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Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive behaviour.
An obsession is an unwanted, unpleasant thought, image or urge that repeatedly enters a person’s mind, causing them anxiety. The word “obsession” sometimes describes something enjoyable, but in OCD the obsession is unpleasant and frightening.
A compulsion is something, such as a behaviour (often repeated) or thought process that someone feels they need to carry out to prevent an obsession coming true.
People with OCD are often feel too ashamed or embarrassed about their symptoms to talk to their GP about it. They may also try to hide or disguise their symptoms from family and friends. However, if you have OCD, there is nothing to feel ashamed or embarrassed about. OCD is a long-term health condition, like diabetes or asthma and it is not your fault you have it.
If you have OCD, seeking help is the most important thing you can do. Left untreated, it is unlikely that your OCD symptoms will improve, and they may get worse. With treatment, the outlook for OCD is good and many people will achieve a complete cure, or at least reduce symptoms enough to be able to enjoy a good quality of life.
How common is OCD?
It is difficult to know exactly how many people have OCD, as many do not tell their GP about it because they feel ashamed or embarrassed.
In Western countries, OCD is the fourth most common mental health condition. It can affect men, women and children. In the UK, it is thought that about 12 out of every 1,000 people are affected by OCD.
Perinatal and postnatal OCD
It is thought that about 2-4% of women develop obsessive compulsive disorder (OCD) during pregnancy or after giving birth.
For more information about this type of OCD, see the Maternal OCD website
OCD symptoms
OCD symptoms can range from mild to severe. Some people with OCD may only spend an hour or so a day engaged in obsessive-compulsive thinking and behaviour. For others, the condition can completely take over their life.
Although OCD affects individuals differently, most people with the condition fall into a set pattern of thoughts and behaviours.
The pattern has four main steps:
- Obsessive thoughts – your mind is overwhelmed by a constant obsessive fear or concern.
- Anxiety – this obsession or fear provokes a feeling of intense anxiety and distress.
- Compulsive behaviours – you begin to carry out behaviours to reduce your anxiety and distress, which as time goes on you feel you have to do to stop the fear becoming real.
- Temporary relief – the compulsive behaviour brings temporary relief from anxiety but the obsession and anxiety soon return, causing the cycle to begin again.
Obsessive thoughts
Almost everyone has unpleasant or unwanted thoughts at some point in their life, such as a nagging worry that their job may not be secure, or a brief suspicion their partner has been unfaithful. Most people are able to put these types of thoughts and concerns into context, and they can carry on with their day-to-day life. They do not repeatedly think about worries they know are probably not true or probably not going to happen.
However, if you have a persistent, unwanted and unpleasant thought that dominates your thinking to the extent it interrupts other thoughts, you may have developed 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, even though this type of behaviour disgusts you.
- Fear of harming yourself or others by mistake or accident – for example, fear you may set the house on fire by accidentally 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.
- Fear of committing an act that would seriously offend your religious beliefs.
Compulsive behaviour
Compulsions arise as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not realistically connected at all.
For example, a person who fears becoming contaminated with dirt and germs may wash their hands 50 times a day, or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to “neutralise” the thought of harm. This latter type of compulsive behaviour is particularly common in children with OCD.
Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on their compulsion.
Some common types of compulsive behaviour that affect people with OCD include:
- cleaning
- hand-washing
- checking (such as checking doors are locked, or that the gas or a tap is off)
- counting (often to specific numbers, or types of number – e.g. odd or even)
- ordering and arranging
- hoarding
- asking for reassurance
- needing to confess
- repeating words silently
- prolonged thoughts about the same subject
- “neutralising” thoughts (to counter the obsessive thoughts)
What causes OCD?
Despite much research being carried out into obsessive compulsive disorder (OCD), the exact cause of the condition has not yet been identified. However, in certain individuals OCD is thought to be triggered by a combination of genetic, neurological, behavioural and environmental factors.
Life events can be a factor that contributes to the development or the severity of OCD. An important life event such as a bereavement or family break-up may trigger OCD in people who already have a tendency to develop the condition (for example, due to genetic factors). A life event can also affect the course of your condition. For example, the death of a loved one may trigger a fear that someone in your family will be harmed.
Stress, which can also be caused by life events, seems to make the symptoms of OCD worse. However, stress does not cause OCD on its own.
OCD is not thought to be linked to upbringing, but certain factors such as having overprotective parents could increase your chances of developing OCD.
Sometimes it can be unhelpful if a family member of someone with OCD intervenes. For example, a person with OCD may ask a member of their family for constant reassurance about one of their fears, such as whether they have locked the door. If the family member continually reassures them that they have done something in order to make them feel better, it may prevent them seeking the help and treatment they need.
Treating OCD
If you are diagnosed with OCD, your treatment plan will depend on how much the condition affects your ability to function. As OCD develops, the unwelcome and obsessive fears that can be overwhelming vary from person to person. This is also the case for the compulsive behaviour people use to try to control their fears.
How much impact OCD has on a person’s life depends on:
- the amount of time spent on a compulsive behaviour or ritual
- the intensity of the behaviour
- how much of it happens in the mind, rather than in actions
Your treatment is likely to involve psychological therapy to change your behaviours and reduce your anxiety, and medication to help control your symptoms.
Psychological Therapy
OCD is usually treated with cognitive behavioural therapy (CBT). CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. It would involve a technique called graded exposure and response prevention. A number of situations that cause you anxiety would be identified. These are placed in order from the situations that cause you the most to the least anxiety.
Together with the therapist you would then identify tasks (‘exposure tasks’) that will put you into the situations that cause anxiety, but at a level you can cope with. You need to do the ‘exposure tasks’ without carrying out your anxiety-relieving compulsions (the actions you usually take to help you cope with the situation).
Although this sounds frightening, people with OCD find that when they confront their anxiety without carrying out their compulsion, the anxiety disappears completely in one to two hours.
The same exposure task should be repeated two to three times a day. Each time, the anxiety is likely to be less and last for a shorter period of time. Once you have conquered one exposure task, you can move onto a more difficult task, until you have overcome all of the situations that make you anxious.
Medication
There are also medications that can help with the treatment of OCD, and these may be recommended if your OCD is more severe and causing more problems for you day to day. The medications would need to be prescribed and you should discuss this first with your GP who can advise you of the different types available.