Some people develop a condition where they feel compelled to check and recheck things many times over – sometimes to the extent where they are unable to get on with normal daily activities. Sufferers may have long and complex rituals which they feel compelled to carry out and if they deviate even marginally they feel an overpowering need to start again until they feel they have ‘got it right’
Sometimes these rituals are not physical but mental – such as counting in a particular way to ones self or repeating a certain group of words. People can become so preoccupied with these activities that they are unable to interact with the outside world. It is not unheard of for rituals to last for many hours.
Associated with these urges to do or think something is a related condition where thoughts, words or ideas spring unbidden into a person’s mind. These sometimes take the form of words or phrases and are usually unpleasant or shocking to the person. They are often obscene or blasphemous. Similarly people often have internal ruminations which they cannot get out of their minds or doubts which cannot be resolved – it is these which often lead to the checking behaviour mentioned above.
More worryingly some people get obsessional impulses – to harm themselves, or more alarmingly still, others. They never actually act on these impulses but the thought that they might fills them with terror.
People who have these symptoms often think they are going mad – particularly when thoughts come into their mind unbidden. They are not. This condition is called Obsessive Compulsive Disorder (OCD) and it is treatable. Sometimes it exists on its own and sometimes it is associated with depression. Which comes first varies from person to person but it is certainly understandable if someone with this condition becomes depressed because it is extremely distressing.
There are a number of different ways to treat this condition. Your GP will be able to put you in touch with appropriate specialist help if necessary. The mainstay of medical treatment is antidepressant medication. Many antidepressants have a specific action on OCD but usually have to be given in a therapeutic dose for some weeks. If this alone is not successful tranquillising drugs can be added to reduce anxiety levels.
If rituals are a major component of the illness a psychological technique called behaviour therapy can help. One well-known example of this is to wear a rubber band around the wrist and to ‘twang’ it sharply whenever the urge to act out a ritual comes upon one. This distracts the mind and if repeated can change behaviour over a period of time. A similar approach to obsessive thoughts called ‘thought-blocking’ is also practised but with less impressive results.
Psychotherapy is usually not helpful if it goes into matters too deeply because the natural tendency of the sufferer to ruminate can be made worse, but support from a therapist can tide people over particularly bad patches.
In extremely rare and unremitting cases, where all treatments have been tried for sufficient time and at high enough dose and the condition has been causing extreme distress to the sufferer for years, brain surgery can be used. It must be emphasised, however, that this is very much a last resort and is only ever performed with the full consent of the sufferer and at very specialised centres.
In summary then, Obsessive Compulsive Disorder is a well-recognised condition, which causes much distress to sufferers. It is associated with depression and it can be treated with medication and/or psychological methods.