Obsessive Compulsive Disorder (OCD)

Symptoms

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thoughts and behaviours.

OCD has 3 main elements:

• obsessions – where an unwanted, intrusive and often distressing thought, image or urge repeatedly enters your mind
• emotions – the obsession causes a feeling of intense anxiety or distress
• compulsions – repetitive behaviours or mental acts that a person with OCD feels driven to perform as a result of the anxiety and distress caused by the obsession

The compulsive behaviour temporarily relieves the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

Most people with OCD experience both obsessive thoughts and compulsions, but one may be less obvious than the other.

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point, such as thinking they may have forgotten to lock the door of the house, or even sudden unwelcome violent or offensive mental images.

But if you have a persistent, unpleasant thought that dominates your thinking to the extent it interrupts other thoughts, you may have an obsession.

Some common obsessions that affect people with OCD include:

• fear of deliberately harming yourself or others – for example, fear you may attack someone else, such as your children
• fear of harming yourself or others by mistake – for example, fear you may set the house on fire by leaving the cooker on
• fear of contamination by disease, infection or an unpleasant substance
• a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way

You may have obsessive thoughts of a violent or sexual nature that you find repulsive or frightening. But they're just thoughts and having them does not mean you'll act on them.

These thoughts are classed as OCD if they cause you distress or have an impact on the quality of your life.

Compulsive behaviour

Compulsions start as a way of trying to reduce or prevent anxiety caused by the obsessive thought, although in reality, this behaviour is either excessive or not realistically connected.

For example, a person who fears contamination with germs may wash their hands repeatedly, or someone with a fear of harming their family may have the urge to repeat an action multiple times to "neutralise" the thought.

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on it and feel they need to do it "just in case".

Common types of compulsive behaviour in people with OCD include:

• cleaning and hand washing
• checking – such as checking doors are locked or that the gas is off
• counting
• ordering and arranging
• hoarding
• asking for reassurance
• repeating words in their head
• thinking "neutralising" thoughts to counter the obsessive thoughts
• avoiding places and situations that could trigger obsessive thoughts

Not all compulsive behaviours will be obvious to other people.

Causes

It's not clear what causes OCD. A number of different factors may play a part, including:

• family history – you're more likely to develop OCD if a family member has it. It may be learned behaviour, or possibly because of your genes
• differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
• life events – OCD may be more common in people who have been bullied, abused or neglected, and it sometimes starts after an important life event, such as childbirth or a bereavement
• personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, also people who are generally quite anxious or have a very strong sense of responsibility for themselves and others

Treatment Options

There are some effective treatments for OCD that can help reduce the impact it has on your life.

The main treatments are:

• talking therapy – usually cognitive behavioural therapy (CBT), which helps you face your fears and obsessive thoughts without "putting them right" through compulsions
• medicine – usually a type of antidepressant medicine called selective serotonin reuptake inhibitors (SSRIs), which can help by altering the balance of chemicals in your brain

CBT will usually have an effect quite quickly. It can take up to 12 weeks before you notice the effects of treatment with SSRIs, but most people will eventually benefit.

If these treatments do not help, you may be offered:

• an alternative SSRI
• a combination of an SSRI and CBT
• an antidepressant called clomipramine

Some people may be referred to a specialist mental health service for further treatment.