Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder is an anxiety disorder with two key parts: obsessions and compulsions.

Obsessions are intrusive and unwelcome images, urges, thoughts or doubts that repeatedly appear in your mind. They interrupt your thinking and make you feel very uncomfortable or anxious.

An image of colleagues sat at a long desk

Compulsions are activities you feel you have to do to reduce the discomfort caused by the obsessive thoughts. If you don’t act on the compulsions, your anxiety or mental discomfort becomes distressing and unmanageable.

People often think OCD just means that you like to wash your hands a lot or you like to be very neat. But obsessions and compulsions can be very difficult to live with. Not everyone with OCD has obsessions and compulsions related to cleanliness.

How does it feel to have obsessive-compulsive disorder (OCD)?

Obsessions and compulsions can appear in lots of different ways.

Types of obsessions

  • Fear of causing or not preventing harm. You might worry that you have accidentally harmed someone or that you might harm someone in the future.
  • Intrusive thoughts, images and impulses. You might have graphic violent or sexual thoughts or intrusive thoughts and ongoing worries about your relationships or your religion. These kinds of thoughts can make you really worried that you’re a ‘bad’ or dangerous person. It’s important to remember that they’re a symptom of OCD and not part of who you are. There are no recorded cases of a person with just OCD carrying out their obsessions.
  • Fear of contamination. You might be worried that you have a disease or are contaminated with germs, dirt or faeces.
  • Fears and worries related to order and symmetry. You might worry that something awful will happen if things are not a certain way – perhaps symmetrical or clean.

Types of compulsions

  • Compulsions are usually performed in response to a particular obsession. Repeating compulsions often takes up a lot of time and doesn’t provide relief for very long.
  • Rituals. For example, you might arrange things in a particular way, touch things a certain number of times or clean a lot.
  • Checking. For example, you might check your route to work to make sure you didn’t cause an accident. You might check your clothes for dirt, check you’ve performed a particular task or check your body.
  • Correcting thoughts. For example, you might count to a certain number or repeat a phrase in your head or out loud. You might try and imagine a different image to replace the intrusive thought.
  • Reassurance. You might ask other people around you for reassurance a lot.

Dealing with obsessions and compulsions every day can cause other difficulties:

  • You might choose to avoid situations that make your obsessions or compulsions worse.
  • You might feel ashamed and find it difficult to open up or get the right help.
  • You might find that your OCD takes up so much time that it disrupts the rest of your life.

What causes obsessive-compulsive disorder?

We don’t fully understand what causes OCD. These things are likely to be involved in the development of OCD.

  • Biological factors. Some studies have suggested that OCD may run in the family in some way, but these are not conclusive. People with OCD often have different levels of the chemical neurotransmitter serotonin in their brain – but it isn’t clear whether this is a cause or an effect of OCD.
  • Difficult life experiences. Things like experiencing trauma, bullying, abuse or neglect as a child may be a factor.
  • Established ways of thinking. For example, you may think you have more responsibility for a situation or a thought than you actually do. Misinterpreting thoughts, being very perfectionist and overestimating threats might also contribute to the development of OCD.

Ongoing stress can sometimes trigger the development of OCD or make it worse. Some women develop OCD, or find their OCD gets worse, during or after pregnancy.

What treatments are available for obsessive-compulsive disorder?

There are a number of different treatments available for OCD. Different treatments will be right for different people.

  • Talking therapies – usually cognitive behavioural therapy (CBT). There’s a particular type of CBT often used for people with OCD called exposure and response prevention (ERT).
  • Medication – usually an antidepressant.
  • Hospital treatment – people with severe OCD may need to be treated in a specialist hospital.

For more information on treatments, see our information on common treatments and support. For more information on OCD visit OCDAction.

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  • Produced by Clare Foster, freelance health editor, and Nick Ridgman, Head of Health Content, Bupa UK, September 2017 Next review due September 2020

    Bupa UK expert reviewers:

    • Naomi Humber, Psychology Services Manager, EAP
    • Stuart Haydock, Resilience Lead, Health Clinics
    • Sarah Deedat, Head of Behaviour Change

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