Obsessive-compulsive disorder (OCD)
It’s thought that up to three in 100 adults are affected by the anxiety disorder OCD. Most people find that their symptoms begin in their early 20s but up to four in 100 children may have symptoms of OCD.
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
If you have OCD, you will have obsessions (intrusive, recurrent, and distressing thoughts, sensations, urges or images) that take the place of your everyday thoughts. You’re also likely to have compulsions (actions) that are used as a way of setting right or cancelling out the obsessive thought. Compulsions are things you feel compelled to do even though you may know the behaviour does not make sense. Compulsions are typically done to reduce the fear or distress associated with obsessive thoughts.
Although everyone will have worrying thoughts occasionally, such as a concern over cleanliness or fear that they have left the oven on, these thoughts usually appear briefly, go away again easily and don’t cause any further problems. With OCD, you will have repetitive, worrying thoughts that often prevent you thinking about anything else. In addition, as a way to combat these obsessive thoughts, you will feel compelled to carry out repetitive behaviours. This could be physically checking and rechecking something, or it may be that you have to repeat in your mind a particular phrase or count to a certain number again and again.
If you have OCD, you will have your own experience of what obsessions and compulsions you have, which will be different to other people with OCD. However, there are some common themes that many people with OCD find they obsess about. The main features of obsessions are that they happen frequently, cause you anxiety, and don’t go away easily. Some of the main obsession themes are listed below.
- Contamination obsessions – fearing dirt and germs.
- Aggressive obsessions – fearing doing harm to yourself or others.
- Sexual obsessions – having forbidden, upsetting thoughts.
- Health-related obsessions – such as concern that you have a serious illness, without having any of the symptoms.
- Magical obsessions – such as believing in lucky or unlucky numbers.
- Religious or moral obsessions – having religious or anti-religious thoughts.
- Hoarding obsessions – worrying about throwing away useless or worn out items.
There are compulsions that you may feel you have to carry out whenever an obsessive thought arises. Examples are listed below.
- Excessive hand washing.
- Checking something again and again, such as making sure a door is locked.
- Repeating an action, such as only walking through doorways in a particular way.
- Praying, saying a phrase over and over or counting in your mind.
- Ordering or arranging items in a certain way.
- Hoarding or collecting things that have no use.
- Excessively asking others for reassurance – this happens more in children who have OCD.
Often the compulsion you carry out is linked to the obsession you have. So, if you obsess about germs and cleanliness, you may feel compelled to wash your hands repeatedly and in a certain way. However, this isn’t always the case and some compulsions may appear to have no relation to the obsession that sets them off. Although the action will push away the obsessive thought for a while, with OCD the thoughts return and get more difficult to get rid of each time. Therefore, more compulsive behaviour builds up and you spend more time doing these actions.
OCD can lead to you spending a lot of time carrying out compulsive behaviour that gets in the way of doing everyday tasks. You may also go to great lengths to avoid situations that could start an obsessive thought pattern.
It’s not fully understood why OCD develops, although there are a number of theories that try to explain it. It’s likely that it begins as a result of a number of factors.
You may find that a stressful event, such as the death of a loved one, the birth of a baby or starting a new job, triggers your OCD or makes it worse. It may be that you had a childhood trauma that set off the OCD cycles. It’s also possible that if one of your parents showed signs of OCD, this may have been passed on to you.
The condition may be the result of different levels of certain brain chemicals such as serotonin. Researchers have found that for some people with OCD there appears to be a link between this chemical and the severity of OCD symptoms. You may find medicines helpful to bring your symptoms under control.
In some children, OCD develops after infection with a type of bacteria called Streptococcus.
You may find that talking to other people who have similar symptoms helps you to understand your condition better. There are also CDs, DVDs and books that you might find useful.
You could try writing down your obsessive thoughts. This may make you feel more in control of them and allow you to dismiss them more easily.
Don’t use recreational 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.
You could learn a relaxation technique to help you to deal with anxiety better and to cope with stressful situations. This might include breathing exercises or exercises designed to help you relax your muscles.
You may be offered a therapy called cognitive behavioural therapy (CBT) that can help you to manage your OCD symptoms. CBT can help you to change how you think ('cognition') and what you do ('behaviour'). If your symptoms of OCD are mild and not affecting your life too much, you may be offered a short course of one-to-one CBT, or sessions by telephone, or group sessions. This will usually be up to 10 hours of sessions with a CBT practitioner. If your symptoms are affecting your life more seriously, you may be offered more one-to-one sessions of CBT.
One of the main forms of CBT that is effective in treating OCD is exposure and response prevention (ERP). This is used as a way to stop your obsessions and compulsions from strengthening each other. It has been found that if you stay in a stressful situation for long enough you will get used to it and your anxiety goes away. With ERP your CBT practitioner will help you to face your fears (exposure) but you will stop yourself from carrying out your usual compulsion (response prevention) and then wait for your anxiety to drop.
For example, you might have a compulsion to wash your hands immediately and thoroughly every time you touch a door handle. In the process of ERP you would break this cycle by not washing your hands straight away. You will find that nothing bad happens and gradually you will feel less anxious about it. Once you have overcome an obsession that you find makes you less anxious you would move onto one that makes you more anxious and face it in the same way.
You may find this process is distressing to begin with so it’s helpful to work with a CBT practitioner. He or she will probably ask you to do homework between each session. This will involve continuing to face your fears and overcoming the compulsions. Completing the homework can have a positive effect on how quickly you overcome your obsessions and compulsions.
If you find that your symptoms don’t improve enough with a therapy such as CBT, you may be offered medicines such as certain antidepressants (ie fluoxetine). These medicines affect the chemicals (particularly serotonin) in your brain and help to ease OCD symptoms or make it easier for you to deal with them. This is particularly helpful if you find your symptoms are worse when you feel depressed.
You may be offered another medicine called clomipramine that works in a different way, which might work better for you.
You may find that a combination of CBT and one of these medicines helps to make your OCD easier to cope with.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.
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