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Obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) is a condition in which you have obsessive thoughts and compulsive behaviour (things that you feel compelled to do). It’s thought that OCD affects up to three in 100 people.

OCD is made up of two features: obsessions and compulsions.

If you have OCD, you will regularly experience obsessive thoughts that can make you feel anxious. You’re also likely to have compulsions. These are behaviours, thoughts or acts that you feel compelled to do to counteract your obsessions and reduce the anxiety they cause. Even though you may understand that these compulsions don’t make sense, you still feel the need to carry them out to ease the distress associated with obsessive thoughts.

It’s important to remember that everyone has worrying thoughts occasionally. For example, you may worry about whether you’ve left the oven on when you go out. These thoughts usually appear briefly, but go away again easily and don’t cause any further problems. With OCD, you will have repetitive, worrying thoughts. These often prevent you from thinking about anything else. As a way to combat these obsessive thoughts, you will feel compelled to carry out repetitive behaviours.

OCD mostly affects young adults under the age of 25, although it can occur at any age.

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Details

  • Symptoms Symptoms of OCD

    If you have OCD, you will have your own experience of which obsessions and compulsions affect you. These will be different to other people who also have OCD.

    Obsessions are often influenced by your personal situation. For example, if you’re very religious, you may have thoughts against religion. There are some common obsessions that many people with OCD experience. Some of the main obsession themes are described below.

    • Contamination obsessions – fearing dirt and germs.
    • Aggressive obsessions – thinking about doing harm to yourself or others.
    • Sexual obsessions – having upsetting thoughts, such as a fear of exposing yourself at work.
    • Health-related obsessions – thinking that you have a serious illness, without having any of the symptoms.
    • Safety obsessions – such as feeling that you are responsible for protecting other people.
    • Religious or moral obsessions – having religious or anti-religious thoughts.

    You may feel the need to carry out a compulsive response whenever you have an obsessive thought. Examples are listed below.

    • Excessive hand washing.
    • Checking something again and again, such as making sure a door is locked.
    • Repeated actions such as touching each light switch in the house a certain number of times.
    • Praying or saying a particular phrase over and over in your mind.
    • Ordering or arranging items in a certain way.
    • Hoarding or collecting things that have no use.

    Your obsessions and compulsions can take up a lot of your time and get in the way of doing everyday tasks. You may also go to great lengths to avoid situations that could trigger your obsessive thoughts.

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  • Diagnosis Diagnosis of OCD

    If you think you have OCD, and it’s affecting how you live your life, see your GP. He or she will ask about your symptoms. Your GP may also ask you about your medical history. You may feel embarrassed about your symptoms and talking about them but try not to. Remember that your GP will be familiar with treating other people who have similar conditions.

    It’s important to be open and honest with your GP about any obsessions and compulsions you have. This will help him or her to make the right diagnosis and recommend the best type of treatment for you. Your GP may refer you to another healthcare professional, who specialises in mental health, for further treatment.

  • Treatment Treatment of OCD

    Self-help

    There are a number of things that you may wish to try to help manage your symptoms. These can include the following.

    • You may find it useful to attend a self-help group. Here you will be able to share your feelings and experiences with other people who are also affected by OCD. You can get details about self-help groups from charities that support people with OCD. Your GP may also be able to give you information about them. You could try using self-help websites, computer programs and books to help manage your symptoms.
    • Learning a relaxation technique may help you to deal with the anxiety associated with your symptoms. This might include breathing exercises or exercises designed to help you relax your muscles.
    • Taking part in regular physical activity. This could help to reduce your anxiety. Aim to do up to 30 minutes of physical activity each day.
    • Don’t use illegal drugs or alcohol to alleviate anxiety or to push away your obsessive thoughts. Using these can have serious consequences for your physical and mental health.

    Talking therapies

    You may be offered cognitive behavioural therapy (CBT) to help you manage your symptoms. CBT is a type of talking therapy that can help you to change how you react to your thoughts. If your symptoms are mild, you may be offered a short course of individual CBT. This could be either face to face or by telephone, or group sessions of CBT. This will usually be up to 10 hours with a therapist. If your symptoms are having a more serious impact on your life, you may be offered more intensive sessions of CBT.

    One of the main forms of CBT is called exposure and response prevention (ERP). This is used as a way to stop your obsessions and compulsions from strengthening each other. ERP works on the theory that if you’re in a stressful situation for long enough, you will gradually get used to it and your anxiety will go away. In ERP, your therapist will help you to gradually face your fears (exposure). He or she will encourage you to try to stop carrying out your usual compulsions (response prevention) and wait for your anxiety to go away.

    Your therapist is likely to ask you to practise this daily. Therefore, you will need to feel able to do so without him or her always being there to guide you. You may feel anxious about not carrying out your usual compulsions but your therapist will manage your treatment to try to prevent this. If you have any questions about what will be involved, ask your therapist or GP. It’s important to understand what will happen in your therapy before you start the treatment.

    Medicines

    You may be offered medicines if you have more severe OCD, or if your symptoms are mild but don't improve with CBT. If your symptoms don’t improve with CBT your doctor may prescribe you an antidepressant medicine, such as sertraline. These medicines can help to ease symptoms of OCD even if you aren’t depressed.

    They work by increasing the levels of serotonin in your brain. You may experience some side-effects while taking these medicines, such as high blood pressure and feelings of aggression. Your doctor will advise you to have regular check-ups in the first few weeks of treatment to monitor any side-effects that you may have.

    If these medicines don’t work, you may be offered another type of antidepressant medicine called clomipramine to help reduce your symptoms. Side-effects of this medicine can include feeling restless, high blood pressure and diarrhoea.

    You may find that a combination of CBT and one of these medicines helps to make your OCD easier to cope with.

    If your OCD is very severe, you may be offered support from a team of healthcare professionals who specialise in mental health. If you’re extremely anxious or if your OCD prevents you from carrying out your daily activities, you may need to go into hospital for further treatment.

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  • Causes Causes of OCD

    It isn’t fully understood what causes OCD. However, it’s likely that a number of factors are involved in its development.

    • OCD may run in families. If one of your parents showed signs of OCD, it’s possible that you may develop it too.
    • A stressful or life changing event, such as starting a new job, could trigger OCD.
    • An imbalance in a chemical called serotonin in your brain could play a role in the development of the condition.
    • Certain personality traits, such as being especially neat, may be linked to the development of OCD.
  • Living with someone who has OCD Living with someone who has OCD

    Living with someone who has OCD can be difficult. The following ideas may help you support someone you know with OCD.

    • Learning more about OCD may help you understand the person you’re supporting.
    • You may find it helpful to accept the obsessions and compulsions that the person has, but without encouraging them. For example, if the person has to clean the bathroom before they can use it there is no need for you to do this as well. Going along with someone’s compulsions can be disruptive and won’t always help his or her anxiety.
    • Where possible, try to support the person if he or she is using a self-help programme. If there are group sessions, you may be able to attend some of these.
    • Encourage the person to seek help from his or her GP or an organisation that can help with mental health issues.
    • You may find it helpful to talk to other people who are in a similar situation to you. You can find details about self-help groups from charities that support people with OCD. Your GP may also be able to give you information about these.
  • FAQs FAQs

    Does OCD occur on its own or is it always accompanied by other mental health problems?

    Answer

    OCD does occur on its own, but it can be associated with other mental health conditions such as depression and anxiety.

    Explanation

    You may have increased anxiety when you have OCD because the condition can cause you to have unwanted and upsetting thoughts. OCD can also interfere with work and family life. If your OCD becomes severe, it can prevent you from doing things that you would like to. You may find it more difficult to leave the house, have relationships or carry out your day-to-day activities.

    If you feel anxious, you could begin to feel depressed. You may find that your obsessions get worse when you’re feeling depressed.

    However, there are many treatments that can help control your symptoms. In particular, talking therapies such as cognitive behavioural therapy (CBT) can help to relieve your anxiety. You may be offered antidepressant medicine if you have more severe OCD, or if your symptoms are mild but don't improve with CBT. These can help to reduce your symptoms even if you aren’t feeling depressed. Speak to your GP if you would like to know more about your treatment options.

    Do the medicines that can help to control OCD have any side-effects?

    Answer

    Yes, the medicines that are often prescribed to help people with OCD can have side-effects.

    Explanation

    A type of antidepressant medicine called selective serotonin re-uptake inhibitors, such as sertraline, is often prescribed to control OCD symptoms. You may find you get side-effects such as:

    • high blood pressure
    • an increased heart rate
    • memory loss (amnesia)
    • feelings of aggression

    Your medicine can take up to 12 weeks to start working. Your GP will advise you to have regular check-ups in the first few weeks of treatment to monitor any side-effects that you may have.

    You may be offered a different medicine called clomipramine. This may cause side-effects that include:

    • dry mouth
    • blurred vision
    • constipation
    • dizziness
    • diarrhoea
    • high blood pressure

    It's important that you don't suddenly stop taking your medicine without speaking to your GP. If you stop or forget to take it, you may get withdrawal symptoms. These can include sweating, sleep disturbances and headaches. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    How will my GP know if I have obsessive-compulsive disorder (OCD)?

    Answer

    Your GP will ask you some questions about your symptoms and how they are affecting your everyday life. From your answers, he or she will be able to make a diagnosis. Depending on your results, your GP will then discuss your treatment options with you.

    Explanation

    Your GP will ask you direct and specific questions about your daily life. This will help him or her to find out whether or not you have OCD. Typical questions are listed below.

    • Do you wash or clean a lot?
    • Do you check things a lot?
    • Is there any thought that keeps bothering you that you would like to get rid of but can’t?
    • Do your daily activities take a long time to finish?

    At first, you may feel embarrassed to talk about your symptoms, or ashamed about admitting to obsessive thoughts and compulsive actions. Try to remember that your GP will be familiar with people who have similar conditions so there is no need to feel uncomfortable. It’s important that you’re open about how these are affecting your life so that you can be treated effectively.

    Is body dysmorphic disorder the same as OCD?

    Answer

    Body dysmorphic disorder (BDD) and OCD are separate conditions. However, they do have some similarities.

    Explanation

    BDD is a condition in which you spend a lot of time being concerned about how you look. If you have BDD, you will usually be worried that you have one or more physical flaw. Most of us worry about our appearance at some time. However, if you have BDD, your preoccupation with your appearance can make you feel distressed and may affect how you live your day-to-day life.

    Much like OCD, if you have BDD, you may feel that you need to repeat certain acts. These may include frequently checking how you look or asking for reassurance about your appearance. Other examples include repeatedly styling your hair or picking your skin to make it smooth. If you have BDD, you may feel that you can't go out in public unless you have hidden your 'flaws' with make-up or clothing.

    The treatment for these conditions is very similar. You will usually be offered cognitive behavioural therapy (CBT). If this doesn't help, your GP may prescribe medicines to help control your symptoms.

    If you think you have symptoms of either condition, speak to your GP for advice.

  • Resources Resources

    Further information

    Sources

    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:994 ̶ 5
    • Understanding obsessive compulsive disorder. Mind. www.mind.org.uk, published 2011.
    • Obsessive-compulsive disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2013
    • Obsessive-compulsive disorder (OCD). Mind. www.mind.org.uk, accessed 24 October 2013
    • Obsessive-compulsive disorder. Core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder. National Institute for Health and Care Excellence (NICE), 2005. www.nice.org.uk
    • Obsessive-compulsive disorder. Medscape. www.emedicine.medscape.com, published 23 September 2013
    • Obsessive Compulsive Disorder: key facts. Royal College of Psychiatrists. www.rcpsych.ac.uk, published November 2012
    • Physical activity guidelines for adults (aged 19 ̶ 64 years). Department of Health, 2011. www.gov.uk
    • Physical activity and mental health. The Royal College of Psychiatrists. www.rcpsych.ac.uk, published November 2012
    • Understanding the mental health effects of street drugs. Mind. www.mind.org.uk, accessed 7 February 2014
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 20 January 2014 (online version)
    • Body dysmorphic disorder. Mind. www.mind.org.uk, accessed 24 October 2013
    • Understanding depression. Mind. www.mind.org.uk, published 2012
    • Obsessive-compulsive disorder. Royal College of Psychiatrists. www.rcpsych.ac.uk, published August 2009 
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