Obsessive compulsive disorder (OCD) is a
chronic mental health condition that is usually associated with both obsessive
thoughts and compulsive behaviour.
An obsession is defined as an unwanted
thought, image or urge that repeatedly enters a person’s
A compulsion is defined as a repetitive
behaviour or mental act that a person feels compelled to perform.
Unlike some other types of compulsive
behaviour, such as an addiction to drugs or gambling, a person with OCD gets no
pleasure from their compulsive behaviour. They feel that they need to carry out
their compulsion to prevent their obsession becoming true. For example, a
person who is obsessed with the fear that they will catch a serious disease may
feel compelled to have a shower every time they use a public toilet
How common is OCD? OCD is one of the most common mental health
conditions. It is estimated that about 1-3% of adults and 2% of children and
teenagers have OCD.
In men, OCD symptoms usually begin during
adolescence. In women they generally start later, usually in the early
20s. OCD symptoms can begin at any time, including childhood. The symptoms of OCD can range from mild to
severe. For example, some people with OCD will spend around one hour a day
engaged in obsessive compulsive thinking and behaviour, while for others, the
symptoms completely dominate their life.
The causes of OCD are unknown.
If left untreated, the symptoms of OCD may
not improve and, in some cases, they will get worse.
With treatment, the prognosis for OCD is
good, and some people will achieve a complete cure. Even if a complete cure is
not achievable, treatment can reduce the severity of a person’s symptoms
and help them to achieve a good quality of life.
A form of psychotherapy, cognitive
behavioural therapy (CBT), can be very successful in helping many people with
Patterns of thought and behaviour
Most people with obsessive compulsive
disorder (OCD) generally fall into a set pattern or cycle of thought and
behaviour. This pattern has four main steps which are described below.
your mind becomes overwhelmed
by a constant obsessive fear or concern such as the fear that your house will
this obsession provokes a
feeling of intense anxiety and distress.
you then adopt a pattern of
compulsive behaviour in order to reduce your anxiety and distress, such as
checking that all your windows and doors are locked at least three times before
leaving your house.
the compulsive behaviour
brings temporary relief from anxiety, but the obsession and anxiety soon
returns, meaning that the pattern or cycle begins again.
Almost all people have unwanted and unpleasant
thoughts, such as a nagging worry that their job may not be secure, or a brief
suspicion that a partner may have been unfaithful. Most people can usually put
these type of thoughts and concerns into context and are able to carry on with
their day-to-day lives.
However, if you experience a persistent,
unwanted and unpleasant thought that dominates your thinking to the extent that
it interrupts your other thoughts, you may have developed an obsession.
Some common obsessions that affect people
with OCD are: Fear of being harmed, Fear of causing harm to others, Fear of contamination by disease, infection,
or other unpleasant substance, A need for symmetry, or orderliness. For
example, someone with OCD may feel the need to ensure that all the labels on
the tins in their cupboard face the same way, Fear of committing an aggressive, or
unpleasant, act, Fear that you will commit an act that would
seriously offend your religious beliefs, Fear that other people will consider you to
be a sexual deviant, Fear that you will make a mistake that has
serious consequences. For example, your house will burn down because you
left the gas on, or all your possessions will be stolen because you forgot to
lock your door.
Most compulsions arise from the initial
obsession. In some cases, the type of compulsive behaviour is in some way
logically connected to the obsession, such as repeated hand washing in order to
However, in many cases of OCD, the compulsion
has no logical connection to the obsession. Instead, it is a type of ‘magical’
or superstitious behaviour that the person believes has the power to prevent
the object of their obsession from occurring. For example, a person with OCD may feel
compelled to count every red car that they see on the road because they believe
that doing so will prevent their mother from dying in a car crash. This type of ‘magical’, compulsive behaviour
is particularly common in children with OCD. Although most people with OCD realise that
such compulsive behaviour is irrational and makes no logical sense, they're
unable to stop acting on their compulsion.
Some common types of compulsive behaviour
found in people with OCD include: Checking that doors are locked, and that gas
taps and light switches are turned off, Cleaning and washing, Repeating certain acts or rituals such as
having to touch every second lamp post while walking down the street, Constantly repeating certain words or phrases
in your mind, Hoarding or collecting objects that usually
have no value, such as supermarket bags and junk mail, and Counting.
If you have obsessive compulsive disorder (OCD), your recommended
treatment plan will depend on how badly your OCD is affecting your ability to
function. OCD that causes mild functional impairment is usually treated using a
short course of cognitive behavioural treatment (CBT). OCD that causes moderate functional impairment can be treated with a more
intensive course of CBT, or the type of antidepressants known as selective
seretonin reuptake inhibitors (SSRIs). Such cases may also require referral to
a specialist mental health service.
OCD that causes severe functional impairment will require referral to a
specialist mental health service for a combination of intensive CBT and a
course of SSRIs. Children with OCD are usually referred to a health professional with
experience in treating OCD in children.
Psychological treatments for OCD
CBT is the most widely used psychological treatment for OCD. It is based
on the idea that most unwanted thinking patterns, beliefs, and emotional and
behavioural reactions are learnt over a long period of time.
The aim of CBT is to identify the thinking patterns that are causing you
to have unwanted feelings and behaviour, and to learn to replace this thinking
with more realistic and useful thoughts and belief. Exposure and response prevention
A particular type of CBT called exposure and response prevention (ERP)
has successfully achieved this aim. ERP involves ‘exposing’ yourself to situations
or objects that are currently causing you fear and anxiety. Exposure can be: Actual, such as handling dirty plates or using a public toilet; Mental, such as mentally picturing yourself forgetting to lock your door
or leaving the oven on. Once exposure has taken place, most people with OCD will feel the need to
engage in compulsive behaviour in order to reduce the anxiety that the exposure
has caused them. However, the CBT therapist will work with you in order to
prevent, or at least delay, this compulsive response. Over time, the exposure to an unpleasant object or situation will cause
less anxiety and the need for a compulsive response will become weake. To begin with, your therapist will set targets for exposure that are
relatively easy to cope with before moving on to targets that are currently
causing you considerable anxiety. People with mild to moderate OCD often require about 10 one-hour
sessions with a CBT therapist. Those with moderate to severe OCD may require a
more intensive course of CBT lasting more than 10 hours.
Medication for OCD
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a type of antidepressant that are usually recommended for
people with moderate to severe OCD.
You will normally need to take a SSRI for 12 weeks before you begin to
notice any benefit.
Side effects of SSRIs may include: Headache and Nausea. These side effects usually pass within a few weeks.
There is a small chance that SSRIs will increase your feelings of
anxiety, which may lead to you experiencing related suicidal thoughts and the
desire to self-harm. Contact your GP immediately if you are taking a SSRI and you experience
suicidal thoughts or the desire to self-harm.
Most people with moderate to severe OCD are required to take SSRIs for at
least 12 months. After that time your condition will be reviewed. If the
condition is causing you no, or very few, troublesome symptoms, you may be able
to stop taking SSRIs.
Clomipramine is a tricyclic antidepressant (TCA) that can be used as an
alternative to SSRIs for the treatment of OCD. TCAs are not as commonly used as
SSRIs because they cause more side effects. They can be effective in treating
people with OCD who are unable or unwilling to take SSRIs.
Side effects of clomipramine include: Dry mouth, Constipation, Headache, Dizziness, Fatigue, and Increased sweating. Clomipramine is not suitable for people with low blood pressure
(hypotension) or heart disease. Therefore, if you are at risk of either of
these two conditions, your GP may recommend a blood pressure test and an
electrocardiogram (ECG) before you begin your treatment.
As with SSRIs, you will usually be recommended to take a 12-month course
of clomipramine, after which your symptoms will be reviewed.