OCD (obsessive compulsive disorder)

What is OCD?

OCD is an often misunderstood mental health condition. Misleading stereotypes lead a lot of people to believe that those who experience OCD focus on making things neat and tidy. OCD is far more complex. It can have a significant impact on those who experience OCD, making their day-to-day life difficult, as well as affecting those close to them.

Previously considered an anxiety disorder, OCD is now considered to be an obsessive-compulsive and related disorder, as while anxiety can be common for those with OCD, it is not always central. Some people with OCD may experience feelings of disgust, guilt, or a sense of things not feeling 'quite right'. It's the cycle of obsessions and compulsions, rather than a single emotion, that defines OCD. 

In this video, counsellor David Levy explains more about OCD and how therapy can help. 

The exact number of people affected by OCD in the UK isn’t known. According to OCD UK, around 750,000 people in the UK have OCD. The Royal College of Psychiatrists (RCPSYCH) says around one in 50 people will experience OCD at some point in their lives. That's around 1 million people in the UK. 

OCD is made up of two main parts: obsessions and compulsions. These are connected in a cycle. But what are obsessions and compulsions? And how do they affect someone with OCD?

Symptoms of OCD: Obsessions and compulsions 

OCD affects everyone in different ways. However, there are patterns of behaviour and thoughts caused by OCD that you may be able to spot the signs of.

The 4 key components that contribute to OCD 

1. Obsession - an intrusive, persistent and uncontrollable thought that enters your mind.
2. Anxiety, distress, discomfort or doubt - you start feeling stressed, anxious, distressed, uncomfortable, or start doubting yourself due to the obsession.
3. Compulsion - you find a compulsive need to exercise repetitive acts or behaviours. This is because of the stress or anxiety that the obsession has caused.
4. Temporary relief - temporary relief from the stress or anxiety gained through the compulsive behaviour. This cycle repeats when the obsession returns, usually soon after.

If you’re worried and these symptoms sound familiar, you may have OCD. Speak with your GP. They can help signpost you to access a formal diagnosis. They can also help you learn about the treatment and support options available in your area. If you are over 18, you can self-refer to NHS talking therapy services in your area. If you are under 18, the NHS shares how to get mental health support for children and young people.

Obsessions

Obsessions are when intrusive thoughts become very hard to manage. Affecting your daily life, they can make you feel very distressed. Obsessions can encompass a wide range of different things. These can include:

• unwelcome thoughts or feelings
• images that keep coming to mind
• urges
• worries, or doubts

It can feel like they are stuck in your mind, lingering or returning no matter what you do. You might worry about what they mean, why you keep thinking about them, or why they won’t stop. They might make you feel distressed, worried, or even scared. You might feel shocked by these thoughts or feelings, and may feel that you have to hide them. Remember: Obsessions are not a reflection of you or your personality. People with OCD are very unlikely to act on their distressing thoughts.

Compulsions

Compulsions are things that you do, over and over, to try and reduce how distressed or uncertain obsessions are making you feel. These repetitive things can be something physical, like checking to see if a door is locked or the oven is turned off. Or it could be something you do mentally, like repeating a certain word to yourself or counting things a certain number of times. Compulsions can be something you do by yourself or that you involve others in. For example, you might repeatedly ask someone to reassure you that they saw you lock the door, or that something will be OK. 

It can be difficult to figure out why you have OCD, even when you know that your obsessions are involuntary. The intrusive thoughts you experience are often rooted in deep-seated fear. For example, if you have intrusive thoughts about hurting someone, this is likely to be something you are most scared of happening.

Compulsions are a coping mechanism. If you have OCD, you use these to try to ‘prevent’ the things you worry about from happening. So, for example, you might worry about harming a close friend. You may then have a compulsive behaviour that OCD convinces you will stop this from happening. It’s not the behaviour or action stopping you from acting. However, the thought of not doing this action or behaviour is very difficult for those with OCD, ‘just in case’.

You may be aware that your worries and fears are irrational, but you may feel unable to control them. The more you try to fight them, the more prominent they become.

Compulsive behaviours are often very structured and become a routine. It might feel like it’s your responsibility to do certain things to stop something bad from happening. While this gains a sense of relief, it is only temporary, leading to the cycle repeating. 

For example, someone without OCD may switch off a light without thinking anything more of it. Someone with OCD symptoms surrounding checking may feel the need to switch the light on and off a certain number of times. This is because OCD has convinced them that this will stop the house from catching fire. 

OCD in children and young people

Symptoms of OCD can start at any time. According to the NHS, children as young as six can start having symptoms of OCD. However, OCD symptoms in young people are more likely to begin around puberty and early adulthood.

Young people with Tourette's syndrome may be more likely to experience OCD. While 1% of us will experience OCD, 35% of young people with Tourette's syndrome show obsessive-compulsive tendencies. 

Young people with OCD may try and hide their symptoms at first, but if they become harder to control, it can be easier to spot the signs. For example, a student may need to write their work in a specific way or arrange their things. They may check their school bag over and over again, or make sure all the taps are turned off or check light switches. Their schoolwork may be directly affected. For example, they may feel the need to reread their homework over and over, destroy written work, or repeat tasks until they are 'perfect'.

A child or young person experiencing OCD may refuse to go to school, frequently be late, seem easily distracted or have trouble concentrating. They may feel anxious when away from family, show signs of low self-esteem, or have difficulty getting on with their classmates. Teachers might report that they frequently ask to leave the classroom or have trouble sitting for long periods of time. Their handwriting might also be poor, and they may have trouble with consistent or flexible thinking. 

Categories of OCD

Most cases of OCD fall under four main categories: checking, hoarding, contamination, or intrusive thoughts/ruminations. There are many different types that fall under each sub-category. 

Checking

You might feel the need to compulsively check things to stop something bad from happening. Some common fears people with OCD can experience include checking:

• water taps out of fear of flood damage to their home or things
• appliances, light switches or lamps, out of fear of an electrical fire
• locks (car, front or back door, windows) out of fear of things being stolen
• gas cookers, appliances or canisters out of fear of explosions
• their wallet, purse, bag or phone from fear of losing personal belongings
• re-reading emails, texts, or letters out of fear of making mistakes or writing something offensive 

Different people have different experiences with OCD. For example, how many times does someone check something to ‘neutralise’ the obsession. One person may check a few times, while another may need to check a few hundred times. It could take seconds, minutes, or hours. Checking can affect other areas of your life, including your personal relationships and your career. 

Hoarding

Hoarding is the compulsion to have and keep things to an excessive degree, which affects your day-to-day life. Unlike collecting, where you want to keep items of personal or monetary value, hoarding is more disorganised. You might find yourself keeping items even if they are damaged or others consider them to be rubbish. Hoards can be physical (clothing, paperwork, containers) or digital (data such as emails or photos). Hoarding can also include living things like animals. 

Hoarding becomes a problem when it starts to interrupt your daily life. For example, if your clothing hoard ends up covering your bedroom so you have nowhere to sleep. Keeping more animals than you can reasonably care for can become overwhelming and impact their welfare, and your own can be another kind of hoarding. Another example can be if you have so many things in your home that you feel ashamed or unable to let others visit.

Contamination

This is an obsessive fear that you need to wash or clean something to avoid contamination, contracting germs, or getting ill. This could include surfaces (e.g. needing to clean a countertop over and over), or people (e.g. needing to sanitise or wash your hands after touching someone). This fear can make being in crowds, using public toilets, shaking hands, or touching surfaces (door handles, bannisters, elevator buttons) difficult. 

Ruminations and/or intrusive thoughts

Rumination refers to long periods of thinking about a theme or question, often with a religious or philosophical context. A common example can be fixating on what happens after death. 

Intrusive thoughts are often obsessional, prolonged, and troubling. Someone with OCD may have intrusive thoughts about causing harm to a loved one, sexually or violently. However, those with OCD are usually the least likely to act on them, as they find them so distressing in nature. Common intrusive thoughts can revolve around relationships, sex, and religion.

With OCD, there’s always a thought in the back of your mind. I know that nothing bad will happen if I don’t do my rituals, but I have to do them - just in case.

- Read Calli's story.

Frequently asked questions about types of OCD

What is ‘Pure O’?

‘Pure O’ stands for ‘purely obsessional'. It is a term sometimes used by those who experience intrusive thoughts without showing any external compulsions. Some people may think this means that they do not experience any compulsions. However, they may experience mental compulsions (such as checking physical sensations) without realising.

While pure O is a term that some people who have OCD use, it can be a confusing and misleading term. Pure O is not a term used in the medical community and is not a diagnosis in itself. As explained by OCD UK, “Pure O is a term commonly used to refer to a form of obsessive compulsive disorder which people mistakenly believe has no outward compulsions. But does ‘Pure O’ exist? As an online term, yes, but as a form of OCD, not really, it’s merely a phrase.”

Treatment used to help someone who feels they have 'Pure O' is the same as someone with OCD who outwardly exhibits compulsions.

What is perinatal OCD?

Perinatal OCD is a type of OCD you may experience during pregnancy or the first year after giving birth. Many people worry about their baby’s well-being and want to protect them. Perinatal OCD is when your thoughts and worries start to affect your daily life and well-being. Perinatal obsessions can vary from person to person, but some examples can include:

• intrusive thoughts about hurting your baby
• fear of giving your baby a serious disease or illness
• fear of making the wrong decisions about vaccinations or medical treatments
• disturbing thoughts of sexually abusing your child

Thoughts can be very upsetting and frightening, but having these intrusive thoughts does not mean you want to act on them, or that you will act on them. Perinatal compulsions can include:

• excessive cleaning of clothes, bottles or toys
• keeping your baby away from others in case they get hurt or contaminated
• repeatedly checking on your baby in a way that is disruptive (e.g. waking them up to check on them)
• repeatedly seeking reassurance that your baby hasn’t been hurt or abused.

What is relationship obsessive compulsive disorder (ROCD)?

Relationship OCD (also known as ROCD) is a type of OCD centred around relationships. It can involve a lot of questioning about your relationship, and can affect your self-esteem and the relationship itself. Counsellor Tracy Foster (Dip.Couns, Dip. CBT Registered) explains more.

"Relationship obsessive compulsive disorder (ROCD) can be extremely distressing and confusing, causing you to obsessively question whether your partner is right for you, whether you love them enough, and whether they love you enough. You are constantly searching for the answer to that thought or that action that will relieve the distress of this type of thinking."

What is POCD?

Pedophilic obsessive compulsive disorder (POCD) is a subtype of OCD and not an indication of personal character or intentions. POCD is a specific fear of being a paedophile. Those with POCD worry that intrusive thoughts might lead them to do something, even if they are convinced they never would. This fear can be consuming and can lead to shame and fear of seeking support. These feelings are all part of OCD, as OCD Therapist Carina Palmer explains:

“It's important to realise that no matter how real all this feels, it's part of the OCD pattern. OCD takes you to the very worst place for you. Whatever you find most abhorrent in the world is where it wants you to go."

What causes OCD?

There are many different theories about what causes OCD; however, the NHS highlights that the exact cause(s) of OCD are not known, but there are several factors that may contribute. Research suggests that OCD may be influenced by both personal experiences and biological factors. If you had a painful childhood or went through trauma, abuse, discrimination, or bullying, obsessions and compulsions might have developed as a way of coping with the anxiety caused by those experiences.

Related factors that might increase the chances of OCD developing can include:

• Family and genetics. It’s thought that, in some cases, OCD may be inherited. If a parent or family member had similar anxieties and showed similar compulsive behaviour, you may also have learned OCD behaviours as a way of coping. 
• Stress, anxiety, and life events. Ongoing experiences like stress and anxiety can trigger OCD, or make existing OCD harder to manage. Other events, like pregnancy or giving birth, can trigger perinatal OCD. If you experience a period of increased responsibility, such as following the birth of a child, the death of a loved one, or starting a new job, you may develop symptoms of OCD. 

Other mental health conditions, such as depression, can make symptoms of OCD worse, rather than being a cause of OCD.

OCD treatment

A number of different treatments are recommended to help manage the symptoms of OCD and how they impact your life. The main types of treatment offered at the moment in the UK by the NHS include:

Talking therapy

Cognitive behavioural therapy (CBT) is most typically recommended. CBT can help you change the way you think and behave, and often has a quick effect. 

Exposure and response prevention therapy (ERP) is a type of CBT recommended by The National Institute for Health and Care Excellence (NICE). ERP exposes people to situations or things which make them feel anxious or frightened in a controlled setting with the support of a therapist. Rather than avoiding the situation or repeating a compulsion, this can help you to learn other ways of coping with these feelings of anxiety and fear.

Medicine

Antidepressant medicine (selective serotonin reuptake inhibitors, or SSRIs) is most commonly prescribed. These can help by changing the balance of chemicals in your brain. They can take up to 12 weeks to notice changes.

A combination of CBT and SSRIs may be offered by the NHS, as well as other alternative medications. Some areas may offer specialist mental health services for further treatment. 

How counselling can help with OCD

CBT (cognitive behavioural therapy) that includes ERP (Exposure and Response Prevention) is recommended to help with OCD. This approach can be particularly effective as Therapist Eleanor Pickett, MBACP (Accred), Dip CBT, explains. 

“The most effective treatment for OCD is CBT with ERP. CBT helps you notice the patterns between your thoughts (or cognitions) and behaviours and how these make you feel. ERP then takes this further by helping you face the fears triggered by intrusive thoughts while resisting the urge to carry out compulsions.”

Therapy gives you a safe, judgement-free space to talk openly and without fear of how others will react. You can speak with a therapist about how OCD may be affecting your daily life, how you feel, your relationships, and those around you. Having the chance to speak to someone openly can be a relief in itself, and can help to remind you that you aren’t alone.

Through counselling, you can begin to recognise and challenge unhelpful ways of thinking and behaving. A therapist can help you learn practical tools to reduce compulsions and challenge intrusive thoughts. They can help you to start to gently expose yourself to areas that may cause discomfort or distress, in a supportive environment. 

Further help

• OCD UK
• OCD Action
• TOP UK - The OCD and Phobia Charity

Find a counsellor for OCD

Ready to start looking for a qualified, experienced therapist who can help support you with managing OCD? Many therapists and counsellors offer support online, by phone, or in-person sessions. This makes it easier for you to help you access the help you need. Use our search below to find an online or local counsellor near you.