Obsessive-compulsive disorder (OCD)

OCD is a type of anxiety disorder where someone experiences obsessions and/or compulsions that affect their everyday life. OCD can make it difficult to do things like leave the house, be in certain situations or spend time doing activities that you once enjoyed.

The word ‘obsessive’ is used a lot, but it can mean different things to different people. Some people use the phrase OCD to describe being very tidy or having a very specific routine. However, just being tidy or precise does not mean that you have OCD.

In people with OCD, these habits are unpleasant and upsetting and can have a huge and negative affect on their lives.

An obsession is a thought, image or urge that keeps coming into your mind even though you may not want it to. An obsession can be annoying, unpleasant or distressing.

An example of an obsession is the thought that your hands are dirty even though they are not. Different people with OCD have different obsessions, that include things like:

• thinking you are unclean or might spread disease
• thinking you might get hurt or hurt someone else
• thinking something bad might happen to you or someone else
• thinking that you might have an illness

Having an obsession often leads to feelings of anxiety or discomfort and you might then get the urge to ‘put it right’. This is where compulsions come in.

Compulsions are things you feel you need to do to control your ‘obsessions’, even though you may not want to. It can be hard to stop yourself from doing these compulsions.

Often, a compulsion means doing something again and again. This is also known as a ‘ritual’. Doing the compulsion will probably make you feel as though you can stop or reduce your anxiety about what you fear may happen. For example, turning the light on and off 20 times because you worry something bad may happen if you don’t.

Different people with OCD have different compulsions. Some examples include:

• washing
• checking
• touching
• ordering, arranging or lining things up
• counting
• thinking certain thoughts

If you have compulsions you might find yourself trying to avoid any situation that could set off obsessive thoughts. For example, if you have obsessive thoughts about dirt, so have to wash your hands often after using door handles, you might avoid using your hands to open doors.

OCD is common and can affect anyone, regardless of their age, race, ethnicity, class, religion or gender.

There are many factors that affect whether someone develops OCD:

• Genes – OCD is a complex disorder. Studies have shown that there are different genetic risk factors involved in whether someone develops OCD. People who have a relative with OCD are more likely to develop OCD than people who don’t.
• Stress – Stressful life events like someone dying or getting sick, can bring on OCD. This is the case in about one or two in every three people who develop OCD.
• Life changes – Big events in someone’s life can be a catalyst for developing OCD. E.g. puberty, moving house or changing school.
• Brain changes – If you have the symptoms of OCD for more than a short time, researchers think that there may be changes in how a chemical called serotonin works in your brain. We don't know if these changes cause OCD, or are caused by OCD.
• Personality – If you are a neat, meticulous, methodical person with high standards you may be more likely to develop OCD. These qualities are normally helpful, but can slip into OCD if they become too extreme.
• Ways of thinking – Nearly all of us have odd or distressing thoughts or pictures in our minds at times. For example, thinking about stepping out in front of a car when you’re on a busy street, even if you don’t actually want to. Most of us quickly dismiss these ideas and get on with our lives. But, if you have particularly high standards of morality and responsibility, you may feel that it's terrible to even have these thoughts. So, you are more likely to watch out for them coming back, which makes it more likely that they will.

There are psychological treatments and medications available to treat OCD. In getting help for OCD, you will be taught a wide range of skills to manage the anxiety that OCD creates and to learn strategies to control the OCD instead of it controlling you.

Cognitive behavioural therapy (CBT)

One of the helpful psychological or talking treatments for OCD is cognitive behavioural therapy (CBT). This is a treatment that helps you to change the way you think and behave so that you can feel better and get on with your life.

Exposure and response prevention (ERP)

ERP is a type of CBT that aims to stop compulsive behaviours and anxieties from strengthening each other.

People with OCD often think that avoiding certain situations or doing compulsions will help to keep their obsessions away or stop them from coming true. However, this does not help the worry to go away.

In ERP your therapist will help you to face the things that you fear and that you have been avoiding. They can then help you to stop responding like you might usually.

For example, if you have an obsessive thought that you are dirty and might spread disease, you might wash your hands frequently in an attempt to make this obsessive thought go away. Your therapist might challenge you not to wash your hands as much to face this obsessive thought.

Sometimes your therapist may suggest that a close family member or friend is involved during the therapy.

Medication

When OCD is severe or you struggle to take part in therapy, you may need medication.

Selective Serotonin Reuptake Inhibitors (SSRIs) are a type of antidepressant that can be effective in treating OCD. They are usually given to help alongside CBT. Medication can help you get the most out of the psychological treatment.

OCD can feel scary, and some people feel like they are ‘going mad’ or ‘losing control’. Remember that OCD is a mental health condition like any other, and help and support are available to you. The sooner you get help, the sooner you can start to get better. A lot of adults with OCD didn’t get help for their problems when they were younger, and now wish they had.

Talk to someone you trust like a parent, carer, friend or teacher. Your GP or school nurse can give you advice and help you get specialist help from the child and adolescent mental health service (CAMHS). They will talk with you to understand the difficulties you are experiencing.

It can feel hard or embarrassing to discuss the details of your obsessions or compulsions. But giving as much detail as possible will help the therapist or psychiatrist to give you the right treatment. Mental health professionals will understand that the thoughts and feelings you are having do not make you a ‘bad’ person and are the result of your OCD.

If your life has become severely affected by OCD, you may also need help from other professionals. For example, help from your teachers to get you back to ordinary life at school or college.

"It started without me really noticing it. I got anxious about someone in my family dying, so I began to tap three times for good luck when I got worried, and that would calm me down. Then I had to do it before I could go to sleep at night – not once but 3 x 3.

“When I watched a programme on TV about germs in hospitals it began to get worse. I couldn’t tell my mum or dad about it because it sounded so silly. I had to wash my hands all the time because I thought I would pass on an infection and someone would die. It was mainly at home, but then I began to worry that I would catch something at school.

“I made my Mum wash my school uniform every day. She tried to say no, but I would get so worked up that she would give in. It came to a head when I couldn’t get to school on time because I was spending hours in the bathroom in the morning. I had to wash my hair three times as well as going through washing in a set order. If I was interrupted because someone needed the bathroom, I had to start again.

“Mum got me some help. Dr Roberts was really nice and understood why I was so worked up about everything. That was when I was 14. Now I am 18. It was hard work doing CBT. You have to try and work out why you are so anxious and try and control it. Now I am at college and doing a course that I like. I still do some counting, but I can keep it under control."

• Epic friends - Mental health problems are common. This website is all about helping you to help your friends who might be struggling emotionally.
• OCD Action - National charity for people with OCD.
• OCD Youth - A website written by and for young people with OCD, giving information on the disorder and its treatments.
• OCD UK - OCD-UK is the charity dedicated to improving the mental health and well-being of people in the UK whose lives are affected by OCD.

Further reading

NICE guidance written for patients and carers, CG31, Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder (2005). 

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB) and the National Collaborating Centre for Mental Health.

With grateful thanks to Dr Bruce Clark, Dr Shobha Puttuswamiah, Dr Virginia Davies and Dr Vasu Balaguru.

This resource reflects the best possible evidence at the time of writing.

Full references for this resource are available on request.