This podcast is produced and presented by Lee Millam.
Obsessive Compulsive Disorder, OCD, is a clinically recognised disorder which affects around 1-2% of the population. It is debilitating and paralysing. People with OCD experience intensely negative, repetitive and intrusive thoughts, combined with a chronic feeling of doubt or danger (obsessions). In order to quell the thought or quieten the anxiety, they will often repeat an action, again and again (compulsions). [definition from OCD Action]
Psychologists believe the condition may run in families or that people with OCD have an imbalance of serotonin in the brain.
Now new research is being done at Goldsmiths, University of London that could, in the future, help with treatment. It identifies the precuneus, considered as a central hub between posterior and prefrontal brain regions (and often involved with processing of self-attribution, responsibility and causal reasoning) as a key area for intervention.
In the meantime, for those with Obsessive Compulsive Disorder, its impact can be devastating as Imogen and Maria explain….
Maria: I was affected by imperfections in goods I’d bought, or around the flat I’d see a mark and that would bother me – I’d have to try and cover it or do something with it. And if something was really bad, I’d lose the ability to function. I’d go into a deep depression and just sit there, not being able to do anything. And that led eventually to a nervous breakdown when I was about 32, which is when it was diagnosed.
Imogen: I can remember I was really scared of being told off in school. I’d do everything I could to prevent being told off. I’d get all my school clothes ready in the morning and I wouldn’t go in my bedroom after 7am. I’d get changed in the hallway, I’d have everything out there. If I’d left something in my room I’d have to get someone else to go in and get it for me because I just felt ‘no I can’t’. I thought if I did go in something bad was going to happen – I wasn’t aware of what – perhaps getting told off at school, or someone getting hurt – I just didn’t know.
LM:Help is available from the helpline OCD Action.
Olivia Bamber, OCD Action: OCD can affect anyone of any age, in any job, any gender. From as young as possible to as old as possible. Anyone.
Maria: You feel that if you don’t think a certain way some harm will happen to someone you love or you care about. Sometimes you have to count certain numbers in your head. You do things but you don’t realise it because you are so living with it all the time. Half the time you don’t realise what you are doing. Most people with OCD have to keep washing their hands or performing tasks all the time, whereas I don’t do that. Mine is a different form of OCD – checking things for imperfections etc. When I was diagnosed, I had peculiar obsessions – ones I don’t have any more. But I still have OCD.
LM: What ‘peculiar’ obsessions?
Maria: When I had my nervous breakdown it was over my little dog, Cherie. Initially my partner bought her for me as a puppy because I thought if I had a dog it would help the OC – it would sort it out – but unfortunately she became the focus of my OCD. She was imperfect. I’d look into her eyes, see a vein that I thought shouldn’t be there, and I’d keep checking her and checking her, until I got to a point where I thought there is something not right here, I’ve got to do something. I don’t want to harm her – it was the worst fear I ever had of harming that little dog that I loved (and I did love her) but I couldn’t function, I couldn’t do anything. I’d be laying in bed and I remember just crying, I couldn’t bear her near me. I completely broke down and I was taken to hospital and diagnosed with OCD.
Imogen: I had great support from my family. They took me to see a CAMS specialist (Child and Adolescent Mental Health Service). CAMS has lots of therapists who children and adolescents can talk to to get help. And alongside that we had family therapy – my whole family would come along and we’d all talk about it and we’d talk about what had been going on and how everyone was feeling. No one was left out, so everyone felt they were getting the support they needed.
LM: Psychologists are getting one step closer to treating Obsessive Compulsive Disorder. A new study has been carried out by researchers at Goldsmiths, University of London – Dr Rhiannon Jones (who is now at Winchester University) and Professor Joydeep Bhattacharya.
Professor Bhattacharya: Obsessive Compulsive Disorder is a psychiatric disorder which affects 1-2% of the population. It can be severe and have severe consequences on a person’s quality of life and wellbeing. They might be aware of the problems but they also have the impairment of modifying those behaviours.
LM: And in terms of mental health, it is a very common problems isn’t it?
JB: It is one of the most common, I believe, in terms of prevalence – after schizophrenia – although there is quite a bit of co-morbidity between the two.
LM: Psychologists recognise that people with schizophrenia quite often have OCD too.
JB: It is a complex disease. You can’t precisely pinpoint one or two reasons for developing this type of behaviour, and there are certain types of genetic underpinning. So far our understanding is quite limited.
LM: If someone has OCD, seeking help is really important. Left untreated it is unlikely the symptoms will improve, they may even get worse. I asked Olivia Bamber from OCD Action what are the main treatments available?
OB: One of the main treatments, and the most well known, is CBT – Cognitive Behavioural Therapy – which is like a talking therapy. You talk about the problems. CBT is usually combined with ‘exposure and response prevention’ (ERP) in which the person with OCD is exposed to their fear. For example, they may be asked to touch the floor if they are afraid of germs on the floor, or they are told not to re-check their lock.
The ‘response’ part of ERP is about learning to deal with responding to the exposure. So, if someone fears touching the floor they will be told to touch the floor, then wait for longer before they do their ritual (eg washing their hands) and over time the anxiety decreases.
It is proven to work and help people control their OCD. It doesn’t mean they are cured, but people can regain control by doing therapy like that.
There are also different medications that can help reduce anxiety – usually combined with therapy (not used on their own). Different things work for different people. There are lots of different treatments available.
JB: OCD has multifaceted characteristics. One characteristic is a cognitive bias called ‘thought action fusion’. This refers to an inflated belief in a coupling between our thoughts and action – especially negative thoughts. OCD sufferers tend to believe that the negative thoughts have certain causal factors or causal influence on the actions. Thought action fusion is quite common in OCD, and you can also find it in patients suffering from anxiety disorders. So our study is about understanding the brain responses underlying these spurious biases – the coupling between thought and action.
LM: For someone with OCD, thought and action are closely linked. They don’t separate their thoughts from events int he real world.
JB: Once we have a good understanding of how this is represented in the brain, and if we can target, with non invasive intervention, the brain regions that are possibly mediating this thought action fusion bias, that could help us mitigate the inflated response or coupling between thought and action.
LM: So it is early days for the researchers but what have they discovered so far? And where next?
JB: We tried to identify certain brain regions. In our research we identified the precuneus, a brain region at the back of the head. The activity of that brain region is correlated with an OCD level of thought action fusion – the higher the level of guilt they experience, the greater the correlation with activity of this specific brain region.
The next step – can we model the precuneus? If we can model the activities of the precuneus , we could perhaps have an impact on the anxiety causing this thought action fusion. So the next step in this research is to use brain stimulation techniques to non-invasively model the activities of the precuneus – to see if that can reduce the overall anxiety and overall impact.
OB: My advice to anyone who thinks they may have OCD, even if they only think they have it and they aren’t sure, is to go and seek help anyway, get advice, do a bit of research. Look on OCD Action’s website- there is a lot of advice and information there – seek advice because you wouldn’t want it to get worse.
Imogen: I still have it, but I fight ever day – I don’t let it stop me!
The research is published in the Neuroimage: Clinical and available at: http://www.sciencedirect.com/science/article/pii/S2213158213001563
Photo: Benjamin Watson (Creative Commons Licence).