Some common questions (and answers) about OCD

The authors of Overcoming Obsessive Compulsive Disorder, David Veale and Rob Willson, address some commonly asked questions about OCD.

How common is OCD?

OCD is one of the more common mental disorders after social phobia, depression, alcohol and substance abuse. Between 1 and 1.5 in every 100 of the adult population are significantly distressed and handicapped by their OCD and this is also true for about 1 in every 200 children and adolescents. The frequency is much the same all over the world, although the form of OCD may differ according to culture. The content of obsessions and compulsions may vary across individuals and various cultures, but the processes remain the same.

OCD is equally common in men and women although there are some interesting differences in the symptoms. For example, more women than men experience compulsive washing or aggressive obsessions. Men are more likely to have obsessions about numbers, symmetry or order or suffer from obsessional slowness or sexual obsessions. Women are especially at risk during pregnancy and in the postnatal period, probably because of the increased sense of responsibility. Very young children with OCD are twice as likely to be boys.

At what age does OCD begin?

OCD can develop at almost any age. There is a group who develop OCD from about six onwards (more often boys). There is another group that starts to develop OCD during adolescence and the average age of onset is the early twenties. More men develop OCD in the late teens while women tend to develop it in the mid-twenties. There is however a wide variation in the age of the onset of OCD, from children as young as five up to the elderly. In many ways, OCD in children is much the same as in adults although children often find it difficult to articulate the meaning of their obsession or their feared consequences of not doing their compulsion. Although there are elderly individuals who have had OCD for decades, and have yet to seek or receive effective treatment, onset in the elderly appears rare. Those who have had mild OCD throughout their life and managed to contain it, can find their OCD worsens and becomes out of control after a major life event such as the death of a partner.

Do my obsessions reflect a darker or more dangerous side to my personality?

It’s only natural for us all to want to make sense of our experience. You may sometimes think that there must be a reason that you are plagued with doubts, impulses, thoughts or images that you find deeply distressing. The truth of OCD is that it reflects your deepest fears, not your darkest wishes. If this is true, the problem should improve as you reduce your fears.

How can I be sure that I’ve got OCD?

The doubt ‘what if this isn’t OCD?’ is a very common one. We’ve seen this worry persist in people that have sought numerous opinions and had their diagnosis confirmed by several specialists. The fact is you’ll need to tolerate a bit of doubt even about your diagnosis. You may even need to do some exposure to your feared outcome ‘if ’ you are wrong to assume your problem is OCD rather than something more sinister. Similar to the point above, you’ll feel most sure that your problem is (or was) OCD as you see it improve as a result of treating it ‘as if ’ it is OCD.

Can OCD change over time?

The course of OCD can vary enormously from one person to another. The symptoms may also change so that you may be a washer at one time and a checker later in your life. At one extreme, OCD can be relatively mild, consisting of one or two episodes and never returning. At the other extreme, usually when the onset is earlier, it is unremitting, chronic and more severely disabling. In between these two extremes are some patterns of OCD which come and go in episodes at times of stress.

One study, done before there were effective treatments, found that if their condition is left untreated, most individuals with OCD will manage minor improvements over the following ten to twenty years but do continue to experience significant symptoms. About 10 per cent made no improvement and 10 per cent become worse. However, OCD is now treatable, and it is possible either to banish it or at least make life more enjoyable and functional.

Can OCD be cured?

We’re often asked, ‘Do you really think OCD can be cured?’ In other words, can someone with OCD recover from it? As being free from OCD is the natural state for the brain and body, the aim is to be able to return to that state. So, recovery is not about finding a ‘cure’, so much as developing an understanding and dealing with your mind and emotions in a different way. It’s more helpful to think of improving your mental health as being like improving your physical health. The principles of overcoming OCD are about breaking free from unhelpful patterns of thinking and behaviour and becoming mentally fitter, stronger and more flexible.