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Obsessive compulsive disorder (OCD)


Expert reviewer Lars Davidsson, Consultant Psychiatrist
Next review due March 2020

Obsessive-compulsive disorder (OCD) is an anxiety disorder. It’s characterised by obsessive thoughts or compulsive behaviour (things that you feel compelled to do), or commonly both. It’s thought that OCD affects up to three in 100 adults and up to two in 100 children and adolescents.

Young woman thinking

An overview of OCD

OCD is made up of two features: obsessions and compulsions. You may also have anxiety as a result of these.

  • Obsessions are unwanted thoughts, images or urges that repeatedly enter your mind.
  • Compulsions are repetitive behaviours or mental acts that you feel compelled to do. They can be physical acts, which other people could notice (for example, repeated checking that doors are locked), or they can be mental acts, which people won’t see, such as repeating a certain phrase in your head.

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. But these thoughts usually appear briefly and you’ll soon be thinking about something else. If you have OCD, you will have repetitive, worrying thoughts, which can prevent you from thinking about anything else. As a way to combat these obsessive thoughts, you may feel compelled to carry out repetitive behaviours.

OCD usually starts in the late teens or early twenties, but it can occur at any age.

Symptoms of OCD

Below are some common obsessions and compulsions. But, if you have OCD, you will have your own experience of which obsessions and compulsions affect you. These might be different to other people who also have OCD.

Common obsessions include:

  • fear of contamination from dirt, germs and viruses
  • fear of harm, for example, you may repeatedly check if the door is locked
  • excessive concern with order or symmetry
  • aggressive obsessions – thinking about doing harm to yourself or others
  • sexual obsessions – you may have unwanted or aggressive sexual thoughts

Common compulsions include:

  • repeatedly checking things, such as locks, light switching, the oven
  • cleaning or washing
  • arranging or touching objects
  • hoarding or collecting things that have no use
  • repeating certain acts or behaviours
  • 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 die. For young people, compulsive rituals almost always involve members of the family.

Your obsessions and compulsions will be repetitive and unpleasant and can take up a lot of your time and get in the way of everyday life.

Many people with OCD may also have another related condition or problem, such as:

  • depression
  • anxiety
  • an eating disorder
  • suicidal thoughts
  • attention deficit–hyperactivity disorder (ADHD)
  • becoming alcohol dependent
  • general anxiety disorder
  • social or other phobias

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. Studies in twins support the fact that genes may play a role in OCD.
  • A stressful or life-changing event, such as starting a new job or having a baby, 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.
  • There have been some reports that OCD can develop following certain infections, such as streptococcal infections or herpes simplex virus.
  • There have also been reports that OCD may be caused by neurological damage, such as a brain trauma or carbon monoxide poisoning.

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 OCD.

Diagnosis of OCD

If you think you have OCD, and it’s affecting how you live your life, see your GP. They will ask you a series of questions related to OCD to help them make a diagnosis. They will ask how your OCD affects you personally and how it affects your day-to-day life. Your GP may also ask you about your medical history.

You may feel embarrassed about your symptoms and it can be hard to talk about them. However, it’s important to be open and honest with your GP about any obsessions and compulsions you have. This will help them 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.

There is a set of criteria (called ICD-10 criteria) you will have to meet to be diagnosed with OCD.

  • Either obsessions or compulsions (or both) happen most days.
  • Obsessions (intrusive thoughts, images or doubts) are repetitive, persistent, unwanted and unpleasant and cause you distress.
  • Compulsions are repetitive behaviours or mental acts that you feel you have to perform.
  • You usually try to resist a compulsion.
  • Carrying out a compulsive act is not pleasurable, but there may be some relief when you do it.

Treatment of OCD

Research shows that some people can spend 10 years or more struggling with OCD before they seek help. This is usually because of shame or embarrassment. But it’s so important to speak up and find a way to treat and manage your 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.

  • Talk about your OCD to 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.
  • You may find it useful to attend a self-help group (peer support). Here you will be able to share your feelings and experiences with other people who are also affected by OCD. Look online for local groups, or on charity websites, or ask your GP.
  • You could try using self-help websites, computer programmes 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. Eat a healthy, balanced diet and make sure you get enough sleep.
  • 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. There’s a lot of evidence that CBT can effectively treat OCD. CBT is a type of talking therapy that can help you to change how you react to your thoughts. How many sessions you have of CBT will depend on how severe your OCD is.

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.

Medicines

You may be offered medicines if you have more severe OCD, or if your symptoms are mild but don't improve with CBT.

You might be offered antidepressant medicines known as SSRIs (selective serotonin re-uptake inhibitors). These can help ease your obsessions and compulsions, even if you’re not depressed.

If these medicines don’t work, you may be offered another type of antidepressant medicine called clomipramine to help reduce your symptoms. As with all medicines, there are some possible side-effects when taking these medicines. Your doctor will explain these to you, but it’s also important to carefully read the information leaflet that comes with your medicine. See our FAQs on medicine side-effects further down the page for more information.

You may find that a combination of CBT and one of these medicines help to make your OCD easier to cope with. Medicines very rarely help cure OCD, but most can help you attend and engage with CBT more easily.

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.

The important thing is that you seek help. It might take a while for CBT sessions or medicines to help, but there is evidence that they work for many people, and will likely make a different to your life too. Don’t suffer in silence.

Living with someone who has OCD

You may be reading this information for someone close to you who has OCD. You may even live with them. This can be difficult and you may feel like you don’t know how to help. Here are some ideas how you can support someone you know with OCD.

  • It may take a while for someone with OCD to accept they need help. Help them learn about OCD and encourage them to seek professional help.
  • Learn about OCD yourself so you can support them.
  • Be patient. Their fears are very real to them, even if they seem unrealistic or extreme to you.
  • Don’t go along with someone’s compulsions. Say ‘no’ to taking part in rituals or ‘checking’, and encourage them to face fearful situations.
  • 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 with them.

Frequently asked questions

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

    More information

    A type of antidepressant medicine called SSRIs (selective serotonin re-uptake inhibitors), such as sertraline, is often prescribed to control OCD symptoms. There can be some side-effects, such as:

    • gastro-intestinal problems, such as diarrhoea, vomiting, constipation and abdominal (tummy) pain
    • headache and dizziness
    • a dry mouth
    • a change in appetite

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

    • abdominal pain
    • blurred vision
    • dry mouth
    • disruptive sleep
    • dizziness and confusion
    • diarrhoea
    • high blood pressure

    Your medicine can take up to 12 weeks to start working. 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. Also, contact your GP if you’re worried about any of the side-effects.

  • Body dysmorphic disorder (BDD) and OCD are separate conditions. However, they do have some similarities and can be related. So if you have BDD, you may also have OCD or another anxiety disorder.

    More information

    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 flaws. Your flaw may not even be apparent to other people, or may only be slightly noticeable. Most of us worry about our appearance to a certain extent, or on the odd occasion. 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 BDD is very similar to OCD. You will usually be offered cognitive behavioural therapy (CBT). If this doesn't help, your doctor may prescribe medicines to help control your symptoms.

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

  • OCD does occur on its own, but it’s commonly associated with other mental health conditions such as depression and anxiety.

    More information

    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. These can all contribute to feelings of anxiety and depression.

    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.


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Related information

    • Obsessive compulsive disorder (OCD). Mind. hwww.mind.org.uk, published July 2016
    • Obsessive-compulsive disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2013
    • Obsessive-compulsive disorder. Royal college of psychiatrists. www.rcpsych.ac.uk, published October 2014
    • Obsessive-compulsive disorder. PatientPlus. patient.info/patientplus, last reviewed August 2015
    • Obsessive-compulsive disorder. Medscape. emedicine.medscape.com, updated April 2016
    • Veale, V. Obsessive-compulsive disorder. BMJ 2014; 348. doi: http://dx.doi.org/10.1136/bmj.g2183
    • Obsessive-complusive disorder. How can I help myself? www.mind.org.uk, published July 2016
    • Obsessive-compulsive disorder treatment & management. Medscape. emedicine.medscape.com, published April 2016
    • Obsessive compulsive disorder (OCD). What treatments can help? Mind. www.mind.org.uk, published July 2016
    • Obsessive compulsive disorder. How can I help others? Mind. www.mind.org.uk, published July 2016
    • Selective serotonin re-uptake inhibitors. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, published February 2017
    • Clomipramine hydrochloride. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, published February 2017
    • Tricyclic and related antidepressant drugs. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, published February 2017
    • Body dysmorphic disorder (BDD). Anxiety and Depression Association of America. www.adaa.org, updated September 2014
    • Obsessive-compulsive disorder differential diagnoses. Medscape. emedicine.medscape.com, published April 2016
    • Anxiety, panic and phobias: key facts. Royal College of Psychiatrists. www.rcpsych.ac.uk, last reviewed February 2014
  • Reviewed by Alice Rossiter, Specialist Health Editor, Bupa Health Content Team, March 2017
    Expert reviewer Lars Davidsson, Consultant Psychiatrist
    Next review due March 2020



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