Overview

Obsessive compulsive disorder (OCD) is a common mental health condition in which a person has obsessive thoughts and compulsive behaviours.

OCD can affect men, women and children. Some people start having symptoms early, often around puberty, but it usually starts during early adulthood.

OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.

Symptoms of obsessive compulsive disorder (OCD)

If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours.

• An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.
• A compulsion is a repetitive behaviour or mental act that you feel you need to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought.

For example, someone with an obsessive fear of being burgled may feel they need to check all the windows and doors are locked several times before they can leave their house.

Women can sometimes have OCD during pregnancy or after their baby is born. Obsessions may include worrying about harming the baby or not sterilising feeding bottles properly. Compulsions could be things such as repeatedly checking the baby is breathing.

Getting help for obsessive compulsive disorder (OCD)

People with OCD are often reluctant to seek help because they feel ashamed or embarrassed.

But there's nothing to feel ashamed or embarrassed about. It's a health condition like any other. It does not mean you're "mad" and it's not your fault you have it.

There are 2 main ways to get help:

• visit your GP – your GP will ask about your symptoms and can refer you to a local psychological therapy service if necessary
• refer yourself directly to a psychological therapy service if that is possible in your area

If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they seek help.

OCD is unlikely to get better without proper treatment and support.

Treatments for obsessive compulsive disorder (OCD)

Treatments for obsessive compulsive disorder (OCD)

There are some effective treatments for OCD that can help reduce the impact the condition has on your life.

The main treatments are:

• psychological therapy – usually a type of cognitive behavioural therapy (CBT) that helps you face your fears and obsessive thoughts without "putting them right" with compulsions
• medicine – usually a type of antidepressant medicine called selective serotonin reuptake inhibitors (SSRIs) that can help by altering the balance of chemicals in your brain

CBT will usually have an effect quite quickly. It can take several months before you notice the effects of treatment with SSRIs, but most people will eventually benefit.

If these treatments do not help, you may be offered an alternative SSRI or be given a combination of an SSRI and CBT.

Some people may be referred to a specialist mental health service for further treatment.

Causes of obsessive compulsive disorder (OCD)

It's not clear exactly what causes OCD. A number of different factors may play a role in the condition.

These include:

• family history – you're more likely to develop OCD if a family member has it, possibly because of your genes
• differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
• life events – OCD may be more common in people who have experienced bullying, abuse or neglect, and it sometimes starts after an important life event, such as childbirth or a bereavement
• personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, as may those who are generally quite anxious or have a very strong sense of responsibility for themselves and others

Support groups

Living with OCD can be difficult. In addition to getting medical help, you might find it helps to contact a support group or other people with OCD for information and advice.

The following sites may be useful sources of support:

• OCD Action
• OCD-UK

OCD Action and OCD-UK can also let you know about any local support groups in your area.

Symptoms

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

OCD has 3 main elements:

• obsessions – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind
• emotions – the obsession causes a feeling of intense anxiety or distress
• compulsions – repetitive behaviours or mental acts that a person with OCD feels driven to perform as a result of the anxiety and distress caused by the obsession

It's possible to just have obsessive thoughts or just have compulsions, but most people with OCD will experience both.

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point, such as thinking they may have forgotten to lock the door of the house, or even sudden unwelcome violent or offensive mental images.

But if you have a persistent, unpleasant thought that dominates your thinking to the extent it interrupts other thoughts, you may have an obsession.

Some common obsessions that affect people with OCD include:

• fear of deliberately harming yourself or others – for example, fear you may attack someone else, such as your children
• fear of harming yourself or others by mistake – for example, fear you may set the house on fire by leaving the cooker on
• fear of contamination by disease, infection or an unpleasant substance
• a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way

You may have obsessive thoughts of a violent or sexual nature that you find repulsive or frightening. But they're just thoughts and having them does not mean you'll act on them.

Compulsive behaviour

Compulsions arise as a way of trying to reduce or prevent anxiety caused by the obsessive thought, although in reality this behaviour is either excessive or not realistically connected.

For example, a person who fears contamination with germs may wash their hands repeatedly, or someone with a fear of harming their family may have the urge to repeat an action multiple times to "neutralise" the thought.

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on it and feel they need to do it "just in case".

Common types of compulsive behaviour in people with OCD include:

• cleaning and hand washing
• checking – such as checking doors are locked or that the gas is off
• counting
• ordering and arranging
• hoarding
• asking for reassurance
• repeating words in their head
• thinking "neutralising" thoughts to counter the obsessive thoughts
• avoiding places and situations that could trigger obsessive thoughts

Not all compulsive behaviours will be obvious to other people.

Getting help

It's important to get help if you think you have OCD and it's having a significant impact on your life.

If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they seek help.

OCD is unlikely to get better on its own, but treatment and support is available to help you manage your symptoms and have a better quality of life.

There are 2 main ways to get help:

• visit your GP – your GP will ask about your symptoms and can refer you to a local psychological therapy service if necessary
• refer yourself directly to a psychological therapy service - if your local services accept self-referrals

Contact your GP or care team immediately if you ever feel you can't go on.

Treatment