Intrusive thoughts that cause distress and repeated rituals to relieve them. OCD is common, often hidden out of shame, and effectively treatable.
People with OCD usually know that their thoughts or rituals are excessive. But knowing is not enough to stop them.
What it is
Obsessive-compulsive disorder is characterised by obsessions, compulsions or both. Obsessions are intrusive, unwanted thoughts, images or urges that cause anxiety or discomfort. Compulsions are repeated behaviours or mental acts performed to relieve that discomfort or prevent something feared.
The relief is temporary and reinforces the cycle: the more the obsession is answered with the ritual, the stronger it tends to become.
ObsessionAn intrusive thought that causes anxiety.
CompulsionA ritual that brings brief relief and reinforces the cycle.
Treatment breaks this cycle: learning to tolerate discomfort without turning to the ritual.
How it presents
fear of contamination, with repeated washing or cleaning;
persistent doubts, with repeated checking of doors, cookers or messages;
a need for order, symmetry or doing things «the right way»;
intrusive thoughts with aggressive, sexual or religious content, experienced with great distress;
mental rituals, such as counting, praying or repeating phrases;
avoidance of situations that trigger the obsessions.
Intrusive thoughts do not mean desire or intention. They are experienced precisely as alien and contrary to the person’s values.
It is not perfectionism
Liking order or being demanding is not OCD. In the disorder, thoughts and rituals take up significant time, cause suffering and interfere with work, relationships or daily life.
Assessment
The assessment characterises the type of obsessions and compulsions, the time they take, the degree of insight and their impact, and looks for associated conditions such as depression, other anxiety disorders or tics. Specific scales help measure severity and follow the response to treatment.
Treatment
cognitive behavioural therapy with exposure and response prevention: the first-line psychological treatment;
medication: some antidepressants are effective in OCD, often at higher doses and with a slower response than in depression;
combination: in more severe cases, psychotherapy and medication together are usually the best option.
No. Almost everyone has occasional intrusive thoughts. In OCD, the thoughts are persistent, very distressing and lead to rituals or avoidance that take up time and limit life.
Can OCD be cured?
With appropriate treatment, most people improve significantly. In many cases symptoms become mild and manageable; follow-up helps prevent relapse.
How can I help a family member with OCD?
Avoid taking part in rituals or giving repeated reassurance, even when asked, and encourage an assessment. Family members can be involved in treatment.
References
National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). 2005.
This page is for information only and does not replace an individual medical assessment. Clinical review: Pedro Zuzarte, psychiatrist · Published and reviewed: .