Overview

Obsessive compulsive disorder (OCD) is a 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 from as early as 6 years old, but it often begins around puberty and 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, and intrusive, unwanted and unpleasant thoughts, images or urges. These can cause anxiety and lead to repetitive behaviours.

If you keep getting these thoughts and they have an effect on your daily life, speak to your GP or health visitor. They can support you or refer you to a specialist mental health team if you need it.

Getting help for obsessive compulsive disorder (OCD)

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

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

There are 2 main ways to get help:

• refer yourself directly to an NHS talking therapies service 
• see a GP – they'll ask about your symptoms and can refer you to a local talking therapies service if necessary

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)

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

The main treatments are:

• talking therapy – usually a type of cognitive behavioural therapy (CBT) which 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 up to 12 weeks 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
• a combination of an SSRI and CBT
• an antidepressant called clomipramine

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 part, including:

• family history – you're more likely to develop OCD if a family member has it. It may be learned behaviour, or 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 been bullied, abused or neglected, 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,also people 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
• TOP UK
• OCD Support | HealthUnlocked

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

The compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

Most people with OCD experience both obsessive thoughts and compulsions, but one may be less obvious than the other.

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.

These thoughts are classed as OCD if they cause you distress or have an impact on the quality of your life.

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 get 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:

• refer yourself directly to an NHS talking therapies service 
• see a GP – they can either prescribe suitable medicine or refer you to a local talking therapies service if necessary

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

• call 116 123 to talk to the Samaritans, or email: jo@samaritans.org for a reply within 24 hours
• contact NHS 111 Wales

Treatment