Obsessive-compulsive Disorder (OCD)

Woman washing her hands

OCD is characterised by obsessive thoughts and by compulsive actions, such as cleaning, checking, counting or hoarding. The sufferer can become trapped in a pattern of thoughts and behaviours that are time consuming, distressing and hard to stop.

An 'obsession' is an unwanted thought, image or urge that repeatedly enters a person's mind. A 'compulsion' is a repetitive behaviour or psychological act that a person feels compelled to perform, even against their will.

Compulsions can make it very difficult for a person with OCD to tolerate work, public places or take part in social relationships.

Amongst the top 10 most debilitating illnesses identified by the World Health Organisation (WHO), obsessive-compulsive disorder is thought to affect 2 to 3 percent of the UK population. In men, OCD symptoms typically start during adolescence. In women they tend to start a little later, usually in the early 20's although symptoms can start at any time, including during childhood.

Do you have the symptoms of OCD? Find out with our free assessment, the Obsessive Compulsive Inventory (OCI).

The symptoms of OCD can range from mild to very severe. Some people with OCD will spend less than an hour each day engaged in obsessive-compulsive thinking and behaviour, while for others the symptoms can completely dominate their lives. Sufferers often try to keep their compulsive behaviours hidden from others rather than risk the embarrassment of being seen as 'odd' or 'different'.

Unlike some forms of compulsive behaviour, for example addiction to drugs or gambling, a person with OCD usually gets no pleasure from their compulsive behaviour. Compulsions are felt as a burden. Some people feel they need to carry out their compulsion in order to prevent the fear associated with their obsession becoming realised - for example, a person who is obsessed with the idea that they might catch a serious disease may feel compelled to wash their hands again and again after touching something used by other people. OCD is 'ego dystonic', meaning that the disorder is incompatible with the sufferer's view of themselves. Because disorders that are ego dystonic contradict an individual's perception of his or herself, they often cause a great deal of distress.

Obsessive-Compulsive Personality Disorder (OCPD), on the other hand, is 'ego syntonic', meaning the individual accepts that the symptoms of the disorder as being in accord with his or her self-image. A person with OCPD is likely to view their compulsive cleanliness as a 'necessary precaution', and so believe themselves to be 'justified' in carrying out their compulsive rituals.

Ego syntonic disorders cause little or no distress. Persons suffering from OCD are often aware that their behaviour is not rational and are unhappy about their obsessions, but nevertheless feel compelled to perform them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational and it is often very difficult to convince them otherwise.

Typical features of OCD

Jo     'I'm afraid of catching germs from other people. I spend hours cleaning my house and wash my hands upwards of twenty times a day. Most days I try not to go out if I can help it. When my husband comes home from work I ask him where he's been, in case he's been somewhere dirty like a hospital. I guess I realise these fears are just silly, but it's gone on for so long now that I can't stop, even though everyone's sick of me'.

Mike     'I have to check everything all the time. It can take me an hour just to get out of the house because I'm never sure I've turned off the electrics and locked the doors and windows. Then I check to make sure that the gas fire is off several times, but if it doesn't feel right I have to check everything all over again, just to make sure. If I miss something out, I have to start checking all over again from the beginning. At work I check everything several times in case I have made a mistake. I have to re-open envelopes to check letters I've written in case I've made a mistake. If I don't check I feel worried and panicky. It's ridiculous I know, but I just can't help it.

Dawn     'I'm afraid I'll hurt my baby. I don't want to, but bad thoughts just keep coming into my head over and over again. I can see myself losing control and stabbing her with a knife. I can see the blood and everything. The only way I can get these thoughts out of my head is to say a prayer over and over. I usually feel a bit better after that, but just in case I've hidden all the knives. I think I'm a horrible person, I must be going mad.

Colin     'I'm married but I cant stop thinking that I might be gay. It started when I was 16, I saw a boy in the church and thought he looked pretty. After that I couldn't get the thoughts out of my mind. Thoughts of us doing things together, awful things. They make me feel sick. I was shocked, I have a girlfriend, but we've been rowing and I thought it must be because I was homosexual. I don't fancy boys, I think, but I keep seeing images all the time. I don't think I'm gay but I keep seeing such strange things and thinking dirty thoughts. I wish I could get these thoughts out of my head'.

Common features of OCD

  • Thoughts - words, phrases or rhymes that are unpleasant, shocking or blasphemous. You might try not to think about them, but they won't go away. You worry that you might be contaminated (by germs, dirt, or a serious illness), or that somebody might be hurt because you've been careless about something.
  • Pictures in your mind - Seeing your family dead, or seeing yourself doing something out of character, violent or perverse, for example stabbing or abusing someone or being unfaithful. We know that people with obsessions do not tend to become violent, or act on these thoughts.
  • Doubts - you wonder whether you might have caused an accident or misfortune to someone. You may worry that you have knocked someone over in your car, or that you have left your doors and windows unlocked
  • Ruminations - you endlessly argue with yourself about whether to choose one thing or another, so much that making the simplest decision can become almost impossible.
  • Perfectionism - you're bothered, in a way that other people aren't, if things are not in the exactly the right order, not equal, not 'balanced' or not in the right place. For example, if books are not lined up perfectly on a bookshelf.
  • Correcting obsessional thoughts - you think 'neutralising' thoughts like counting, praying or saying a special word over and over again. It feels as though this prevents bad things from happening and makes you feel a bit better.
  • Rituals - you wash your hands often, do things really slowly and carefully, perhaps arrange objects or activities in a particular way. This can take up so much time that it can take ages to go anywhere or do anything useful.
  • Checking - your body for contamination, that appliances are switched off, that the house is locked or that your journey route is safe.
  • Avoidance - of anything that is a reminder of worrying thoughts. You might avoid touching certain objects, going to certain places or taking risks. For example, you may avoid the kitchen because you know there are sharp knives there.
  • Hoarding - of useless or worn out possessions. You might find you just can't throw anything away.
  • Reassurance - you repeatedly ask others to tell you that everything is going to be alright, that nothing bad will happen.
  • Body dysmorphic disorder - you might become convinced that part of your face or body is the wrong size or shape, and spend hours in front of a mirror checking and trying to cover it up. You may even stop going out in public.
  • Trichotillomania - you might have the urge to pluck your hair or eyebrows, or pull your hair out with your fingers.

What causes OCD?

We don't know for sure, but it seems that some people have a genetic predisposition to developing OCD, which can be 'triggered' by things that happen in their lives.

  • Genes: OCD is sometimes inherited so can run in families.
  • Stress: Stressful life events particularly those which make us feel 'out of control' seem to bring on OCD in about one out of three cases.
  • Life changes: Times where someone suddenly has to take on more responsibilities - for example, puberty, the birth of a child or a new job can make us more at risk of developing OCD.
  • Brain changes: We don't know for certain, but if you have the symptoms of OCD for more than a short time, researchers think that an imbalance of a chemical called serotonin (also known as 5HT) develops in the brain.
  • Personality traits: If you are a neat, careful person with high standards you may be more likely to develop OCD. These qualities are normally helpful, but can develop into OCD if they become too extreme.
  • Ways of thinking: All of us have upsetting thoughts or images from time to time - 'what if I stepped out in front of that car?' or 'I might kill someone'. Mostly we dismiss these ideas. If we have especially high standards of morality and responsibility, we may feel that it's terrible to have these thoughts at all, and so become alert and on the lookout for their return - which makes it all the more likely that they will. Psychologically speaking, we tend to get what we try to guard against.

What keeps OCD going?

Some of the ways in which we try to help ourselves can work against us, and actually keep OCD going:

  • Trying to banish unpleasant thoughts from the mind usually only makes the thoughts return. Try not to think of Michael Jackson for the next minute - you may find your thoughts keep returning to him.
  • Rituals, checking, avoiding and seeking reassurance can all make us less anxious for a little while. However, every time we do them we strengthen the unhelpful belief that they stop bad things from happening - so we feel more pressure to do them. We can easily get into a vicious circle.
  • Thinking 'neutralising thoughts' - if we spend time 'neutralising' a negative thought with another thought (for example, counting to ten or reciting a prayer) we can come to depend on the ritual, which can then become more of a problem than the thought or the image it was meant to replace.

Helping yourself

  • Notice your troubling thoughts. It may sound odd, but it's a way of getting more control of them. Don't try to 'crowd them out' with other thoughts, simply notice them and practice letting them go. Repeatedly distract yourself from them, time and time again. If you find yourself dwelling on some unhelpful thought, keep distracting yourself from that thought with something more interesting. This is simple, but not easy to do.
  • Resist the compulsive behaviour, not the obsessional thought. Do not alleviate your anxiety by giving in to the rituals if you can at all help it. Face the fear down, feel your anxiety peak and learn ways of soothing yourself other than by performing rituals.
  • Don't use alcohol to help control your anxiety, or you risk ending up making your problems worse.
  • Speak to a religious leader if your thoughts involve worries about your faith or religion. This can sometimes be helpful in working out if this is an OCD problem.

OCD without overt compulsions

'OCD without overt compulsions' is sometimes referred to as 'pure-O'. Rather than engaging in observable rituals and compulsions, the person with 'OCD without overt compulsions' engages in all manner of internal neutralising behaviours (i.e. thoughts which are 'hidden' or 'inner compulsions').

Intrusive thoughts may involve thoughts about hurting oneself or others, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or car, harming a child or some other vulnerable person or urges to push another person in front of a train or car.

What these thoughts have in common is that they are abhorrent to the person experiencing them, who often feels tortured by these thoughts or images.

The likelihood that people suffering from intrusive thoughts will ever act on those thoughts is very, very low; people who feel intense guilt, anxiety and shame over 'bad thoughts' are very different from the type of person who actually acts on their 'bad thoughts'.

However if you are concerned in any way about intrusive thoughts or images, it's best to discuss your thoughts with a mental health professional, who should be able to put your mind at rest.

Thanks for reading to the end,

Best wishes to you

Steve Cottrell

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Page last updated:  Monday, January 4, 2016