Obsessive compulsive disorder (OCD) and anxiety disorders could be considered a silent epidemic in mental health. These conditions are extremely common with the 2007 Australian National Survey of Mental Health and Wellbeing showing 12 month prevalence of 11.8 per cent and lifetime prevalence of 20 per cent1. Furthermore, people affected by these conditions often suffer in silence with significant delay before seeking help. Some of the more common anxiety disorders include generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia and specific phobia. OCD has been moved into its own category in DSM 5.
In the film, “As Good as it Gets”, Jack Nicholson portrays an individual living with OCD. OCD is characterised by obsessions and compulsions which typically take up significant amounts of time, cause distress and interfere with function. Obsessions are intrusive, unwanted and persistent thoughts, images and impulses with themes such as contamination and danger to self or others. Compulsions are repetitive ritualistic behaviours that the individual feels unable to resist and provide some relief from anxiety such as washing and checking.
OCD and anxiety disorders are very treatable conditions with a strong evidence base supporting cognitive behavioural therapy (CBT) involving exposure and response prevention (ERP) as the first line treatment. ERP works on the principle of systematic and graded exposure to the anxiety provoking obsession whilst not engaging in the compulsion, hence undoing the OCD connections. This is often combined with medication such as SSRIs eg sertraline, escitalopram and fluoxetine. A helpful guide to treatment by Lampe (2009) is included as Table 1 below2.
A review by Fineberg and Brown (2011) provides a suggested pathway for treatment-resistant OCD based on a review of the evidence at that time and is reproduced in Figure 1 below3.
Another recent development has been the increasing evidence base for Acceptance and Commitment Therapy (ACT) in Anxiety4. Whilst, Epworth Clinic Camberwell has had an ACT for anxiety program for some time, we have recently commenced an ACT for OCD program.
1. McEvoy PM, Grove R, Slade T (2011) Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Aust NZ J Psychiatry 45(11):957-67.
2. Lampe L (2009) How to treat: obsessive-compulsive disorder. Australian Doctor 9 October 2009.
3. Fineberg N, Brown A (2011) Pharmacotherapy for obsessive-compulsive disorder. Adv Psychiatr Treat 17:419-34.
4. Bluett EJ, Homan KJ, Morrison KL, Levin ME, Twohig MP (2014) Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. J Anxiety Disord 28:612–624.
Dr Terence Chong is an adult psychiatrist and psychogeriatrician with a special interest in the holistic treatment of OCD and anxiety disorders. He also has public appointments with the St Vincent’s and Royal Melbourne Hospitals and is a research fellow at the University of Melbourne.
ROOMS | Epworth Clinic, 888 Toorak Road, Camberwell VIC 3124
PH | 03 9805 4309 FAX | 03 980 54388
WEB | google.com/DrTerenceChongCamberwell