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The Royal College of Psychiatrists Improving the lives of people with mental illness

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Obsessive Compulsive Disorder: key facts

 

What is Obsessive Compulsive Disorder?

We can all be obsessive about certain things at times, but if:

  • you get awful thoughts coming into your mind, even when you try to keep them out
  • you have to touch or count things or repeat the same action like washing over and over

you may have Obsessive Compulsive Disorder (OCD).

 

Who gets OCD?

About one in 50 people have OCD at some point in their lives. OCD usually starts in the teens or early twenties. It tends to get better and worse over time, but people often don't seek help for many years.

 

What are the signs and symptoms of OCD? 

  • Recurring thoughts - 'obsessions' - that make you anxious. These can be unpleasant words or phrases, pictures in your mind or doubts.
  • The things you do over and over again - 'compulsions' - that help you to feel less anxious.  You may try to correct or ‘neutralise’ obsessional thoughts by counting, saying a special word, checking or doing a ritual, over and over again.

What causes OCD?

Many factors might play a part:

  • OCD is sometimes inherited, so it can run in the family. 
  • Stressful life events bring it on in about one in three cases.
  • Life changes - when you have to take on more responsibility, such as puberty, the birth of a child, or a new job,
  • If you have OCD for a long time, some experts think that an imbalance of a brain chemical called 'serotonin' (also known as 5HT) may be involved. 
  • You are a neat, meticulous, methodical person – but go too far.
  • If you have particularly high standards of morality and responsibility, you may feel bad when you have unpleasant thoughts. So, you watch out for them – which makes them more likely to happen.

Helping yourself

  • You may be able to control the troubling thoughts if you record them, with a microphone or on paper, and then listen back to them or re-read them. You need to do this regularly for around half an hour every day. At the same time, try to resist the compulsive behaviour you feel like doing.
  • Don't use alcohol to control your anxiety.
  • If your thoughts involve worries about your faith or religion, talk it over with a religious leader to help you work out if it is an OCD problem.
  • Try a self help book.

Professional help

Psychotherapies

  • Exposure and Response Prevention (ERP)

This helps to stop compulsive behaviours and anxieties from strengthening each other.

 

We know that if you stay in a stressful situation long enough, you gradually become used to it and your anxiety goes away. With this type of therapy, you will gradually face the situation you fear (exposure), but stop yourself from doing your usual compulsive rituals, checking or cleaning (response prevention), and wait for your anxiety to go away. You may find that learning to use relaxation techniques can help you to resist the rituals and reduce your anxiety. This type of therapy woks best for the mild OCD, and can also be done without a therapist, using a self-help book if you are motivated and prepared for some hard work.

 

Instead of trying to get rid of your thoughts, it helps you to change your reaction to them. It particularly targets unrealistic self-critical thoughts. This is useful if you have obsessional thoughts, but do not perform any rituals or actions to make yourself feel better. It can be used with exposure and response prevention (ERP).

         

SSRI antidepressants can help even if you are not depressed.  Medications can be useful in combination with CBT if your OCD is severe, or you have not felt better with one type of treatment on its own. If medication treatment has not helped at all after three months, you can change to a different SSRI or to a medication called 'clomipramine'.

 

How effective is the treatment?

  • Psychotherapies

About 3 out of 4 people who complete this are helped a lot, but 1 in 4 will get symptoms again and will need extra treatment. About 1 in 4 people are not able to cope with Cognitive Behavioural Therapy (CBT) as they feel it's too difficult.

  • Medication

About 6 out of 10 people improve with medication and their symptoms reduce roughly by half. Medication does help to prevent OCD coming back for as long as it is taken, even after several years. Unfortunately, about half of those who stop medication will get symptoms again in the months afterwards. This is less likely when medication is combined with CBT.

 

For more in-depth information see our main leaflet: Obsessive Compulsive Disorder.

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Amy Green

© January 2014. Due for review: January 2016. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 3701 2552.

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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