Obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) is an anxiety disorder. If you live with OCD, you will usually have obsessive thoughts and compulsive behaviours. This page gives information on the symptoms, causes and treatments for OCD. It also has information for carers and family members.

Overview

If you have obsessive compulsive disorder (OCD), you have obsessive thoughts and compulsive rituals and behaviours.

OCD affects 1.2% of the population in the UK.
A mix of different factors can cause OCD.
The usual treatment options for OCD are cognitive behavioural therapy (CBT) and medication.
If you have OCD you may find that it affects areas of your life like work or relationships.

OCD: What is it?

What is obsessive compulsive disorder?

Obsessive compulsive disorder (OCD) is an anxiety disorder. If you live with OCD, you will usually have obsessive thoughts and compulsive behaviours. These can be time-consuming, distressing and interfering in your day-to-day life.

Obsessive thoughts

An obsessive thought is a thought or image that repeatedly comes into your head. 

These thoughts are unwanted and you can’t control them. They can be hard to ignore. You may not want these thoughts and they can be upsetting. They can make you feel distressed, anxious or guilty. These thoughts can be in different areas. 

Examples of common obsessions include:

worries that you, or something like your food, might be contaminated,
fear that something bad might happen if things are not in order or symmetrical,
being worried about harm coming to yourself or other people,
sexually disturbing images or thoughts,
religious beliefs – focusing on the importance and significance of religion and religious matters,
relationships – constantly thinking about your relationship, your sexuality, if your partner is unfaithful, that your relationship will end at any moment,
magical thoughts – these are thoughts that if you do certain things you will stop bad things from happening. Or that imagining bad events will increase the possibility they will happen, and
violent thoughts – thoughts of being violent to a loved one or other people. Such as killing innocent people, jumping in front of a train.

People who have intrusive thoughts can be afraid of telling health professionals about it. They are worried that they will label them or think they are a risk to people around them. 

But health professionals will usually see your intrusive thoughts as a symptom of your condition. And they will use the information to think about the right support and treatment for you. 

They can only take action without you agreeing if they think you are a serious risk to yourself or other people.

Compulsions

Compulsions are things you think about or do repeatedly to relieve the anxiety from your obsessive thoughts. You might also hear these being called ‘compulsive behaviours’. 

You might believe that you, or someone close to you, might come to harm if you don’t do these things. You may realise that your thinking and behaviour isn’t logical but still find it difficult to stop.

When you carry out a compulsion, your relief usually doesn’t last long. This makes your original obsession stronger. You may then feel you need to carry out your compulsion again to feel better. 

Not everyone with OCD show signs of compulsive behaviours to others. Their compulsions might not be seen by others, but might be things like repeating a word or phrase in your head. Examples of compulsions include:

checking things repeatedly - for example, whether an appliance has been switched off,
washing or cleaning things excessively,
carrying something out in a particular order, in a repeated pattern or a certain number of times, and
counting to a particular number, or going through a standard sequence of numbers, repeatedly.

Thoughts and rituals can take up a lot of your time and affect your day-today life. Fear of contamination, compulsive checking and hoarding can be common for people who live with OCD. There is more information about these things below.

Contamination

Some people who live with OCD have a fear of contamination. This means you might constantly feel the need to make sure that something is clean and free from germs or dirt. This is a compulsion. 

Your obsessive thought is usually that any contamination will harm yourself or a loved one. You might fear:

shaking someone’s hand,
using public toilets or shared toilets,
touching door handles,
using plates, glasses or cutlery in a public place,
using public telephones,
visiting hospitals or GP surgeries,
visiting someone else’s house, and
touching shared objects. Such as remote controls, computer keyboards or money.

Checking

This is a compulsion where you will feel the need to check something repeatedly. You might be worried that something, or someone, might be harmed if you don’t check something. Common checking can include:

that a light is switched off,
that an appliance is turned off. Such as a cooker, an iron, a tap or a lamp,
that a window is closed or a door is locked,
health conditions and symptoms online,
that you have your wallet, purse, phone or keys on you, and
re-reading something to check you have taken in all the information.

Hoarding

Hoarding is where you find it difficult to get rid of items in your home even when space is becoming limited. Or when most people would see the items as not being useful. You may find that you buy, collect and store items even when you don’t need them. You may hoard things because of:

fear that you, or someone else, will be harmed if you throw something away,
feeling an object may come in useful at a later point, or
because you are emotionally attached to the item.

Ben’s story

I realised at a young age that I had ‘odd’ rituals that I had to carry out. When I started university these became worse. I would not be able to leave our shared flat unless I had closed the bedroom door a number of times. Or until I heard the door click. I would repeat this endlessly until I felt comfortable and that it was ‘enough’. I told a couple of friends but I felt stupid and embarrassed. It caused problems in my studying and social life. It developed into worse rituals. It was only after I got help that I managed to get the right support and treatment.

How common is OCD?

According to the charity OCD-UK, OCD affects 1.2% of the population in the UK.

Many people have obsessive compulsive parts of their personality that don’t have too much of an effect on their day to day life. For example, worrying that a window is closed, or preferring things in a particularly neat or organised fashion. This might not mean you have OCD. However, if your thoughts or actions are so severe that they affect your day to day life, a doctor may diagnose you with OCD.

Diagnosis and Causes

How is OCD diagnosed?

Diagnosis

If you think you have OCD, you should share your concerns with a healthcare professional, like your GP.

When you first see a healthcare professional about your symptoms, they will want to consider whether they think you have OCD. If you see your GP, they may refer you to a specialist mental health service. They should do this if they think your symptoms are severe.

A specialist doctor, called a psychiatrist, may then see you for an assessment. Healthcare professionals may ask you the following questions:

Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
Do your activities take a long time to finish?
Are you concerned about putting things in a special order or are you very upset by mess?
Do these problems trouble you?

This will help the healthcare professional decide if you have OCD and how severe your symptoms are. And what course of treatment will be best for you. 

You can find more information about ‘What to expect from your GP by clicking here. 

What causes OCD?

We don’t know exactly why someone may develop OCD. The following things could all play a part on why a person develops OCD:

personal experience,
biological and genetic factors, and
personality.

Although it is not known exactly why OCD develops, it can be treated successfully.

Treatment

How is OCD treated?

OCD is usually treated with the following evidenced based treatments:

cognitive behavioural therapy (CBT)
exposure and response prevention (ERP), and
medication.

Cognitive behavioural therapy (CBT)

CBT looks at the link between how you think, feel and behave. CBT focuses on problems and difficulties in the present rather than your past or childhood. CBT can help you to understand how you think about yourself and the things around you and how that affects your reaction to situations.

Exposure and response prevention (ERP)

NICE guidelines say that you should only be offered ERP alongside CBT. You can read more about the NICE guidelines below. 

ERP helps people deal with situations or things that make them anxious or frightened. With the support of your therapist, you are ‘exposed’ to whatever makes you frightened or anxious. For example, dirt or germs. 

You learn other ways of coping with your fear or anxiety instead of avoiding the situation or repeating a compulsion. You repeat this until you are no longer anxious or afraid.

Medication

Your doctor may offer you a type of antidepressant called an SSRI to help with your OCD. SSRI stands for selective serotonin reuptake inhibitor. The main types of SSRIs doctors use for OCD are fluoxetine, fluvoxamine, paroxetine, sertraline and citalopram. 

If your doctor prescribes any medication, they should tell you how it might help and what side effects to expect.

NICE guidelines

The National Institute for Health and Care Excellence (NICE) produces guidance on recommended treatments for OCD. You can find this guidance at:

www.nice.org.uk/guidance/cg31.

If you have OCD and your symptoms are mild, your doctor should offer you low intensity psychological treatments of up to 10 hours. Low intensity treatments include:

brief CBT, including ERP, using self-help materials,
brief individual CBT, including ERP, by telephone, and
group CBT, including ERP.

If you have moderate OCD, your doctor should offer you the choice of either:

a course of SSRIs, or
arrange more intensive CBT, including ERP. The therapy should be one-to-one with a therapist.

You might have severe symptoms. Your doctor should offer you CBT including ERP, together with an SSRI.

What if these treatments don’t work?

If these have not helped, your doctor or therapist may suggest further treatment. This might be further psychological therapy or medication. Your doctor may offer you a different type of SSRI or an antidepressant called clomipramine. 

If these treatments still don’t work then you will be referred to a specialist OCD team. They should give you additional treatments, which might include:

having additional CBT with ERP or cognitive therapy,
taking an antipsychotic drug in addition to an SSRI or clomipramine,
taking clomipramine and a drug called citalopram at the same time.

Specialist OCD services

Further treatment by a specialist team may sometimes be necessary. This might happen if you've tried the treatments above and your OCD is still not under control. 

If you have severe, long-term OCD you may be referred to a specialist national OCD service. Especially if you have not responded well to the treatments available from local or regional services.

The following webpage from the NHS Choices website gives details of some specialist OCD services:

www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/treatment/

Cultural or religious guidance

OCD symptoms may sometimes involve a person's religion, such as religious obsessions or cultural practices. 

The boundary between religious or cultural practice and OCD symptoms might sometimes be unclear to healthcare professionals. The NICE guidelines say if they need to professionals might seeking the advice and support of an appropriate religious or community leader. But they should only do this with your consent. 

You can find more information about:

Talking therapies by clicking here.
Antidepressants by clicking here.
Antipsychotics by clicking here.

How can I get help and treatment?

To begin with you can:

See your GP, and
Get talking therapy.

Seeing your GP

You should make an appointment to talk with your GP if you are worried about your symptoms. Or they are causing problems in your day to day life. 

Your GP will look at different things when deciding on your treatment such as the following:

Your diagnosis and symptoms.
What options you have tried already.
Your goals and preferences.
Any other conditions you have.
Guidance from the National Institute for Health and Care Excellence (NICE).

The NHS should follow the NICE guidelines for the treatment and care of OCD. The guidelines aren’t legally binding. This means that your GP can decide not to follow the guideline. But they should be able to explain their decision to you.

Your GP might think your symptoms are severe. They might refer you to a specialist mental health team, like the community mental health team (CMHT). 

Getting talking therapy

You can access talking therapy by:

Contacting your local NHS talking therapy service. These are known as Improving access to psychological therapies (IAPT) services, or
Getting a private therapist.

You can find more information about:

GPs – what to expect from your doctor by clicking here.
Community mental health team (CMHT) by clicking here.
Talking therapies by clicking here.

What if I am not happy with my treatment?

If you are not happy with your treatment you can:

talk to your doctor about your treatment options,
ask for a second opinion,
get an advocate to help you speak to your doctor,
contact Patient Advice and Liaison Service (PALS) and see whether they can help, or
make a complaint.

There is more information about these options below. 

Treatment options

You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try. 

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment ask your doctor to explain why it is not suitable for you.

Second opinion

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

Advocacy

An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available. 

Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. 

You can get an NHS Complaints advocate to help you make a complaint against an NHS service. You can search online to search for a local advocacy service. 

The Patient Advice and Liaison Service (PALS)

PALS is part of the NHS. They give information and support to patients. You can find your local PALS’ details through this website link:

www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

Making a complaint

It is best to try and solve the problem with the team or doctor first. If this doesn’t help you can make a formal complaint. You can get an NHS Complaints advocate to help you make a complaint against an NHS
service.

You can find out more about:

Medication. Choice and managing problems by clicking here.
Second opinions by clicking here.
Advocacy by clicking here.
Complaining about the NHS or social services by clicking here.

Risks and Complications

What risks and complications can OCD cause?

Compulsions can take up a lot of your time. They can affect things like work, personal relationships and home life. For example, checking something repeatedly can take up hours of your day. 

If you have a fear of contamination, you may feel the need to clean or wash things multiple times. This could affect your day-to-day life. Washing yourself repeatedly could have physical effects, or you may be spending a lot of money on cleaning products. 

Hoarding can make it difficult to live in your own home comfortably. You may experience problems with hygiene. For example, mounting clutter can lead to rodent infestations. In extreme cases, hoarding items may become a safety risk due to fire or injury.

You might find it difficult to leave your house or to be in a clinic because of your OCD. A therapist may be able to visit you at home. Or offer you CBT over the phone. You should speak to your doctor or therapist if you need this sort of help.

Information for carers, friends and relatives

How can I get support?

You can speak to your GP. You should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health. And what support you need. 

You can get peer support through carer support services or carers groups. You can search for local carers’ groups and services on the Carers Trust website here:

https://carers.org/search/network-partners.

You can ask your local authority for a carer’s assessment if you need more practical and financial support to help care for someone. 

As a carer you should be involved in decisions about care planning. But you don’t have a legal right to this.

Support the person you care for

Supporting the person you care for You might find it easier to support someone with OCD if you understand their symptoms, treatment plan and self-management techniques. You could ask them to share this information with you. 

The person that you care for may also have a care plan. This outlines the care that they will get and who is responsible for it. A care plan should always have a crisis plan. A crisis plan will have information about who to contact if they become unwell.

You can use this information to support and encourage them to stay well and get help if needed. 

You can find out more information about:

Supporting someone with a mental illness by clicking here.
Getting help in a crisis by clicking here.
Suicidal thoughts. How to support someone by clicking here.
Responding to unusual thoughts and behaviours by clicking here.
Carers’ assessment and support planning by clicking here.
Confidentiality and information sharing. For carers, friends and family by clicking here.
Supporting someone with a mental illness by clicking here.
Benefits for carers by clicking here.

Useful contacts

OCD-UK

Supporting children and adults with OCD. Their phone line is staffed by volunteers and may not always be answered. They advise you to email if you cant get through.

Phone: 03332 127 890

Address: OCD-UK, Harvest Barn, Chevin Green Farm, Chevin Road, Belper, Derbyshire, DE56 2UN

Email via website: www.ocduk.org/contact-us

Website: www.ocduk.org

 

OCD Action

National charity focusing on OCD.

Phone: 0845 390 6232

Address: Suite 506-507 Davina House, 137-149 Goswell Road, London EC1V 7ET

Email: support@ocdaction.org.uk

Website: www.ocdaction.org.uk

 

Triumph Over Phobia (TOP UK)

A UK registered charity which aims to help people who experience phobias, obsessive compulsive disorder and other related anxiety. They do this by running a network of self-help therapy groups.

Phone: 01225 571740

Address: PO Box 3760 Bath BA2 3WY

Email: info@topuk.org

Websitewww.topuk.org

 

Hoarding UK

The UK national charity for people impacted by hoarding behaviours.

Phone: 020 3239 1600

Address: Suite 103 Davina House, 137-149 Goswell Road, London, EC1V 7ET

Email: info@hoardinguk.org

Website: https://hoardinguk.org/

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