Obsessive compulsive disorder (OCD) is a common long-term mental health condition which causes obsessive thoughts and compulsive behaviours.
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Find out more about the symptoms, treatment and management of the condition
OCD is a mental health condition that can affect both thoughts and behaviour. While it can develop in childhood, it usually emerges in early adulthood.
People with OCD experience obsessive and unwanted thoughts, images, or urges. They often deal with or neutralise these thoughts by engaging in compulsive and repetitive behaviours. This can lead to a cycle of repeated, uncontrolled and unwanted thoughts and behaviours that can have a significant impact on their daily lives. For example, a person with an obsessive fear of burglars may repeatedly and excessively check door and window locks.
Many people will experience similar distressing and unwanted thoughts and the urge to complete repetitive behaviours at some point, but this can be short-lived and doesn’t mean they have OCD. In OCD, the distressing thoughts and repetitive behaviours are persistent. People with OCD will continue to struggle with their obsessive thoughts, even if they know the ideas they reflect aren’t based in reality.
The compulsive behaviours that individuals use in response to their obsessive thoughts can temporarily relieve the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.
OCD is a single condition, but people may experience it in different ways. Most people with OCD tend to experience both obsessive thoughts and compulsions, but it is possible to just experience one without the other. In addition, the types of obsessive thoughts and compulsive behaviours will vary between individuals; for example, some people may focus on cleanliness while others may develop hoarding as a symptom.
Some experts think the OCD that begins in childhood differs from that which develops in adults. One study looking at pairs of twins showed that genes play a larger role in OCD that starts in childhood than in OCD whose symptoms begin in adulthood.
A study of OCD prevalence in people aged 20 and over in 17 major European countries estimated that there were 6.4 million cases in 2019, and forecast the 12-month prevalence in 2029 to range from 16 per 1,000 in Italy to 17 per 1,000 in Norway.
Worldwide rates of OCD have been estimated at 1.5% for women and 1.0% for men. Males are more commonly affected in childhood, although women have a slightly higher prevalence in adulthood., The condition affects people of all genders, ethnicities, and socio-economic statuses.
It’s important to remember that everyone experiences autism differently. Just like anyone else, autistic people have their own strengths and weaknesses, likes and dislikes.
People with OCD may have symptoms of obsessions, compulsions, or both. The symptoms can have a negative impact on all aspects of their life, such as work, school, college, and personal relationships.
OCD can cause people to experience repeated unwanted and distressing thoughts, known as obsessions. They may also feel the urge to complete certain repetitive behaviours to respond to and neutralise those thoughts; these are known as compulsions. Common symptoms include:
While some obsessive thoughts may be frightening for people with OCD, having these thoughts in no way means they will act on them.
Not all compulsions have an obvious or logical link to the obsessive thought they are used to neutralise; however, acting out the behaviour can provide the individual with some relief from that thought.
Some individuals with OCD may also have a tic disorder. These can include sudden repetitive movements such as blinking, grimacing, or jerking of the head or shoulders, or vocalisations such as repetitive throat-clearing, sniffing, or grunting.
OCD symptoms may come and go and may reduce or get worse over time. Treatments will help most people with the condition to manage their symptoms and reduce the impact on their day-to-day life.
Parents or teachers typically recognise OCD symptoms in children, while many adults will seek support when they realise their obsessive thoughts and behaviours are not based in reality and are affecting their quality of life.
In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.
People with OCD usually first display mild symptoms of obsessions and compulsions, which can worsen over time. Early signs can include repetitive behaviours and set ways of doing things, problems with relationships, and hoarding.
Often parents or teachers will first notice the early signs in children, which are similar to those in adults and may include being obsessed with germs, looking for reassurance or checking things constantly, and worrying that a particular thing might happen.
The exact causes of OCD are unknown; however, risk factors are thought to include genetics, the make-up of the brain, and the wider environment.
There are a number of possible causes of OCD. People may develop it as a result of their genes; those who have parents or siblings with OCD are at a higher risk of developing it themselves.
There could also be a connection between OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear, and research is continuing. Some people with OCD have areas of unusually high activity in their brain, or low levels of the chemical serotonin.
OCD may be more common in people who have been bullied, abused, or neglected, and can be triggered by an important life event such as becoming a parent or suffering a bereavement. It may also be more likely to develop in people who are highly methodical with high personal standards, or in those who are generally anxious with a very strong sense of responsibility for themselves and others.
In some cases, children may develop OCD symptoms following an infection with streptococcal bacteria – this is known as ‘paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections’ (PANDAS). PANDAS happens very suddenly, with symptoms appearing seemingly overnight, and has a very severe impact on the child’s life.
OCD can affect men, women, and children. Some people start having symptoms early – often around puberty – but the condition usually starts during early adulthood.
Women can sometimes develop OCD during pregnancy or after their baby is born. In this instance, obsessions will commonly relate to worry about harming the baby, with compulsions such as repeatedly checking the baby is breathing.
OCD is not life-threatening. Its impact can vary over time as the severity of the symptoms varies. The obsessive thoughts and compulsive behaviours may naturally reduce or increase at different times. Treatments and coping mechanisms can help people affected by OCD to manage the effects of the symptoms and improve overall quality of life in the longer term.
Most people are diagnosed by about age 19, with the onset of symptoms typically earlier in boys than girls. However, onset after the age of 35 can also occur.5
OCD must be diagnosed by an experienced mental healthcare professional. They will generally talk with the patient about their obsessions and compulsions, how often they occur, and the impact they are having on that person’s day-to-day activities and their quality and enjoyment of life overall.
Generally, for a diagnosis, the symptoms should be present for an hour or more each day and should be having a long-lasting impact on the patient’s life and activities.
Assessment scales may be used to measure the severity of OCD. The National Institute of Mental Health–Global Obsessive Compulsive Scale (NIMH-GOCS) can be used to assess overall OCD severity on a scale from 1 (minimal symptoms) to 15 (very severe), while the Yale-Brown Obsessive Compulsive Scale is used to measure the severity of symptoms of OCD, without being influenced by the type of obsessions or compulsions present. This scale is used by clinicians to rate symptoms from non-existent to extreme, with separate subtotals for severity of obsessions and compulsions.
Healthcare professionals will also need to rule out any other possible mental health conditions that may be causing the symptoms, and consider any other conditions the patient may have (for example, depression, anxiety, or an eating disorder) so that the right treatment is offered.
There are no physical tests that can be used to diagnose OCD. It is diagnosed through consultations with an experienced mental healthcare professional who can assess a patient’s thoughts, behaviours and their impact on daily life.
OCD can be distressing for the affected individual and those close to them; however, treatment can help manage the symptoms. This can both improve everyday life and help those affected to enjoy relationships and better social and leisure time.
OCD is typically treated with psychological therapy, medication, or a combination of both. Although most patients with OCD respond to treatment, some will continue to experience symptoms.
Sometimes people with OCD also have other mental disorders, such as anxiety, depression, or body dysmorphic disorder. These must be taken into account when discussing potential treatments.
A short course of therapy is usually recommended for relatively mild OCD. People with moderate symptoms may need a longer course of therapy and possibly medication, and most will respond to treatment. People with more severe OCD will generally receive both therapy and medication, and some may be referred for specialist mental health support.
While OCD can’t be prevented, its symptoms can be reduced through therapy and medication. Early identification and treatment can also prevent mild OCD worsening into a more severe form.
Research is ongoing into the efficacy of pharmacological interventions in OCD. A 2019 review of research into drug treatment found prolonged administration of SSRIs to be most effective and that combining the treatment with cognitive behavioural therapy (CBT) or exposure and response prevention (ERP) gives best results.
Other studies are underway into medications and other new treatment approaches that could be used for patients who do not respond to SSRIs, including combination and add-on treatments and deep brain stimulation.5 Some studies show that a type of surgery known as anterior capsulotomy can also be effective.,