Barnet, Enfield and Haringey Mental Health NHS Trust. Understanding OCD. Obsessive-Compulsive Disorder (OCD) Information for patients and carers.

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1 Barnet, Enfield and Haringey Mental Health NHS Trust Understanding OCD Obsessive-Compulsive Disorder (OCD) Information for patients and carers Page

2 What is Obsessive-Compulsive Disorder (OCD) People with OCD experience two main categories of symptoms: 1. Obsessions - including unpleasant thoughts, images or impulses that are out of character, distressing and difficult to get rid of. The most common obsessions concern themes of violence, doubts, morally repugnant sexual acts, perfectionism and contamination by germs, dirt, faeces or body fluids. 2. Compulsions - the things you feel driven to do to control your obsessions, relieve your doubt and distress or to prevent bad things happening. These often follow rules, for instance, the rule to repeat an action a certain number of times or until "it feels right". Compulsions include: Internal actions - such as counting to a certain number, saying a prayer or phrase over and over again and replacing distressing images with less distressing ones. External actions - such as washing, checking or touching an object repeatedly, asking for reassurance repeatedly or constantly striving to create order and symmetry around you. Some people also hoard possessions that they find impossible to throw away. People with OCD also frequently avoid triggers (people, places and objects) associated with their obsessions limiting what they can do in their lives. Obsessions and compulsions are normal. Several studies of people who do not have OCD have confirmed that more than 80% of the population occasionally have thoughts, images and impulses that are unwanted, unpleasant or meaningless. Such experiences are just part of the normal working of the mind. However, when you have OCD you become much more preoccupied with, and distressed by, your thoughts (obsessions) and in some cases the repetitive rituals or actions (compulsions) become very time-consuming and hard to put a stop to. Page 2

3 You fear bad things will happen or that you will do inappropriate things because of your obsessions, but there is no evidence of a link between such experiences and the occurrence of bad events or inappropriate actions. When OCD becomes severe, it can affect you living a normal life. If your OCD is left untreated it can become chronic and you can also become depressed. How common is it? Studies show that around 1 to 2 people in every 100 in the UK experience OCD at some point in their lives. It is one of the most common mental health problems and one of the most disabling. Both men and women are affected equally. When does OCD begin? OCD can occur in childhood but the most common age of onset is between teenage years and early twenties. Although common, people experiencing OCD often avoid talking about their experiences because they feel ashamed and embarrassed and they often have the disorder for years before seeking help. What causes OCD? There is no final answer to this. Some of the suggestions for the cause of OCD include: Genes - OCD seems to occur more commonly in relatives of people with OCD Brain or neuro-chemical causes - including an imbalance of the brain chemical called serotonin Beliefs - involving the meaning you give to your obsessive experiences Page 3

4 What can someone with OCD do to help themselves? It is important for you to acknowledge that there is a problem and seek help because the condition can get worse. You and your family can also build a support network by linking with OCD support groups on the internet and attending local OCD support group meetings. There are several self-help books available too. Some are listed on the back of this leaflet You may need professional psychological help and/or medication. Your General Practitioner (GP) can make a referral where specialist help is needed. What treatments work? The recommended treatments for OCD include Exposure and Response Prevention (ERP) and Cognitive Behaviour Therapy (CBT). ERP ERP consists of gradual exposure to obsessions and the external things you have been avoiding, but you are encouraged to stop yourself from doing your usual compulsive rituals (counting, cleaning, checking etc). The aim is to gradually reduce or remove the level of distress and anxiety you experience because of your obsessions, a process called habituation. CBT CBT is used to challenge the meaning you give to your unpleasant thoughts and help you change how you react to them. Instead of trying to get rid of your thoughts, an approach that does not work, you will be encouraged to find different ways of dealing with, and experiencing, them. The aim of this treatment is to reduce the importance you place on your obsessions and reduce the distress they cause. Medication Certain types of anti-depressant medication have been found helpful in treating OCD. These can be used alone or with psychological therapy and there is some evidence that for many people a combination of the two is the best approach. The drugs prescribed for the treatment of OCD should be taken as advised by your doctor and you should not stop taking them without advice. These drugs can have side-effects and you should discuss these with your doctor. It is important to know that these drugs are not addictive. Page 4

5 What can families and carers do to help? OCD can have a big impact on the whole family but family members often feel unsure about the best way to respond. Frequently the person's OCD puts a great strain on relationships. It is helpful if family members and carers can: Find out more about OCD so they can understand what the person is going through Be patient and not criticise or act in a hostile manner to the OCD sufferer Avoid helping the person complete their rituals Avoid giving repeated reassurance to the person about their fears as this will always make the OCD worse It is often helpful for families and carers of the person with OCD to be involved in their therapy when this is agreed. Living with and supporting someone with OCD can be very stressful so it can be very helpful to join carer support groups or create a network of support through family and friends. Services for people with OCD at Barnet, Enfield & Haringey Mental Health Trust and how to access them There are a range of services offered for the treatment of OCD in the Trust which includes an OCD-focused CBT group as well as individual and intensive work including ERP. When appropriate, therapy in small groups can be very helpful as you can learn a lot from other people in the group and support each other's efforts to change your thoughts and behaviours. People with mild to moderate OCD can either refer themselves or ask their GP for a referral to the Improving Access to Psychological Therapies (IAPT) service where they can access a range of CBT services including guided selfhelp, computer-delivered and individual CBT. Contact details for the IAPT teams are at the back of this leaflet. People with more complex and severe OCD, or who have failed to respond in the primary care service, can be referred by their therapist or GP to the Complex Care Service, which provides a comprehensive OCD assessment and treatment programme that includes group and individual CBT. Page 5

6 Useful organisations Improving Access to Psychological Therapies (IAPT) services Enfield IAPT Tel: Barnet IAPT Tel: Haringey West IAPT Tel: Haringey East IAPT Tel: Websites for all IAPT services: or OCD Action Tel: (or London ) Web: OCD Action provides information, advice and support to people with OCD and related disorders OCD-UK Tel: (admin enquiries only) Web: OCD-UK is a national charity working with and for people with OCD. Service include 24/7 online support and information and advice for those suffering from OCD, their families and carers. Page 6

7 No Panic Helpline: Tel: Web: Provides support for people with anxiety problems, their families and their carers SANE SANELINE: Direct line: Fax: Website: SANELINE is the national out-of-hours telephone helpline that offers emotional and crisis support to people coping with mental illness, their families and friends, and information to professionals and organisations working in the mental health field. Further Reading Overcoming OCD: a self help guide using CBT by David Veale and Rob Wilson, (published by Robinson, London) Break free from OCD: Overcoming OCD with CBT, F Challacombe, V Oldfield & P Salkovskis (published by Vermillion Press) Overcoming obsessive thoughts: How to gain control over your OCD, D Clark (published by New Harbinger Press) Brain Lock, Jeffrey M Schwartz, (published by Harper Collins) For more information on Barnet Enfield and Haringey Mental Health NHS Trust and the services we offer, please visit: Page 7

8 You can ring for a translation Monday - Friday 9.00am pm. Please give this number: and also for Audio, Large Print and Braille, call now on: Produced By: Date of Publication: Page 12Review Date: Reference: Communications Team 17/03/ /03/2017 lc