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Understanding the Mind – Obsessive Compulsive Disorder

Friday, May 11, 2018

It’s common to have finicky ways of doing things – washing up the glasses first, start dressing with socks, mow the lawn in straight lines, count the pegs as you hang up the clothes. These quirky habits don’t cause any problems…that is, unless something cuts across the ritual and causes a meltdown, or you just can’t snap off the thoughts. In the same vein, we all have times when our thoughts keep going back to something specific, maybe an idea we’ve had or something that isn’t yet solved. Again, this is not a problem as long as it’s easy to turn it off and re-focus onto something else.

When thoughts get stuck or quirky habits take up too much time and can’t be stopped, this is Obsessive Compulsive Disorder (OCD). It sits in the category of Anxiety problems because the person caught up by these rituals typically suffers high levels of distress when they are blocked from doing the rituals (compulsions) or they are exhausted from the constant thoughts churning around in the mind (obsessions). In some extreme cases, everything else in life takes a back seat to the obsessive thoughts or behaviour rituals.

Do I have OCD?

Worrying about something, or liking to do things a certain way, are not generally a problem. The DSM-5 defines OCD as “the presence of either obsessions or compulsions which are significantly distressing, time-consuming, or interfering with normal routines and social or occupational functioning”. That is, thoughts or rituals that interrupt our lives so we can’t function normally. A quick and easy online screening test is available at

What causes OCD?

The precise cause of OCD still isn’t known but like many mental health disorders, is likely to be a mix of genetic, biological, and environmental factors.

Brain scan studies show that certain areas of the brain function differently in people with OCD compared with those who don’t. Faulty wiring in the neural pathways between different parts of the brain, including the orbitofrontal cortex, the anterior cingulate cortex (both in the front of the brain), the striatum, and the thalamus (deeper parts of the brain) has been found in people with OCD. This is often linked to irregularities in key neurotransmitters – the chemicals that send messages between brain cells, such as serotonin, dopamine, and glutamate.

About 25% of people with OCD have an immediate family member with the disorder. Twin studies suggest that genetics contributes about 45-65% of the risk for developing OCD. This may be linked to a mutation of the human serotonin transporter gene (hSERT) which is then inherited.

Operant learning – having rewards or punishment linked to behaviours – also plays a part. People who are vulnerable to stress, where the sympathetic arousal system doesn’t settle quickly, seem to get an instant reward – relief – when they engage in rituals, either actions or thoughts. The disorder might start this way, as a means of self-soothing which is rewarding, but then it becomes almost like an addiction where the need for relief takes over everything.

Cognitive theories suggest that OCD starts with misinterpreting the meaning of certain thoughts, for example, over-personalising something another person has said, or exaggerating the meaning given to a thought. This triggers stress which is then relieved by doing certain compulsive actions. This is known as thought-action fusion.

Finally, OCD can develop from environmental factors. Having highly critical parents or experiencing trauma in childhood often underlie OCD. Some brain injuries trigger this disorder, and there is evidence that some severe bacterial or viral infections in childhood underlie the condition.

How is it treated?

There is no cure for the disorder, but there are effective, evidence-based therapies that mean the person with OCD can get on and still manage the condition so it has less impact on day-to-day life. Medications such as selective serotonin reuptake inhibitors (SSRI’s) may be necessary in extreme cases where the disorder is profoundly affecting quality of life or threatening health. In extreme cases, other medical treatments such as antipsychotics or tranquillizers, deep-brain stimulation, and brain surgery may be necessary.

Treatment plans should also include “talk therapies” to help the patient understand the disorder and develop better coping skills. This can include cognitive therapy – learning to think differently about rituals so they are given less significance. Paired with coaching in anxiety reduction techniques such as mindfulness, deep relaxation or self-hypnosis, this approach has a high success rate.

Danger Ideation Reduction Therapy has recently been shown to be highly effective. This treatment targets danger-related thoughts through a 6-step process aimed at restructuring faulty beliefs using techniques like attentional focusing, providing corrective and factual information, and cognitive restructuring.

Like all serious mental health problems, the sooner treatment is started the higher the chance of a good recovery. However, successful treatment depends on investing time and effort into getting well again and having a strong positive believe that the brain can be healed.

Dr Kate Lemerle, Psychologist

Chrysalis Counselling & Coaching, Norfolk Island


TEL: 52112 or email

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