What is OCD?

This information is taken from our book Overcoming Obsessive Compulsive Disorder.

Obsessive Compulsive Disorder (OCD) involves a pattern of persistent thoughts or repetitive actions, or both, which can disrupt daily life.

What are obsessions?

Obsessions are persistent, intrusive thoughts, images, or urges that are difficult to ignore. These thoughts often cause significant distress or anxiety. They may seem illogical, but the emotional impact is real, and it can be hard to focus on anything else.

Common obsessions include fears about contamination—whether from germs, dirt, or harmful substances. This often leads to compulsive cleaning or excessive hand washing in an attempt to eliminate the perceived threat.

Another frequent obsession is the fear of accidentally causing harm or danger. You might feel the need to check that doors are locked or that appliances are turned off, repeatedly, to ensure safety.

Obsessions can also involve violent, sacrilegious, or sexual thoughts. Some individuals find it difficult to express these thoughts, but avoiding situations that might trigger anxiety is a common coping strategy.

What are compulsions?

Compulsions are actions that individuals feel compelled to repeat to reduce the anxiety caused by their obsessions. These repetitive behaviors are often seen as rituals. Even though the actions are voluntary, they can feel almost uncontrollable. Common compulsions include:

  • Repetitive checking to prevent feared situations, such as ensuring that appliances are off
  • Excessive washing or cleaning to remove contamination
  • Repeated reassurance-seeking to confirm that feared events won’t occur
  • Counting or touching objects in specific ways to avoid a feared event
  • Arranging or organizing objects to reduce anxiety, even if it causes delays
  • Frequent confessing or questioning others to relieve distress
  • Hoarding unnecessary or old items out of fear of needing them in the future

In some cases, people may also experience mental compulsions, which involve repetitive thoughts or actions in the mind, aimed at neutralizing negative thoughts or intrusive images.

How widespread is OCD?

Approximately 1% of the population, or about 1 in 100 individuals, experiences OCD. The disorder is slightly more prevalent in women than in men. Some famous figures who struggled with OCD include:

  • Howard Hughes, the wealthy businessman obsessed with contamination
  • Martin Luther, the religious leader who battled obsessive thoughts
  • John Bunyan, the writer of *Pilgrim’s Progress* who also faced OCD-like symptoms

When Does OCD Start?

OCD can begin during childhood, though it is more commonly first seen in the teenage years or in early adulthood. Many people with OCD, however, may not seek help for years after the condition first emerges.

What Triggers OCD?

From a psychological perspective, OCD can develop when a person learns to avoid certain situations and uses compulsive behaviors to relieve anxiety, which only reinforces the cycle. Individuals with OCD often feel an exaggerated sense of responsibility, believing they can control or prevent negative events from happening. This belief is frequently combined with a tendency to expect the worst-case scenario and an intense need for certainty that bad events won’t occur.

From a biological standpoint, some families may have a genetic tendency toward anxiety, which can make it more likely for OCD to run in the family. Stressful life events or significant changes can trigger the onset of OCD. Once the disorder takes root, the brain overcompensates by trying to regulate itself, leading to changes in serotonin levels, though these changes are thought to be consequences rather than causes of the condition.

What Are the Additional Symptoms of OCD?

People with OCD often experience feelings of shame and hopelessness due to their symptoms, and many may also suffer from depression.

OCD is also commonly associated with a number of related conditions, including:

  • Trichotillomania: An irresistible urge to pull out hair, including from the scalp or eyebrows.
  • Hypochondriasis: A persistent fear of having a serious illness despite lack of medical evidence.
  • Body Dysmorphic Disorder: An overwhelming concern with perceived flaws or defects in appearance.
  • Tourette’s Syndrome: A neurological condition characterized by involuntary vocal and motor tics.

How Impactful is OCD?

The severity of OCD varies greatly from person to person. In some cases, the condition can be debilitating, making it difficult to hold down a job or maintain family relationships. Individuals with OCD who have employment or family obligations often find that their lives would be significantly more fulfilling if they didn’t have to deal with the symptoms. Additionally, family members may also become involved in rituals and suffer as a result of the disorder.

What Treatments Are Available?

There are two primary treatments that have proven to be effective for OCD: Cognitive Behavioural Therapy (CBT) and antidepressant medication. Of these, CBT is typically considered the most beneficial approach.

Cognitive Behavioural Therapy

According to NICE guidelines, there are two main CBT techniques recommended for treating OCD. The first is cognitive-behavioral therapy with exposure and response prevention. This method is rooted in understanding the psychological mechanisms that maintain the condition.

During therapy, the therapist may work with you to address the inflated sense of responsibility, magical thinking, and the need for guarantees regarding the risks of exposure, as well as the criteria you use to decide when to stop performing compulsive behaviors.

The goal of treatment is to help you face your fears (through a process called “exposure” or a “behavioral experiment”) without performing a ritual (“response prevention”). This involves learning to relinquish control, resist compulsions, and tolerate the discomfort that arises.

At first, confronting your fears may feel difficult, but over time, it becomes easier to manage the anxiety. You will begin with less challenging situations and progressively move on to more difficult ones. In the short term, the side effects are anxiety and distress, but these tend to decrease as you continue with the process. For those who follow the treatment, around 75% experience significant improvement. However, there is a 25% chance of relapse, which may require further treatment.

It is important to note that there is no strong evidence supporting the effectiveness of psychodynamic therapy, analytical therapy, or hypnotherapy for treating OCD.

Support Groups for OCD

In the UK, many support groups are available for individuals with OCD, which you can find listed on the OCD Action website.

Seeking Support

If you or someone you know is struggling with OCD, it’s important to seek professional help. Discussing your concerns with a GP is a good first step, and they can refer you to a specialist for assessment and treatment. We are a practice specializing in OCD and related disorders. If you’re seeking help, contact us here.