Mental Health

Author: Canadian Mental Health Association, BC Division

What is it?

OCD or obsessive-compulsive disorder is part of a group of mental illnesses called obsessive-compulsive and related disorders. It used to be grouped with anxiety disorders and it still is closely linked with anxiety disorders.

OCD is made up of two parts: obsessions and compulsions.

Obsessions are thoughts that people can't control. Obsessions often come up on their own and cause a lot of distress. Obsessions can be very difficult because they can shock people who experience them. For example, people may experience thoughts of harming someone else or images of a horrific accident. It's important to remember that people don't act out their obsessions—obsessions are only thoughts.

Compulsions are actions individuals use to manage obsessions. These actions are used as a way to reduce anxiety brought on by obsessions, often with the intention of neutralizing or negating a threat (e.g. "If I do x, y won't happen" or "I need to do x just in case"). Compulsions can be visible to others, such as spending a lot of time washing your hands or putting items in a specific order. Compulsions can also be invisible, such as repeating a word or phrase to yourself or counting items in your mind. Compulsions may bring some temporary relief of the anxiety or distress around obsessions, but compulsions aren't pleasurable and don't stop obsessions from coming back.

Most people who experience OCD understand that obsessions probably aren't true and that compulsions probably aren't based in reality. However, they still can't control obsessions or compulsions.

Obsessions and compulsions take a long time—at least an hour a day. OCD is a spectrum like other mental illnesses. Some people experience mild or moderate symptoms and can go about their usual lives, while others may experience significant disruptions to their lives and may need a lot of support. People with OCD may also experience periods of time where OCD symptoms are more serious or hard to control and periods of time with few or no symptoms. Obsessions and compulsions can worsen as a result of different triggers. Triggers may be things that are related to obsessions (like being around sick people when you have obsessions around sickness or germs) or situations that aren't related to obsessions, such as high-stress events, conflict, grief, or poor sleep.

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What does OCD look like?

Common obsessions include:

• Thoughts of accidentally harming yourself or others—such as, "What if I accidentally leave the stove on and burn down my house? What if I accidentally hit someone in my car and didn't notice? What if I don't clean something properly and gets someone sick?"

• Thoughts of making a mistake—such as, "What if I make a typo in this email and my boss thinks I'm incompetent? What if I miss a detail on this contract and cost the company a lot of money?"

• Thoughts of germs or contamination—such as, "What if I catch something bad when I'm in public? What if I bring germs into the house? What if I use a cleaning product that contains harmful chemicals?"

• Mental contamination—avoiding thoughts, experiences, or other people out of fears that those situations will influence you and make you do something that you think is wrong or immoral. For example, "If my car gets broken into, I might want to steal from others" or "If I'm around a friend who cheated on their partner, I might cheat on my partner."

• Thoughts of harming others, including violence—such as, "What if I push someone into the street or put this child in a life-threatening situation?" (Remember, experiencing obsessions does not mean that you'll act on them, and these thoughts often don't reflect your desires, personality, or values.)

• Intense focus on your body's functions or a specific feeling—such as being unable to stop focusing on your heart beat, the sensation of swallowing, or the way you breathe.

Common compulsions include:

• Checking—such as repeatedly making sure the door is locked, checking emails at work, checking to see if certain appliances are left on or plugged in.

• Ordering or arranging—such as making sure that items on a bookshelf are arranged "just right" or doing something that gives that same feeling of "just right."

• Washing—such as spending a lot of time cleaning your home or washing yourself in a specific way

• Counting or touching—such as counting to a certain number or touching things a certain number of times

• Hoarding—such as keeping items most people would throw away (these can be physical items or they can also be items that are kept in virtual spaces like emails or images on your computer)

• Mental rituals—such as avoiding a specific number or word or repeating a specific word or phrase in your mind

• Need to confess or seek reassurance—such as telling a friend or family member about your obsessions to be reassured that you are safe or not a bad person for thinking something. Reassurance can also come in the form of looking for information like research papers, forums of other individuals with similar experiences, or information about the triggers to prove that obsessions aren't the same (such as researching what traits violent offenders have to see if they have any similarities)

Many people worry about germs if a co-worker is sick, prefer items on their desk to be arranged in a specific way, or think about a mistake they’ve made. However, these are usually realistic thoughts and realistic actions that last for a reasonable period of time. People without OCD can usually shake the thought off or recognize the thought they are having does not mean anything about them. OCD, on the other hand, is about thoughts and behaviours that are excessive and unrealistic that cannot be shaken off. OCD can cause people to avoid other people, places, or things that they link to obsessions or compulsions. It can make it really hard for people to go about their daily life.

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Who does it affect?

About 1-2% of people experience OCD at some point in their life. OCD is usually diagnosed when people are teens or young adults, around the age of 20, but it can start in childhood. People who experience "taboo" forms of OCD (such as obsessions around violence or sexuality) may not be diagnosed until they are older as a result of shame or embarrassment. OCD tends to run in families, though genetics aren't the only cause.

People who are diagnosed with OCD are more likely to experience an anxiety disorder like panic disorder, generalized anxiety disorder, or a phobia at some point in their lives. OCD can also go along with depression, skin picking/hair pulling, and hoarding disorder. About a third of people with OCD are also diagnosed with a tic disorder in their lifetime. Tics are unusual and recurring movements or sounds that people make that they can't control.

Researchers have seen children very suddenly experience symptoms of OCD or very suddenly experience worsening symptoms after an infection of a bacteria called streptococcus or strep. This is called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). It's not clear exactly how the relationship between OCD and strep infections work, so it's best to talk to your doctor if you have concerns about PANDAS.

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Could I have OCD?

• I'm bothered by thoughts that don’t make any sense and they keep coming back to me even when I try to make them stop

• I consistently try to ignore or neutralize them with another thought or action, and I feel like I have to do it over and over again

• My obsessions and compulsions are time consuming and take up at least an hour a day

If you think that you or someone else might have OCD, it's best to talk to a doctor or mental health professional.

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What can I do about it?

Obsessive-compulsive disorder is a very treatable illness. Without treatment, OCD can last a long time, so it’s important to seek help. The following are common treatments for OCD:

Psychotherapy—The most common treatment is a psychotherapy called cognitive-behavioural therapy or CBT. CBT helps you understand your thoughts, feelings, and behaviours, teaches you skills to help you understand and challenge obsessions and compulsions, and helps you cope with anxiety in healthier ways. Exposure and response prevention (ERP) helps you systematically and safely confront a feared situation without using compulsions with the goal of challenging untrue beliefs around obsessions. It may be included in CBT or other psychotherapies, or you may use ERP on its own.

Medication—Antidepressant medications may help treat OCD, usually alongside psychotherapy. A group of antidepressants called SSRIs (selective serotonin reuptake inhibitors) are the most common medications for OCD.

Self-management—Self-management strategies are things you do at home to take care of yourself. Self-management includes learning about OCD and how it affects you, practicing skills you learn in treatment, taking care of yourself as well as you can, and connecting with friends, family, or other important people in your support network.

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Where do I go from here?

A good first step is talking to your doctor. They can help you find a mental health professional, if needed. Other helpful resources include:

Anxiety Canada

Visit www.anxietycanada.com for information about OCD and anxiety disorders, My Anxiety Map and other self-management tools, the Mindshift CBT app, and a help finder to find service providers across Canada.

BC Partners for Mental Health and Substance Use Information

Visit www.heretohelp.bc.ca for the Managing a Mental Illness series of info sheets, activities, workbooks, and personal stories about OCD and other mental health problems. You'll find tips and self-tests to help you understand mental health problems.

International OCD Foundation

Visit iocdf.org for the US-based International OCD Foundation, which helps people affected by obsessive-compulsive disorder and related disorders like hoarding disorder and body dysmorphic disorder. Find information, join virtual events, and learn more about the Anxiety in the Classroom resource for educators, students, and parents.

HealthLinkBC

Call 811 or visit www.healthlinkbc.ca to access free, non-emergency health information for anyone in your family, including mental health information. Through 811, you can also speak to a registered nurse about symptoms you're worried about, or talk with a pharmacist about medication questions.

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