Obsessive compulsive disorder (OCD)
Obsessive Compulsive Disorder (OCD) is a mental disorder in which people experience recurring obsessive thoughts that evoke uncomfortable feelings, such as anxiety, fear, guilt or a feeling of disgust that people then react to by performing a compulsive behaviour. The problem is characterised by the person getting stuck in this vicious cycle of obsessive thoughts and compulsive behaviour, which can gradually start taking more time and energy. Thus, OCD can escalate and take over your life if nothing is done.
When people think of obsessive compulsive disorder, most people think of fear of germs and infections, where people repeatedly wash their hands, or fear of causing harm where people repeatedly check locks and plugs. However, obsessive compulsive disorder can be about anything. For example, whether one is a good person ("What if I hurt my girlfriend when I said this?") or doubts about one's feelings for another person or the quality of the relationship ("What if I'm not in love enough?" or "What if she doesn't like me enough?”). Obsession can also be connected to doubts about sexuality or sexual experience and doubts about whether one actually exists or what will happen after death. In addition, anxiety associated with fear of causing harm to other people is also common as well as repeated unwelcome obsessive thoughts about incest, child abuse and sexual violence.
Most commonly, those diagnosed with obsessive compulsive disorder have many different manifestations and themes in their obsessive thoughts. It is also common for the manifestation to change over time.
How does OCD manifest itself?
Obsessive thoughts can be either verbal thoughts (e.g. "This might be contaminated." or "What if I am a paedophile?"), an image (e.g. imagining stabbing a loved one with a knife or imagining violent scenes in one’s mind) or a motive (e.g. an urge to fix a picture that is out of alignment on the wall or an urge to touch something). People experience obsessive thoughts as unwelcome and intrusive and do not want to have these thoughts. These thoughts often revolve around what stands closest to them to and they experience as horrible thoughts, which causes them to become frightened of these thoughts. A common example of this is when a new parent gets obsessive thoughts about harming their child.
Obsessive thoughts always evoke an uncomfortable feeling, such as anxiety, fear, feeling of disgust or guilt. Sometimes the feeling is impenetrable and is best described as uneasiness or that "something is not as it should be" feeling.
Compulsive behaviour serves the purpose of getting rid of the obsessive thoughts and discomfort they cause and in some cases to prevent something bad from happening. Compulsive behaviour can be noticeable behaviour, such as washing your hands after touching a door handle or checking the front door to make sure it is locked. Compulsive behaviour can also be an invisible behaviour that occurs in the mind, such as repeatedly going over what one was saying to their girlfriend to make sure that they did not say something hurtful or to say some kind of prayer, mantra or comfort ("Nothing bad will happen." or "I've checked, it's fine."). People often feel it is necessary to perform the compulsive behaviour in a fixed manner, to do things in a certain order or to do things a certain amount of times before they can stop.
The vicious circle of obsessive compulsive disorder describes itself as something triggering an obsessive thought, such as seeing a knife, then up comes an obsessive thought "What if I stab my husband?" that arouses fear. Then, the person responds with compulsive behaviour, such as removing the knife or reassuring themselves ("No, I would never do that, I love my husband!"). In doing so, the person in question experiences relief, but only temporarily. Within a short while, another obsessive thought arises ("What if the chicken is infected with salmonella?") accompanied by a feeling of disgust and a need to perform a compulsive behaviour.
When an obsessive compulsive disorder becomes severe, obsessive thoughts and compulsive behaviour take up a lot of time and sometimes the whole day. When symptoms are milder, the obsessive thoughts and the compulsive behaviour is sometimes more dependent on the situation and takes up less time.
Although many may recognise the feeling of wanting to wash their hands after touching something or checking their locks a few times or even getting obsessed with something for a while, there is a big difference between that and having an obsessive compulsive disorder. The person with obsessive compulsive thoughts feels uncomfortable getting these obsessive thoughts and, although the person in question experiences relief after performing the compulsive behaviour, they do not feel well. Thus, the person who likes to keep their surroundings clean and who experiences pleasure after cleaning their apartment does not have an obsessive compulsive disorder. People who suffer from an obsessive compulsive disorder do not experience pleasure after performing a compulsion, they never feel like they are done.
Resources in Iceland
The OCD team at Kvíðameðferðarstöðin
At Kvíðameðferðarstöðin (KMS), a team of psychologists operates who have been trained in cognitive behavioural therapy/exposure therapy (exposure and response prevention) for obsessive compulsive disorders. They perform both individual therapy and periodical therapy (the Bergenska 4 day treatment).
The Bergenska four day treatment
At KMS, the four day Bergenska treatment is offered, which is a four day periodical treatment. This is a new therapy approach based on intensively experienced and proven methods of cognitive behavioural therapy/exposure therapy for obsessive compulsive disorder. In this therapy, participants will learn the techniques and methods to deal with the problem as well as receiving good support while practising exposure exercises. In each treatment group, there are six people with OCD who are assisted by six specially trained psychologists. It is, therefore, really individual therapy that takes place in a group environment. Participants receive a follow up by telephone interviews and a follow up interview for a year after therapy.
Health care clinics: When people seek help from professionals, the first point of contact is usually the health care clinic. The first step is to make an appointment with a doctor who can refer you to the appropriate person if the problem cannot be resolved. heilsugaeslan.is
Mental health ward emergency reception: If the situation is acute or severe, do not hesitate to reach out to the mental health ward emergency reception at Landspítali, where people with urgent mental health issues can go without having an appointment. The psychiatric ward emergency reception is located on the 1st floor of the psychiatric building at Hringbraut. The emergency reception is open from 12:00 to 19:00 on weekdays and from 13:00 to 17:00 at weekends and the telephone number is 543 4050. In case of an emergency outside these hours, you can reach out to the emergency department at Landspítali Fossvogur. https://www.landspitali.is/default.aspx?pageid=bad59938-e65f-11e7-a10b-005056be0005#panel-1fa820b3-e660-11e7-a10b-005056be0005-2
Psychologists' private offices: On the psychologist's website, you can search for psychologists who attend to a variety of problems, such as depression. http://sal.is/almenningur/gagnagrunnur-salfraedinga/
Psychiatrists' private offices: A number of psychiatrists conduct medical and conversational therapy for depression in their private clinics.
A more detailed list of resources in Iceland can be found here.
Text written by: Ólafía Sigurjónsdóttir, PhD psychologist, team manager of the obsessive compulsive disorder team of Kvíðameðferðarstöðin.