Obsessive-compulsive disorder (OCD) has two main parts: obsessions and compulsions.
You might find that sometimes your obsessions and compulsions are manageable, and at other times they may make your day-to-day life really difficult. They may be more severe when you are stressed about other things, like life changes, health, money, work or relationships.
Although many people experience minor obsessions (such as worrying about leaving the gas on, or if the door is locked) and compulsions (such as avoiding the cracks in the pavement), these don’t significantly interfere with daily life, or are short-lived.
If you experience OCD, it's likely that your obsessions and compulsions will have a big impact on how you live your life:
Obsessions are persistent thoughts, pictures, urges or doubts that appear in your mind again and again. They interrupt your thoughts against your control, and can be really frightening, graphic and disturbing. They may make you feel anxious, disgusted or uncomfortable.
You might feel you can't share them with others or that there is something wrong with you that you have to hide. You might feel upset that you are capable of having such thoughts.
You might experience more than one type of obsession. They are often linked together. For example you might experience a fear of contamination and a fear of doing someone harm by accidentally making them ill.
Compulsions are repetitive activities that you feel you have to do. The aim of a compulsion is to try and deal with the distress caused by obsessive thoughts.
You might have to continue doing the compulsion until the anxiety goes away and things feel right again. You might know that it doesn't make sense to carry out a compulsion - but it can still feel too scary not to.
Repeating compulsions is often very time-consuming and the relief they give you doesn't usually last very long.
Pure O stands for 'purely obsessional'. People sometimes use this phrase to describe a type of OCD where they experience distressing intrusive thoughts but there are no external signs of compulsions (for example checking or washing). The name is slightly misleading as it suggests that there are no compulsions at all.
If you have Pure O you will still experience mental compulsions but you might not be aware of them. Because they are not as obvious as physical compulsions, it can sometimes be difficult to define exactly what these compulsions are.
Here are some examples of internal compulsions:
You might find that some activities, objects or experiences make your obsessions or compulsions worse. For example if you are worried that you might stab someone then you might avoid the kitchen because you know there are knives there.
Sometimes it might feel easier to avoid situations that mean you have to do a compulsion. For example if you have to do a long and time-consuming ritual every time you leave the house, you might just decide it's easier to stay indoors. But avoiding things can have a major impact on your life.
There are different theories about why OCD develops. None of these theories can fully explain every person’s experience, but researchers suggest that these are likely to be involved in causing OCD:
Even though we don't fully understand what causes OCD, it can still be successfully treated.
Some theories suggest that OCD is caused by personal experience. For example:
Some research suggests that people with certain personality traits may be more likely to have OCD. For example, if you are a neat, meticulous, methodical person with high standards, you may be more likely to develop OCD.
Some biological theories suggest that a lack of the brain chemical serotonin may have a role in OCD. However, it's unclear this is the cause or is an effect of the condition.
Studies have also looked at genetic factors and how different parts of the brain might be involved in causing OCD, but have found nothing conclusive.
There are a number of things you can do to help you through the OCD and these could include:
The first step to getting treatment for OCD is to visit your GP. Your GP will ask about your symptoms and discuss different treatment options.
The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – suggests that treatment for OCD should include talking treatments and medication.
The combination of treatments you are offered depends on how severe your OCD is, and what treatments have worked or not in the past. If you feel a treatment isn’t working for you, it’s a good idea to discuss this with your GP, as there may be other alternatives available.
You may be offered the following talking therapies for OCD, either on their own, or along with medication
Cognitive behavioural therapy (CBT) focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour.
Exposure and response prevention (ERP) is specifically designed for OCD. It encourages you to confront your obsessions and resist the urge to carry out compulsions.
During ERP, your therapist will support you to deliberately put yourself in a situation that would usually make you feel anxious. Instead of performing your usual compulsion, you will be encouraged to try and tolerate the anxiety.
ERP helps you to see that the uncomfortable feelings will eventually go away even if you don't perform a compulsion.
This type of therapy can be challenging and may make you feel more anxious at first. It’s a good idea to talk to a health care professional before you start about what it involves, and whether you are in a good place to start it.
Cognitive therapy focuses on identifying and changing negative feelings about yourself, to help you change unhelpful responses and behaviours.
You may be offered the following medications for OCD, either on their own or alongside talking therapy:
Different people find different medications helpful. You can talk to your doctor about your options – you might find you need to try out a few different types of medication before you find one that works for you.
Depending on how your OCD impacts your life, you may be eligible for social care. Social care services support people who struggle to manage day-to-day activities.
If your OCD is very severe and the above treatment options have not helped, you may be referred to a specialist OCD service. Unfortunately, not all areas have specialist services and you might have to travel outside your local area.