Dual Diagnosis: OCD

• “He’s an obsessive football fan.”
• “She’s obsessive about shoes.”
• “He’s a compulsive liar.”

We use these phrases to describe people who think about something a lot or do something repeatedly, even when others can’t see any reason for it. It isn’t usually a problem and, in some lines of work, can even be helpful.

However, some people have distressing thoughts that come into their mind again and again, or experience urges to do the same thing again and again. This can come to dominate your life, stop you from enjoying things and even stop you from doing things you need to do.

So, if:

• you get awful thoughts coming into your mind, even though you struggle to keep them out

or

• you have to touch or count things, or repeat the same action like washing over and over again

you could have Obsessive Compulsive Disorder (OCD).

This leaflet is for anyone who has problems with obsessions or compulsions. We hope it will also be helpful for family and friends – and anyone else who wants to find out about OCD.

It describes what it’s like to have OCD, some of the help that is available, and how well it works, how you can help yourself and how to help someone else who is depressed. It also mentions some of the things we don’t know about OCD. At the end of the leaflet, there is a list of other places to find more information, and references to the research on which this leaflet is based.

What is it like to have OCD?

The components of OCD

OCD has three main parts.

• Obsessions – the thoughts that make you anxious
• Emotions – the anxiety you feel
• Compulsions – the things you do to reduce your anxiety

Let’s look at these in more detail.

Obsessions – the thoughts that make you anxious

“I fear I will harm my baby daughter. I know I don’t want to, but bad thoughts keep coming into my head. I can picture myself losing control and stabbing her with a knife. The only way I can get rid of these ideas is to say a prayer, and then have a good thought such as “I know I love her very much”. I usually feel a bit better after that, until the next time those awful pictures come into my head. I have hidden away all sharp objects and knives in my house. I think to myself “you must be a horrible mother to think like this. I must be going mad”. – Dawn

• Thoughts – single words, short phrases or rhymes that are unpleasant, shocking or blasphemous. You try not to think about them, but they won’t go away. You worry that you might be contaminated (by germs, dirt or disease), or that someone might be harmed because you have been careless.
• Pictures in your mind – you see your family dead, or see yourself doing something violent or sexual which is completely out of character – stabbing or abusing someone, or being unfaithful. Such thoughts can be very alarming, for the sufferer, their family and even professionals. But we know that people with obsessions do not act on these thoughts even though they fear they will do so¹. A person with OCD is at no greater risk of causing harm than any other member of the public. Even so, if you do have such thoughts, it is best to see a mental health professional with specialist experience in treating OCD.
• Doubts – you wonder for hours whether you might have caused an accident or misfortune to someone. You may worry that you have knocked someone over in your car, or that you have left your doors and windows unlocked.
• Ruminations – you endlessly argue with yourself about whether to do one thing or another so you can’t make the simplest decision.
• Perfectionism – you are bothered, in a way that other people are not, if things are not in the exactly the right order, not balanced or not in the right place. For example, if books are not lined up precisely on a bookshelf.

Emotions – the anxiety you feel

“My whole day is spent checking that nothing will go wrong. It takes me an hour to get out of the house in the morning, because I am never sure that I’ve turned off all the electrical appliances like the cooker, and locked all the windows. Then I check to see that the gas fire is off five times, but if it doesn’t feel right I have to do the whole thing again. In the end, I ask my partner to check it all for me again anyway. At work I am always behind as I go through everything several times in case I have made a mistake. If I don’t check I feel so worried I can’t bear it. It’s ridiculous I know, but I think if something awful did happen, I’d be to blame”. – John

• You feel tense, anxious, fearful, guilty, disgusted or depressed.
• You feel better if you carry out your compulsive behaviour, or ritual – but it doesn’t last long.

Compulsions – the things you do to reduce your anxiety

“I’m afraid of catching something from other people. I spend hours bleaching all the surfaces in my house to stop the germs, and wash my hands many times each day. I try not to go out of the house if possible. When my husband and children come back home, I ask them in great detail where they have been, in case they have visited somewhere dangerous, like a hospital. I also make them take off all their clothes and wash themselves thoroughly. Part of me realises these fears are stupid. My family are sick of it, but it has gone on for so long now I can’t stop”. – Liz

• Correcting obsessional thoughts – you think alternative ‘neutralising’ thoughts like counting, praying or saying a special word over and over again. It feels as though this prevents bad things from happening. It can also be a way of getting rid of any unpleasant thoughts or pictures that are bothering you.
• Rituals – you wash your hands frequently, do things really slowly and carefully, perhaps arrange objects or activities in a particular way. This can take up so much time that it takes ages to go anywhere or do anything useful.
• Checking – your body for contamination, that appliances are switched off, that the house is locked or that your journey route is safe.
• Avoidance – of anything that is a reminder of worrying thoughts. You avoid touching particular objects, going to certain places, taking risks or accepting responsibility. For example, you may avoid the kitchen because you know you will find sharp knives there.
• Hoarding – of useless and worn out possessions. You just can’t throw anything away.
• Reassurance – you repeatedly ask others to tell you that everything is alright.

How common is OCD?

About 1 in every 50 people suffer from OCD at some point in their lives², men and women equally³. That adds up to over 1 million people in the U.K.

Famous sufferers may include the biologist Charles Darwin, the pioneering nurse Florence Nightingale, the actress Cameron Diaz, and the soccer player David Beckham.