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Obsessive compulsive disorder (OCD)


Expert reviewer Dr Rahul Bhattacharya, Consultant Psychiatrist
Next review due June 2022

Obsessive-compulsive disorder (OCD) is a mental health condition where you have obsessive 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.

A woman is thinking

About OCD

OCD has two main features — obsessions and compulsions — which we describe here.

  • 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 before 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, repeated checking that doors are locked). 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. See our section on symptoms for more information about obsessions and compulsions.

OCD is quite common, affecting between two and three people in a hundred. It usually starts in your late teens or early twenties, but it can occur at any age. Women may develop OCD during pregnancy.


If you need help now

This page is designed to provide health information about obsessive compulsive disorder. If you need help now, the following helpline is free for you to call and talk to someone.

  • Samaritans
    116 123 (UK and ROI)

Alternatively, follow this link to Mind’s website and click on the yellow ‘I need urgent help’ button at the top left of the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you need immediate help or are worried about someone, call the emergency services.

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. But if you have OCD, you’ll have your own experience of which obsessions and compulsions affect you. Your obsessions and compulsions will be repetitive and unpleasant and take up a lot of your time. They get in the way of everyday life.

Common obsessions include:

  • fear of contamination from dirt, germs and viruses
  • fear of coming to harm
  • excessive concern with how things are arranged — needing them to be in order or symmetrical
  • superstitions such as a fear of ‘bad’ numbers
  • 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
  • having to keep 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 die’. 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 directly to a therapist on the NHS, without a referral from your GP. Look online for IAPT (improving access to psychological therapies) services near you.

Many people with OCD also have another related condition or problem such as depression or anxiety. See our FAQ on OCD and other mental health conditions for more information.

Causes of OCD

No one’s sure yet what causes OCD — there are lots of different theories. It’s likely that a number of factors are involved in its development. Here are some of the things we know.

  • 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. OCD can also develop during pregnancy.
  • 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 in the development of the condition. And brain scans have shown some overactive areas in people with OCD.
  • Certain personality traits, such as being especially neat, may mean you’re more likely to get OCD.
  • It seems that OCD can develop following certain infections, such as streptococcal infections or herpes simplex virus 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.

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 a series 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.

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 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 further treatment.

Treatment of OCD

Many people with OCD spend years struggling with their symptoms before they seek help. This is usually because of shame or embarrassment — they may worry what other people will think or say about them. 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’ll be able to share your feelings and experiences with other people affected by OCD.
  • You could try using self-help websites, computer programmes and books to help manage your symptoms. These can be helpful while you’re waiting to start talking therapies (see below).
  • Learning a relaxation technique may help you when you’re feeling anxious or stressed. This might include breathing exercises or exercises designed to help you relax your muscles. 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. Using these can harm your physical and mental health.

See our section on other helpful websites for contact details of organisations that may help. You’ll find lots of information about OCD, tips and hints on coping with it, and recommendations for useful resources.

Talking therapies

You may be offered a type of talking therapy called cognitive behavioural therapy (CBT) to help you manage your symptoms. It can work well as a treatment for OCD. CBT is a type of talking therapy that can help you to change how you react to your thoughts. How many sessions of CBT you have will depend on the severity of your OCD. You may have one-to-one sessions or group therapy.

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’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.

You might be offered antidepressant medicines known as SSRIs (selective serotonin re-uptake inhibitors). These can work well in treating OCD. If SSRIs aren’t suitable, your doctor may offer 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.

If you get OCD while you’re pregnant, your doctor will discuss with you the benefits and potential risks to your unborn baby of taking these medicines.

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, you may be offered support from 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. Don’t suffer in silence.

Supporting someone who has OCD

You may be reading this information because someone close to you has OCD. You may even live with them. This can be difficult and you may feel that you don’t know how to help. Here are some ideas on how you can support someone you know 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 remedies (see our treatment section).
  • Learn more about OCD and how it’s treated. Read about other people’s personal experiences to get an idea of what your friend 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 even 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.

You’ll find lots of information, tips and hints on how to support someone with OCD from the organisations listed under ‘other helpful websites’.

Frequently asked questions

  • Body dysmorphic disorder (BDD) is a mental health condition where you spend a lot of time being concerned about how you look. If you have BDD, you’ll usually be worried that you have one or more physical flaws. Your flaw may not 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.

    Around one in seven people who have OCD also have BDD. They are separate conditions, but have features in common. Much like OCD, if you have BDD, you may feel that you must do certain acts. These may include you repeatedly:

    • checking how you look in the mirror
    • asking for reassurance about your appearance
    • styling, pulling or plucking your hair
    • changing your clothes
    • picking your skin to make it smooth.

    If you have BDD, you may feel that you can't go out in public unless you’ve hidden your flaws with make-up or clothing.

    The treatment for BDD is very similar to OCD. Your doctor will usually offer you cognitive behavioural therapy (CBT). If this doesn't help, they may prescribe medicines to help control your symptoms.

    If you think you have symptoms of either condition and they’re interfering with your day-to-day life, contact your GP or look online for your local IAPT (improving access to psychological therapies) services.

  • OCD does occur on its own but it’s often linked to other mental health conditions, especially anxiety and depression.

    You may get anxiety when you have OCD because the OCD 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’d like to do. 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.

    Other mental health problems you can have at the same time as OCD include:


    The presence of one or more of these conditions can sometimes make it difficult for your doctor to diagnose OCD.


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Related information

    • Obsessive-compulsive disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2018
    • Obsessive-compulsive disorder. BMJ Best practice. bestpractice.bmj.com, last reviewed April 2019
    • Obsessive-compulsive disorder. Medscape. www.emedicine.medscape.com, updated May 2018
    • Obsessive-compulsive disorder. Patient. patient.info/doctor, last edited August 2015
    • Cognitive and behavioural therapies. Patient. patient.info/doctor, last edited April 2014
    • Body dysmorphic disorder. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2018
    • Obsessive-compulsive disorder. The MSD Manuals. www.msdmanuals.com, last full review/revision June 2018
    • Dealing with a mental health crisis or emergency. www.nhs.uk, last reviewed April 2019
    • Can I get free therapy or counselling? www.nhs.uk, last reviewed August 2018
    • Obsessive-compulsive disorder. Mind 2019. www.mind.org.uk
    • Perinatal OCD. Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed May 2019
    • Obsessive compulsive disorder. National Institute for Health Research. www.dc.nihr.ac.uk, accessed May 2019
    • Body dysmorphic disorder. OCD UK. www.ocduk.org, accessed May 2019
    • Personal communication, Dr Rahul Bhattacharya, Consultant Psychiatrist, June 2019
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, June 2019
    Expert reviewer Dr Rahul Bhattacharya, Consultant Psychiatrist
    Next review due June 2022



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