Lifelines: Dr Nick Stafford on Obessive Compulsive Disorder

JACK Nicholson's Oscar-winning performance in the 1997 film As Good as It Gets demonstrates many of the problems someone with Obsessive Compulsive Disorder (OCD) suffers.

His character knows his obsessions or compulsions are excessive and unreasonable. He struggles to help himself even though they cause distress, are time-consuming and interfere with his daily occupational and social life.

He is difficult to be around but, despite appearances, always tries to be "a better man". Obsessions are unpleasant thought processes associated with a feeling that something is not right.

The person recognises these thoughts and feelings are inappropriate and will try to suppress them. Compulsions are behaviours or mental acts performed to reduce the obsessions. The compulsive act may be related to the obsession, such as checking behaviours so that the house appears safely locked, but can also be irrelevant, for example by touching one's glasses 100 times before every car journey so the journey will be safe.

DETAILED STUDY

My son is studying medicine and is hard working but over the last year has become quite isolated. He has a ritual of trying to learn every single word and image in every detail from his text books.

He knows he must succeed in his exams; he must also compete against other students. This anxiety may have led him to believe his work must be perfect in every way. He believes his learning technique will give him a library-like brain in exams. In reality, his technique is inefficient. He realises this and tries harder. Counselling in the form of Cognitive Behavioural Therapy (CBT) will help him manage his thoughts by exploring how his fears drive his behaviour. It will allow him to face situations like exams without performing the compulsion of excessive revision.

OBSESSIVE PARTNER

My wife has had OCD for years. Counselling has not helped. She performs checking rituals before leaving for work and this can cause her to be late. If she doesn't do the checking she fears something terrible will happen.

Sometimes talking therapies alone are not enough; many sufferers will need medication, and some professionals believe combining both medication and counselling is the best approach.

The newer antidepressants known as the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and citalopram, if used at higher doses, are proven to be effective in OCD. One of the older antidepressants, clomipramine, is also effective. Sometimes a combination may be needed. And in very resistant cases an antipsychotic, such as quetiapine, may be required, though these cases are rare.

NATURAL THERAPY

My daughter has been diagnosed with OCD but she does not feel comfortable with taking medication.She is asking if there are any complementary therapies that have evidence in helping with OCD.

Mindfulness meditation comes from Buddhist practice and is being developed successfully for a range of psychiatric disorders. It is a practice of becoming increasingly aware of the connections between one's own thoughts, feelings and physical body. Kundalini yoga has been shown to improve the symptoms. St John's Wort, too, has limited evidence for use in OCD. Hypnotherapy is commonly used with NLP to 'collapse' obsessions and compulsions. However, there are no formal scientific trials comparing hypnotherapy against other treatments.

Dr Nick Stafford is a consultant psychiatrist in the Midlands and vice chair of MDF the Bipolar Organisation