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Fact sheet 37
What is OcD?
Anxious thoughts can influence our behaviour and this is helpful at times. For example, the thought I may have left the oven on leads to the behaviour of checking the oven and keeping things safe. However, once the thought becomes obsessive (recurring) it can influence unhealthy patterns of behaviour that can cause difficulties in daily functioning. The obsession or persistent thought I have left the oven on, can lead to repeated checking. For someone with the anxiety disorder known as Obsessive Compulsive Disorder (OCD), either obsessions (thoughts, ideas, images that cause distress) or compulsions (acts performed to alleviate the distress or neutralise the thought), or both, are present. Compulsive behaviours or rituals are often performed in the hope of preventing obsessive thoughts or making them go away. Performing these compulsions provides only temporary relief, and not performing them markedly increases anxiety. People with OCD often think that unless they carry out these ritualistic behaviours, dire consequences will follow, such as the death of a loved one. Even though they know such thoughts are irrational, they are difficult to dismiss and cause much distress. People with OCD often experience feelings of intense shame about their need to carry out these compulsions. These feelings of shame can exacerbate the problem. Shame and the consequent secrecy associated with OCD can lead to a delay in diagnosis and treatment. It can also result in social disability (for example, children failing to attend school or adults becoming housebound). Shame can also be associated with unwanted thoughts or images (also known as intrusive thoughts) that enter the mind of the person with OCD and cause distress, leaving the person obsessing about the thought. For example, What if I hurt my child? These thoughts are out of character and therefore cause much distress as the person struggles with what it means about them as a person to be thinking this way. Some people with OCD seem to infer that a morally unacceptable thought is on par with the action. As a result, their anxiety increases when these problematic thoughts arise.
performs repetitive, often seemingly purposeful, ritualistic behaviours (compulsions) in order to reduce distress or neutralise the thought. In addition, obsessions, whether thoughts, ideas or images and compulsions share the following features: repetitive and unpleasant with at least one obsession or compulsion recognised as excessive or unreasonable persisting symptoms for at least one hour a day or significantly interfering with normal functioning the person tries to resist them, however, at least one obsession or compulsion is not resisted the person derives no pleasure from the obsessive thought or compulsive act. There may be initial relief from the compulsion, but this passes. the obsessions or compulsions cause distress or interfere with the persons day-to-day functioning, for example, work, social life, school, and are disabling. the person considers that the obsessions and compulsions do not occur exclusively within episodes of depression. Its important to note that this is only a guide to recognising OCD. For a diagnosis, talk to a health professional. People with OCD may also experience other mental health issues including depression, other anxiety disorders, an eating disorder and/or alcohol or substance-use problems.
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1 Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007 (4326.0). Canberra: Australian Bureau of Statistics. 2 Heyman, I., Mataix-Cols, D., Fineberg, NA. (2006). Clinical review: Obsessive-compulsive disorder. British Medical Journal. 333(7565): 42429.
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psychological therapy
Cognitive behaviour therapy (CBT) is the most commonly used therapy for people with OCD and can be conducted in group sessions, but the treatment of OCD is usually delivered individually. Cognitive behaviour therapists work closely with people to develop a shared understanding of thinking and behavioural difficulties. Therapists can assist people to uncover unhelpful and unrealistic ways of thinking. They can help a person to move closer to more helpful and realistic ways of thinking. Cognitive behaviour therapists also have techniques that help minimise the distress associated with obsessions. By minimising the distress associated with the obsession, the thought pattern is broken down and occurs less frequently. Therapists may also examine how an individuals way of thinking prompts negative behavioural patterns, exacerbating and prolonging the OCD and reinforcing the fear. Then behavioural tasks, such as exposure tasks, are carried out by the person to enable a return to more helpful behaviours. Graded exposure is the term that is commonly given to this series of exposure tasks as the person is gradually exposed to the situation that is feared. For example, a person with an obsessive thought about burning down the house may feel compelled to check all electrical equipment before leaving a room a ritual which may be even more time-consuming and more exhausting if the person plans to leave the house. Over time, the therapist may provide strategies which enable the person to check fewer pieces of equipment in fewer rooms less often, so the person gradually learns to reduce the anxiety and manage his/her particular obsessions and compulsions. Another effective part of CBT is psycho education. This relates to education regarding the symptoms of anxiety and why they occur. For example, people tend to be less fearful of symptoms if they are informed about the human physiological response to fear. People react to the threat of imminent danger with an acute stress response, commonly known as the fight-or-flight response, during which the brain releases hormones such as adrenaline that prepare the body for action. Understanding this process may assist the person in understanding the importance of breathing and relaxation techniques, as well as the benefits of aerobic exercise. Often, breathing and relaxation strategies are also taught to minimise physical symptoms of anxiety and manage stress in general.
medication
While psychological treatment is usually the first choice for the treatment of OCD, medication may also be helpful and has been found beneficial, particularly for OCD. Antidepressants may be prescribed to treat anxiety and depressive disorders. Talk to your doctor for more information and see beyondblue Fact sheet 11 antidepressant medication. the therapeutic goods Administration (Australias regulatory agency for medical drugs) and manufacturers of antidepressants do not recommend antidepressant use for depression in young people under the age of 18. For more information see beyondblue Fact sheet antidepressants for the treatment of depression in children and adolescents. Although fluvoxamine and sertraline have been approved for treating Obsessive Compulsive Disorder in this age group, close monitoring by a medical professional is recommended. benzodiazepines: These anti-anxiety and sedative drugs are used to relieve anxiety and aid sleep. They are, however, addictive and so are only useful for a short period of time (two or three weeks) or if used intermittently. Benzodiazepines can be difficult to stop taking, and if a person has become dependent, withdrawal symptoms may be quite severe. A common withdrawal symptom is high anxiety, which paradoxically can worsen the problem and make it difficult to assess whether current anxiety is related to the OCD or a result of long-term use of the Benzodiazepines. See www.reconnexion.org.au for more information and talk to your doctor. If you decide that you wish to stop taking your medication, it is crucial that you discuss this with a health professional before taking any action.
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Self-monitor: It can be useful to keep a diary of the frequency, intensity and types of unwelcome thoughts (obsessions) you have. Resist completing rituals (compulsions) as much as possible. If the need to carry out compulsions becomes stronger, let your treating health professional know. Practise letting go and putting things into perspective. Dont feel you must relentlessly meet unrealistic standards. Focus on successes rather than failures and dont be too hard on yourself. Try to reduce your stress in general. Practise relaxation techniques such as breathing and muscle relaxation. Relaxation techniques can provide quick relief from anxiety and, if practised regularly, can also reduce anxiety and stress in general. For more information on relaxation techniques see beyondblue Fact sheet 6 reducing stress. Recognise triggers Consider which situations or circumstances make you feel anxious or increase your stress levels (for example, too much caffeine, excessive workload, going to staff meetings or to the shops). Then try to develop strategies to confront situations, rather than avoiding them in order to manage and minimise general stress and anxiety. Set some realistic and small goals for yourself to manage stress better, for example, walking three times a week, joining a yoga class and eating regular meals. Develop some self statements that you find reassuring. For example, This is not my responsibility, Maybe its time to take a breath, Good enough is sometimes good enough. Make time for pleasurable activities. Set aside time to do enjoyable things, such as reading, gardening or listening to music, and seeing family and friends. For more information see beyondblue Fact sheet 8 Keeping active and Fact sheet 15 recovery. Maintain a healthy lifestyle; get regular exercise, have adequate sleep, eat a balanced diet and limit your intake of alcohol and other stimulants, such as caffeine to reduce anxiety. For more information, see beyondblue Fact sheet 7 sleeping well, Fact sheet 8 Keeping active, Fact sheet 9 reducing alcohol and other drugs and Fact sheet 30 healthy eating for people with depression, anxiety and related disorders.
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For more information
lifeline
13 11 14 24-hour counselling, information and referral (local call cost)
mensline Australia
1300 78 99 78 Support for men especially those with family and relationship problems
relationships Australia
1300 364 277 www.relationships.com.au Support for people with relationship problems
Facing Anxiety
www.mentalhealth.asn.au/ada Information on anxiety disorders, related resources and support groups
mOre inFOrmatiOn
beyondblue: the national depression initiative
To find out more about depression, anxiety and related disorders call the beyondblue info line 1300 22 4636 (local call cost) or visit the website www.beyondblue.org.au
Youthbeyondblue
www.youthbeyondblue.com beyondblues website for young people information about depression and anxiety and how to help a friend
e-Couch
www.ecouch.anu.edu.au Evidence-based information about emotional problems (including anxiety) and strategies to help you prevent problems and understand yourself better
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moodgYm
www.moodgym.anu.edu.au Online psychological therapy
Reconnexion
1300 273 266 www.reconnexion.org.au Psychology services for people experiencing anxiety and depression and tranquilliser dependency
state-speciFic services
ACt mental health Foundation
(02) 6282 6658 www.mhf.org.au Information about anxiety, depression, schizophrenia and bipolar disorder in the Australian Capital Territory
beyondblue gratefully acknowledges the contribution of Reconnexion in the development of this fact sheet.
beyondblue: the national depression initiative, 2009. PO Box 6100, Hawthorn West VIC 3122 T: (03) 9810 6100 beyondblue info line 1300 22 4636 F: (03) 9810 6111 E: bb@beyondblue.org.au W: www.beyondblue.org.au
beyondblue Fact sheet 35 Generalised Anxiety Disorder beyondblue Fact sheet 36 Panic Disorder beyondblue Fact sheet 37 Obsessive Compulsive Disorder beyondblue Fact sheet 38 Specific Phobias beyondblue Fact sheet 39 Social Phobia beyondblue wallet-size information card Anxiety Disorders beyondblue envelope-size information card Anxiety Disorders
06/09
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