'Obsessive' is one of those clinical words that changed in meaning as it became part of everyday speech. We talk of pedantic, nit-picking people as being 'obsessional', for example - or say that someone is 'obsessed' with cars, or sex, or football.
But doctors use these terms in a more limited, clinical way. 'Obsessions' are thoughts or ideas that keep coming into your mind, even when you don't want them to; compulsions are things that people feel they have to do, even though they try to resist.
OCD is an illness characterised by these unpleasant, repetitive thoughts and acts. It used to be considered a very rare condition, but in fact it probably affects two to three per cent of the general population. The World Health Organisation ranks it as the tenth cause of worldwide disability. Men and women are equally affected.
What are the symptoms?
There are (so far) no reliable clinical tests for this condition, so the diagnosis depends on accurately identifying symptoms. An interesting 'diagnostic questionnaire' is available - but, of course, the condition should only be formally diagnosed and treated by a specialist.
Cars, sex and football may be compelling - but these pleasurable interests are never part of clinical OCD. People with OCD suffer from more mundane compulsions: things like repeated and stereotyped checking, counting, ordering or cleaning. Obsessive thoughts are sometimes distressingly violent or obscene.
OCD sufferers carry out compulsive rituals to such extremes that they interfere with normal living. It's normal, for example, to double-check that the gas fire has been turned off, and the front door locked, before you go to bed. But it's not normal to have to wash your hands 20 or 30 times a day in a rigid routine. Likewise, it's not normal to clean the house so thoroughly that you wear out the wallpaper, or to start meticulously setting the table for Christmas dinner in late September.
Features of OCD
- unpleasantly repetitive thoughts, images, or impulses coming from the patient's own mind
- the thoughts are recognised as being silly or inappropriate
- the obsessions are resisted unsuccessfully (at least initially)
- the thought of carrying out the act isn't pleasurable in itself
- present on most days for at least two weeks
What causes OCD?
Freudians thought of OCD routines as a psychological defence against increased anxiety, and this is probably true in normal situations. Many of us would triple-check we had our passports before leaving on holiday, or have little mental routines we carry out before sitting exams.
But it seems that true, clinical OCD is a form of biological mental illness. It has a tendency to run in families, often occurs with other conditions such as depression and anxiety, and researchers have linked it to brain changes seen in specialised brain scans.
Treatment
Untreated OCD tends to get better over time without treatment, but most people benefit from the group of antidepressants called SSRIs. This includes drugs such as sertraline or paroxetine. As with depression, it can take two to four weeks for the drug to have effect, and improvement may continue for several weeks or months after that.
Treatment might also include cognitive behavioural therapy, carried out by a psychologist or nurse therapist.
This article was last medically reviewed by Dr Rob Hicks in May 2005.
First published in October 1997.
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