets of OCD, which categorise a person's OCD, although some themes overlap.
"You've got the contamination ones, which are usually a fear of getting an STI or AIDS, or a flesh-eating bacteria, you name it, they could get it," Dr O'Leary says.
"Other people are afraid of harm-related OCD, which is fears around either hurting other people, sometimes hurting themselves, but it's more focused on people they love."
Dr O'Leary says this subset is seen "a lot" with children.
"They're worried about stabbing or hurting family, or family getting home safely," she says.
OCD around sexual orientation and identity is also common, Dr O'Leary says.
"It might be if someone identifies as straight, they think they're bisexual or gay, or it could be someone obsessing about being trans," she says.
Symmetry and ordering is also a subtype of OCD, where people require things to be a certain way.
Dr O'Leary says there is also relationship OCD, where people can be consumed with doubts about their relationship.
"It's if a person really loves another person, then all of a sudden it's, 'No, this is completely wrong. You don't love them. You're going to cheat on them'," she says.
"It can be quite hard, because therapists then go, 'Hang on, do you not love them?' instead of actually going, 'That's relationship OCD'."
Who is likely to have OCD?
Dr O'Leary says OCD affects around 3 per cent of the Australian population, making it "as common as diabetes".
"It's actually a really common condition. It's just not talked about because, fundamentally, when a person says 'I'm having these really bizarre thoughts' … people are fearful they won't be understood, and so people don't talk about it," she says.
Family history plays a big role in OCD, with research suggesting it can be genetic.
"If you've got a first-degree relative with OCD, you're five times more likely to have it," she says.
"It's hard for parents because, often, they have a lot of guilt around, 'Did I give this to my child?' and all those sorts of things."
Other medical conditions can also be closely related to OCD, including body dysmorphic disorder, anorexia nervosa, hypochondriasis and compulsive hair pulling.
People with OCD are also more likely to develop depression or other anxiety disorders.
"We do know, with OCD, that mood disorders and depression are highly comorbid, around 60 per cent," Dr O'Leary says.
"Sometimes the comorbid conditions, not the OCD, are the things that can really exacerbate conditions, like whether people go and use substances or avoid school or excessively sleep."
How can OCD be treated and managed?
Ways to treat and manage OCD vary from person to person but, Dr O'Leary says, the fundamentals are similar.
"It depends on [a number of] things a lot of the time, which [include]: how long they've had the disorder, what the severity is like, what the degree of impairment is like, and sometimes [their] age," she says.
Evidence-based therapy sessions — which include cognitive behaviour therapy with a psychologist — are usually the first port of call.
For those with OCD, the first part of therapy includes talking about what the condition is, and understanding their behaviours and thought patterns.
"You will start with that. You'll assess how they're going by, maybe session five or six, and if they're finding it hard to attend to what you're saying, you will have a discussion with the family, if it's a child, or the individual if it's an adult, and discuss the role of medication and combination therapy," Dr O'Leary says.
"With that, we tend to then get a referral to a psychiatrist, or if there's a really good GP informed about OCD and anxiety.
"Then we continue with combination treatment, and most research says, with children, it's about 12 to 16 sessions."
Dr O'Leary says exercise can also help manage OCD.
"There is research that specifically says, if you exercise, that's equivalent to almost a low-dose SSRI (medication to increase levels of serotonin)."
I suspect I have OCD. How do I get a diagnosis?
Your first port of call should be your GP or healthcare professional, who can listen to your concerns and can refer you to the relevant mental health professional, such as a psychologist.
However, it can be a costly exercise, both financially and in terms of time. Waitlist times have worsened since COVID-19, so patients can be waiting months to get into see a professional.
"Once children, adolescents or adults present, we do what's called a clinical interview, which sounds scary, but it's not," Dr O'Leary says.
"It's fundamentally looking at the behaviours that they feel they need to do to keep themselves — and usually their family — safe.
"So, following a clinical assessment, we see whether they meet the criteria for OCD. Then we also do what's called psychometric testing, which is looking at the symptoms and then rating the degree of severity.
"From that, then we develop an individualised treatment plan."
For parents who suspect their child may have OCD, Dr O'Leary recommends having them assessed.
"There are different stages of development, there will be repetitive behaviours, and kind of self-stimming behaviours where people are doing things repetitively," she says.
Stimming is the repetitive performance of certain physical movements or vocalisations that often serve to calm the person displaying that behaviour.
"But if it starts to interfere in their day, and you're starting to be concerned, then go and get assessed."
