Original article: http://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/treatments/#.Vd9SZn0jnm4
If you are concerned that you have OCD, and you want to seek professional help, the first step would normally be to visit your GP.
Your GP can provide an assessment and diagnosis, and help you access appropriate treatment.
If you visit a doctor to talk about OCD, they are likely to ask you direct questions about possible symptoms. For example:
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
- Do your daily activities take a long time to finish?
- Are you concerned about putting things in a special order or do you find mess very upsetting?
- Do these issues trouble you?
- How are they affecting your everyday life?
A doctor will then consider your answers against a list of medical criteria in order to make a diagnosis. If you receive a diagnosis of OCD, it should also say how severe your OCD is; for example, if you have mild, moderate or severe OCD.
It can be extremely difficult to discuss your experiences with a doctor, particularly if you experience distressing thoughts about issues such as religion, sex or violence. However, it is important to try and talk as honestly as you can, so your GP can suggest the right type of help for you.
If you find it difficult talking about your OCD, you may find it useful to prepare beforehand. You could think about how you would answer the questions above and write down the answers to take with you. Then if you start to feel embarrassed or overwhelmed when you are with your GP, you can refer to your notes – or even hand them to the doctor.
What treatments are available?
Before you have any treatment, your doctor should discuss all your
treatment options with you, and your views and wishes should be taken
NICE’s ‘stepped’ model
If you access help on the NHS, your treatment should be in line with
NICE (National Institute for Health and Care Excellence) guidelines.
NICE recommends ‘stepped’ treatment for OCD. This means that you
should receive different types of treatment depending on how severe
your symptoms are and how you responded to any previous treatment.
The diagram below is adapted from NICE’s guidelines.
However, the treatments recommended in the NICE guidelines are not appropriate for everyone. There are a number of options available to treat OCD and different things work for different people. You may find that a combination of approaches is most helpful for you, and different approaches may help you at different times.
Cognitive behavioural therapy (CBT)
CBT techniques helped me to see the intrusive thoughts for what they are, and put them in their place. Cognitive behavioural therapy (CBT) is a talking treatment which aims to identify connections between your thoughts, feelings and behaviour. It aims to help you develop practical skills to manage any negative patterns of thinking or behaviour that may be causing you difficulties. It can be done one-to-one, or in a group. There is considerable evidence to suggest that this therapy is especially effective in dealing with OCD.
The behavioural element (also known as Exposure Response Prevention – ERP) is strongly recommended for treating OCD. ERP works by helping you to confront your obsessions and resist the urge to carry out compulsions. The aim is to help you feel less anxious about obsessive thoughts over time, and make you less likely to engage in compulsive behaviour. For example, if you fear that you will harm someone and avoid sharp objects as a result, you might build up to a therapy session where you hold a knife while sitting in a room with other people. This technique needs to be carefully managed to avoid causing distress and anxiety, so it is important that you understand the treatment fully and feel comfortable with your therapist.
“It’s hugely frustrating and exhausting trying to break out of patterns that you know aren’t helpful or healthy. It can feel hopeless. But by challenging the behaviours, thoughts or compulsion you can eventually achieve fresh change that seemed impossible.”
You are entitled to receive free CBT on the NHS, and your GP should be able to refer you to a local practitioner. However, waiting times for talking treatments on the NHS can be long. If you feel that you don’t want to wait or that you would like more support than is being offered, you may choose to see a therapist privately. The British Association for Behavioural and Cognitive Psychotherapies maintains a register of accredited CBT therapists.
Some people find drug treatment helpful for OCD, either alone or combined with talking treatments, such as cognitive behaviour therapy (CBT).
“I’ve been on meds for the last three years and my OCD is so much more controllable. Before taking any medication, it is important to read the patient information leaflet (that comes with the medicine) and discuss possible benefits and side effects with your doctor.”
The drugs prescribed most commonly are SSRI antidepressants, such as fluoxetine (Prozac), fluvoxamine (Faverin), paroxetine (Seroxat), citalopram (Cipramil) and sertraline (Lustral). These drugs are all recommended by NICE for the treatment of OCD. These drugs may have side effects, including nausea, headache, sleep disturbance, gastric upsets and increased anxiety. They may also cause sexual problems. The tricyclic antidepressant clomipramine (Anafranil) is also licensed for the treatment of obsessional states in adults. This should normally only be prescribed if an SSRI antidepressant has already been tried and not been effective. The side effects of clomipramine can include a dry mouth, blurred vision, constipation, drowsiness and dizziness.
If you are experiencing very severe anxiety as a result of OCD, you may be offered tranquillising drugs, such as diazepam (Valium). This type of medication should only be used for short periods of treatment because of the risk of addiction. The side effects of tranquillisers can include drowsiness, confusion, unsteadiness and nausea.
Beta-blockers are occasionally given to people to treat the immediate symptoms of severe anxiety. They don’t treat the anxiety itself, but act on the heart and blood pressure to reduce physical symptoms, such as palpitations. The beta-blocker most commonly used for anxiety is propranolol (Inderal). The main side effects include a slow heartbeat, diarrhoea and nausea, cold fingers, tiredness and sleep problems.
Neurosurgery for mental disorder
Neurosurgery (previously known as psychosurgery) is surgery on the brain. It is not recommended for treating OCD, but is very occasionally offered in severe cases, when other treatments have been unsuccessful. Neurosurgery is strictly regulated under the Mental Health Act, and can’t be given without consent.
Community mental health and social care
If your OCD is severe or complex, your GP may refer you to a community mental health team (CMHT). A CMHT is usually made up of range of professionals, such as psychiatrists, psychologists, social workers and occupational therapists. The team can offer medication, basic counselling or other mental health treatments like cognitive behaviour therapy (CBT). They should also be able to help with you with wider issues you have as a result of your OCD, such as difficulties around housing, benefits or everyday living. Even if you are not referred to a CMHT, or if you feel you are not receiving the support you need, you may be entitled to have a social care assessment to see if you are eligible for social care support.
Specialist OCD services
If you require more intensive support, it is recommended that you are referred to a specialist OCD service in your area. However, in reality, access to specialist services across the country is patchy and you may need to travel outside your local area.
If you feel you are not getting access to the treatment you require, you may find it useful to have an advocate. This is someone who can support you and speak up for you, so you can get the help you need. You can find an advocate by contacting your local Patient Advice and Liaison Service (PALS) via NHS Choices. Some local Minds also run advocacy services.