Embarrassing Illnesses

Treatment plan

If you have obsessive compulsive disorder (OCD), your recommended treatment plan will depend on how badly your OCD is affecting your ability to function.

OCD that causes mild functional impairment is usually treated using a short course of cognitive behavioural treatment (CBT).

OCD that causes moderate functional impairment can be treated with a more intensive course of CBT, or the type of antidepressants known as selective seretonin reuptake inhibitors (SSRIs). Such cases may also require referral to a specialist mental health service.

OCD that causes severe functional impairment will require referral to a specialist mental health service for a combination of intensive CBT and a course of SSRIs.

Children with OCD are usually referred to a health professional with experience in treating OCD in children.

Psychological treatments for OCD

CBT is the the most widely used psychological treatment for OCD. It is based on the idea that most unwanted thinking patterns, beliefs, and emotional and behavioural reactions are learnt over a long period of time.

The aim of CBT is to identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and to learn to replace this thinking with more realistic and useful thoughts and beliefs.

Exposure and response prevention

A particular type of CBT called exposure and response prevention (ERP) has successfully achieved this aim. ERP involves ‘exposing’ yourself to situations or objects that are currently causing you fear and anxiety. Exposure can be:

• Actual, such as handling dirty plates or using a public toilet.
• Mental, such as mentally picturing yourself forgetting to lock your door or leaving the oven on.

Once exposure has taken place, most people with OCD will feel the need to engage in compulsive behaviour in order to reduce the anxiety that the exposure has caused them. However, the CBT therapist will work with you in order to prevent, or at least delay, this compulsive response.

Over time, the exposure to an unpleasant object or situation will cause less anxiety and the need for a compulsive response will become weaker.

To begin with, your therapist will set targets for exposure that are relatively easy to cope with before moving on to targets that are currently causing you considerable anxiety.

People with mild to moderate OCD will usually require about 10 one-hour sessions with a CBT counsellor. Those with moderate to severe OCD may require a more intensive course of CBT lasting more than 10 hours.

Medication for OCD

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant that are usually recommended for people with moderate to severe OCD.

You will normally need to take a SSRI for 12 weeks before you begin to notice any benefit.

Side effects of SSRIs include:

• Headache.
• Nausea.

These side effects should pass within a few weeks.

There is a small chance that SSRIs will increase your feelings of anxiety, which may lead to you experiencing related suicidal thoughts and the desire to self-harm.

Contact your GP immediately if you are taking a SSRI and you experience suicidal thoughts or the desire to self-harm.

Most people with moderate to severe OCD are required to take SSRIs for at least 12 months. After that time your condition will be reviewed. If the condition is causing you no, or very few, troublesome symptoms, you may be able to stop taking SSRIs.

Clomipramine

Clomipramine is a tricyclic antidepressant (TCA) that can be used as an alternative to SSRIs for the treatment of OCD. TCAs are not as commonly used as SSRIs because they cause more side effects. They can be effective in treating people with OCD who are unable or unwilling to take SSRIs.

Side effects of clomipramine include:

• Dry mouth.
• Constipation.
• Headache.
• Dizziness.
• Fatigue.
• Increased sweating.

Clomipramine is not suitable for people with low blood pressure (hypotension) or heart disease. Therefore, if you are at risk of either of these two conditions, your GP may recommend a blood pressure test and an electrocardiogram (ECG) before you begin your treatment.

As with SSRIs, you will usually be recommended to take a 12-month course of clomipramine, after which your symptoms will be reviewed.

If SSRIs or clomipramine prove to be ineffective, you will be referred to a specialist mental health service.

Support groups

Many people with OCD find support groups helpful. These groups can provide reassurance, help to reduce any feelings of isolation, and give you a chance to socialise with other people. 

Support groups can also provide advice and information to family members and friends who may be affected by your OCD.

See Useful links for more information about support groups.

Surgery

Surgery for obsessive compulsive disorder is usually considered to be a last-resort treatment for severe OCD when all other forms of treatment have failed. Most surgeons would only consider a person suitable for surgery if they have spent at least five years trying other forms of treatment, such as CBT, without success.

During surgery, a neurosurgeon (a surgeon who specialises in surgery involving the brain and nervous system) will use an electric current or a pulse of radiation to burn away a small part of the limbic system. The limbic system is a structure in the brain that is responsible for some of the most important brain functions, such as the higher emotions, memory and behaviour.

By burning away a small part of the limbic system, the surgeon is often able to ‘re-wire’ the brain and fully, or at least partially, resolve chronic mental health conditions such as OCD.

However, surgery is not a guaranteed cure for OCD. Information collected by the Royal College of Psychiatrists (RCP) found that out of 478 cases of surgery for OCD:

• 54% resulted in a marked improvement.
• 27% resulted in a lesser improvement.
• 14% made no difference.
• 1% made the symptoms worse.

Surgery for OCD carries the risks of both short- and long-term side effects.

Short-term side effects include:

• Headaches.
• Mental confusion.
• Memory loss.
• Poor concentration.
• Seizures.

These short-term side effects should resolve about a month after surgery.

Long-term side effects include:

• Weight gain.
• Apathy (a lack of interest).

Long-term side effects may last for up to 12 months.

Back to the Embarrassing Bodies Condition Guide or view information about Obsessive Compulsive Disorder on www.nhs.co.uk »