Recognising and seeking treatment for an obsessive-compulsive disorder

In obsessive-compulsive disorder, thoughts repeatedly intrude, or those affected feel compelled to perform certain actions and rituals. The disorder usually involves obsessive thoughts and compulsive behaviours. Both forms can occur together and reinforce one another.

Obsessive thoughts are intrusive thoughts that recur frequently and are difficult to dismiss. A compulsive behaviour is an action or ritual performed compulsively. In children, checking behaviours are a common manifestation. Organising and counting also occur.

Not every preference for order and cleanliness constitutes an obsessive-compulsive disorder. For medical classification, what matters is how frequently the symptom occurs and whether the compulsions interfere with daily life. An intense preoccupation with order and symmetry can be an indicator during the diagnostic consultation.

The condition can begin at an early age. The first signs often appear as early as childhood or adolescence. According to patient guidelines, women often develop the condition later than men. The obsessive-compulsive symptoms can therefore become apparent at different stages of life, depending on the individual.

Typical symptoms include thoughts or actions that are intrusive and difficult to control. The presentation varies from person to person. The key factor is the extent to which the compulsions interfere with daily life.

• Obsessive thoughts: intrusive thoughts that recur repeatedly
• Compulsive behaviours: certain routines are repeated
• Compulsive checking: things are checked repeatedly
• Compulsions relating to order: order or symmetry demand a great deal of attention
• Compulsive washing and cleaning: washing or cleaning becomes a ritual
• Compulsive counting: objects or sequences must be counted

In children, compulsions involving washing and cleaning are among the most common manifestations. Compulsions relating to checking, order and counting are also frequent. Parents should be alert if hand-washing or another ritual increasingly dominates the child’s daily life.

The condition, with its compulsive rituals, can also be extremely stressful for family members. They also witness just how much time these actions take up. As the condition progresses, isolation and social withdrawal may set in.

The causes of obsessive-compulsive disorder cannot be attributed to a single trigger. The factors that play a significant role vary from person to person.

• Genetic influences: a possible biological factor
• Environmental influences: experiences and external living conditions
• Life events: personal experiences can interact with other factors

Genetic factors may play a part in the development of the condition, alongside environmental influences such as life events. No single cause can be identified from this. Nor is it possible to predict the onset of the condition with certainty. A supposed triggering event therefore does not automatically explain the symptoms in full.

The diagnosis is based primarily on a targeted discussion about thoughts and behaviours. This also covers their impact on everyday life. Potential signs must be explicitly enquired about. A self-assessment test cannot replace this clinical consultation.

The specialist may ask, for example, to what extent someone is preoccupied with order and symmetry.

Describe as openly as possible which thoughts intrude and which compulsive actions follow. It is also helpful to indicate how much of your life the symptoms take up. Stressors within the family or at work may be relevant to the assessment. The same applies to school, education and social contacts.

Professional help is advisable if thoughts or rituals recur and interfere with everyday life. A psychotherapy consultation offers an initial assessment if a mental health condition is suspected.

You do not need a doctor’s referral to book an appointment at a psychotherapy clinic. Medical psychotherapists specialising in psychiatry and psychotherapy, as well as psychological psychotherapists, are suitable for treatment.

Parents should not hesitate to seek professional help if they suspect their child has compulsive behaviours requiring treatment. Family members can calmly and clearly explain to the person affected that a professional assessment is necessary.

The first-line treatment should be disorder-specific cognitive behavioural therapy with exposure. Exposure means that, during therapy, those affected confront situations that trigger their compulsions. Through response prevention, they practise refraining from carrying out their habitual compulsive behaviour.

Psychotherapy can be provided on an outpatient or inpatient basis. Medication may also be considered. Selective serotonin reuptake inhibitors, or SSRIs for short, increase the concentration of the neurotransmitter serotonin in the brain.

Treatment in a clinic is an option as a form of inpatient care. Disorder-specific cognitive behavioural therapy is offered on both an outpatient and inpatient basis. The treatment team discusses with the person affected which form is best suited to their personal situation.

With outpatient therapy, sessions usually take place once a week. An individual session generally lasts about an hour. The total duration of treatment depends on the type of disorder. Its severity and the chosen approach also play a part.

A clinic specialising in obsessive-compulsive disorder provides inpatient treatment. It is not possible to make a blanket decision as to whether this form of care or outpatient care is appropriate. The treatment team should explain the choice based on the individual’s personal situation.

Without appropriate treatment, obsessive-compulsive disorder is usually a chronic condition. The severity of the symptoms can vary. It is therefore not possible to make a general statement about whether or when the condition will resolve completely.

Persistent compulsions can impair social interactions and lead to withdrawal or isolation. Family members can also be severely affected by the OCD. Those affected should discuss with the treatment team whether and how family members should be involved.

Once treatment has been completed, self-help groups can help prevent relapses. They are not a substitute for professional treatment.