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Obsessive compulsive disorder (OCD)

Expert reviewer, Dr Pravir Sharma, Consultant Psychiatrist
Next review due February 2025

Obsessive-compulsive disorder (OCD) is a mental health condition where you have obsessive, intrusive thoughts or compulsive behaviours (things you feel you must do) or both. People of all ages can get OCD, including children.

OCD can be very distressing and can interfere with your day-to-day life. Treatments, including cognitive behavioural therapy and antidepressant medicines, can often help.

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About OCD

OCD has two main features – obsessions and compulsions.

  • Obsessions are unwanted thoughts, images or urges that keep coming into your mind over and over again. Everyone has worrying thoughts occasionally, but they usually appear briefly then another thought comes along to take their place. If you have OCD, you’ll have repetitive, worrying thoughts, which can stop you from thinking about anything else.
  • Compulsions are repeated behaviours or mental acts that you feel you need to do to get rid of or block the obsessive thoughts. They can be physical acts, which other people could notice (for example, you keep checking that doors are locked or wash your hands repeatedly). Or they may be mental acts, which people won’t see (such as repeating a certain phrase in your head).

If you have OCD, you may have either of these features but it’s common to have both. They may cause you a lot of anxiety and distress. For more information about obsessions and compulsions, see our section on symptoms.

OCD is quite common – it affects about one in 50 people in the UK. It usually starts in your teens or early twenties, but you can get it at any age.

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Causes of OCD

  • OCD may run in families. If one of your parents or a brother or sister has OCD, it’s possible that you may develop it too.
  • People who have experienced abuse or neglect as a child are more likely to develop OCD.
  • Traumatic life events, social isolation or bullying could trigger OCD or make it worse.
  • A stressful event or a major change in your life may bring on OCD. This could be anything from going through puberty to taking on a new job.
  • OCD can develop during pregnancy. There are lots of things that might cause this. For example, hormones may be involved and OCD can run in families.
  • There may be differences in the brain in people with OCD. An imbalance in a chemical called serotonin in your brain could play a role. And brain scans have shown some overactive areas in people with OCD.
  • Certain personality traits – for example, being very neat – may mean you’re more likely to get OCD.
  • OCD may develop after you’ve had certain infections – for example, streptococcal infection.

If you have OCD, you probably won’t know what caused it. What’s important is that you seek treatment to help you manage your symptoms.

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Symptoms of OCD

Your symptoms may be mild and not affect you very much or they may be more severe. Below are some common obsessions and compulsions. If you have OCD, you’ll have your own experience of which affect you. Your obsessions and compulsions may be repetitive, unpleasant and take up a lot of your time, They can get in the way of everyday life too. Many people with OCD also have another related mental health condition or problem, such as depression or anxiety.

Common obsessions include:

  • fear of contamination from dirt, germs and viruses
  • fear of coming to harm
  • aggressive obsessions — thinking about doing harm to yourself or others
  • excessive concern with how things are arranged — needing them to be in order or symmetrical
  • superstitions such as a fear of ‘bad’ numbers
  • sexual obsessions — you may have unwanted or aggressive sexual thoughts

Common compulsions include:

  • repeatedly checking things such as locks, light switching, the oven
  • repeatedly cleaning – for example, washing your hands or body or things around you
  • arranging or touching objects in a particular way
  • hoarding or collecting things that have no use
  • mental compulsions such as having to repeat words or prayers in a set order or manner

In children and younger people, obsessive thoughts are more likely to include magical or superstitious thinking – for example, ‘I must close that door, or my parents will come to harm’. For young people, compulsive rituals almost always involve members of the family.

If you have these symptoms and they’re distressing and interfering with your life, contact your GP. Or you can refer yourself to a therapist on the NHS, without going through your GP. Look online for IAPT (improving access to psychological therapies) services near you.

Diagnosis of OCD

If you think you have OCD and it’s affecting how you live your life, see your GP or look online for your local IAPT (improving access to psychological therapies) services. They’ll ask you lots of questions related to OCD to help make a diagnosis. These include how your OCD affects you personally and how it affects your day-to-day life. Your GP or therapist may also ask you about your family and your general health.

It can be hard to talk about your symptoms. But it’s important to be open and honest with your GP or therapist about any obsessions and compulsions you have. This will help them make the right diagnosis and recommend the best type of treatment for you. Your GP may refer you to a healthcare professional who specialises in mental health for more treatment.

Self-help for OCD

Here are some things you can try to help manage your symptoms and support your physical and mental wellbeing.

  • Talk about your OCD with someone you trust. You could show them some information you’ve read online about OCD to help them understand the condition. Or you could write down how you feel and what you experience to share with someone close to you.
  • A self-help group (peer support) may be a useful source of support. You’ll be able to share your feelings and experiences with other people affected by OCD.
  • Self-help websites, computer programmes and books may help you to manage your symptoms.
  • Relaxation techniques may help you when you’re feeling anxious or stressed. This might include breathing exercises, for example. Practising mindfulness may help improve your wellbeing.
  • Look after your physical health by being more active, eating a healthy, balanced diet and making sure you get enough sleep.
  • Don’t use illegal drugs or alcohol to alleviate anxiety or to push away your obsessive thoughts. These can harm your physical and mental health.

For details of organisations that have information about OCD and advice on how to cope with it, see our section: Other helpful websites.

Treatment of OCD

There are a number of treatments for OCD. It’s important to speak up and find a way to treat and manage your symptoms to improve your quality of life.

Talking therapies

A type of talking therapy called cognitive behavioural therapy (CBT) can help you manage your symptoms. CBT can help you to change how you react to your thoughts. The number of CBT sessions you have will depend on how severe your OCD is. You may have one-to-one sessions or group therapy.

One of the main types 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’ll gradually get used to it and your anxiety will go away. In ERP, your therapist will help you to gradually face your fears (exposure). They’ll encourage you to try to stop carrying out your usual compulsions (response prevention) and wait for your anxiety to go away.

Medicines

Your doctor may offer you medicines if you have more severe OCD or if your symptoms are mild but don't improve with CBT.

Antidepressant medicines known as SSRIs (selective serotonin re-uptake inhibitors) can work well to treat OCD. If SSRIs aren’t suitable for you, your doctor may prescribe another type of antidepressant medicine called clomipramine to help reduce your symptoms. As with all medicines, there are some possible side-effects. Your doctor will explain these to you. It’s also important to carefully read the information leaflet that comes with your medicine.

You may find that a combination of CBT and one of these medicines helps to make your OCD easier to cope with. Medicines can ease your symptoms and so help you get the most from your CBT sessions.

If your OCD is very severe or CBT and medicines haven’t helped you, your doctor may refer you to a team of healthcare professionals who specialise in mental health.

The important thing is that you seek help. It might take a while for CBT sessions or medicines to help, but they do work for many people.

Supporting someone who has OCD

You may be reading this information because someone close to you has OCD. Perhaps you live with someone who has OCD. This can be difficult if you feel that you don’t know how to help. Here are some ideas on how you can support someone with OCD.

  • Be patient and listen carefully. Their fears are very real to them, even if they seem unrealistic or extreme. Ask them what help they would like from you.
  • It may take a while for someone with OCD to accept they need help. Gently encourage them to see their GP, get help from a therapist or try self-help for OCD (for more information, see our section on self-help).
  • Learn more about OCD and how it’s treated. Read about other people’s personal experiences to get an idea of what your friend or family member is going through.
  • Make an agreement with them that you won’t go along with their compulsions. Say ‘no’ to taking part in rituals or ‘checking’. It may be right to offer emotional support (or a hug) instead. Where possible, try to support them if they’re using a self-help programme.
  • Remember that it’s important to look after yourself too. Don’t take too much on and try to share your caring role with others if you can. By protecting your own mental health you’ll be in the best place to help someone else.

For more information, tips and hints on how to support someone with OCD, see our section: Other helpful websites.

Frequently asked questions

  • Therapists can measure how severe obsessive-compulsive disorder is on a scale called the Yale-Brown Obsessive-Compulsive scale (Y-BOC). The Y-BOCS consists of 10 questions – five about obsessions and five about compulsions; answers to these will generate a score. There are five categories on the scale of severity ranging from no symptoms to extremely severe OCD.

  • It’s likely that a number of things are involved. OCD may be triggered by having experienced abuse or neglect as a child, for example. Or a stressful event in life may bring on OCD. A major change to your life, such as taking on a new job with new responsibilities may trigger OCD. It can develop during pregnancy too.

    For more information, see our section: Causes of OCD.

  • A person with OCD will have obsessions and compulsions. Obsessions are in their mind but you may notice some compulsions, which are repeated behaviours in response to their obsessive thoughts. You may notice that they keep checking that doors are locked, for example, or they may wash their hands a lot.

    For more information, see our section: Symptoms of OCD.

  • No, OCD isn’t a form of depression but it’s often linked – many people with OCD also have depression or anxiety. OCD can cause you to have unwanted and upsetting thoughts. It can interfere with life and prevent you from doing things that you’d like to do. These can all contribute to feelings of anxiety and depression.

    For more information, see our section: Symptoms of OCD.



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Related information

  • Discover other helpful health information websites.

    • Obsessive-compulsive disorder. Summary. BMJ Best Practice. bestpractice.bmj.com, last reviewed 3 December 2021
    • Obsessive-compulsive disorder (OCD). Royal College of Psychiatrists. www.rcpsych.ac.uk, published October 2019
    • Obsessive-compulsive disorder (OCD). MSD Manuals. msdmanuals.com, last full review/revision January 2021
    • Obsessive-compulsive disorder. Medscape. emedicine.medscape.com, updated 17 May 2018
    • Boger S, Ehring T, Berberich G, et al. Impact of childhood maltreatment on obsessive-compulsive disorder symptom severity and treatment outcome. Eur J Psychotraumatol 2020; 11(1):1753942. doi: 10.1080/20008198.2020.1753942
    • Obsessive-compulsive disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2018
    • NHS talking therapies. NHS. www.nhs.uk, last reviewed 28 August 2018
    • Obsessive-compulsive disorder (OCD). How can I help myself? Mind. mind.org.uk, published May 2019
    • Obsessive-compulsive disorder (OCD). Mind. mind.org.uk, published May 2019
    • Perinatal OCD. Royal College of Psychiatrists. www.rcpsych.ac.uk, published November 2018
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, February 2022
    Expert reviewer, Dr Pravir Sharma, Consultant Psychiatrist
    Next review due February 2025

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