OCD: obsessions, compulsions, causes and treatment options explained

Most people double-check a lock or like things tidy now and then. OCD is different: the thoughts and actions feel impossible to control, take up a lot of time and cause real distress. This article explains the condition using information from the NHS, the US National Institute of Mental Health and MedlinePlus.

1. Introduction

The NHS describes OCD as a mental health condition with obsessive thoughts and compulsive behaviours. It can affect men, women and children, and symptoms can begin as early as age 6, though they often start around puberty or early adulthood ^[1]. The National Institute of Mental Health defines it as uncontrollable, recurring thoughts, repetitive and excessive behaviours, or both, and says it usually begins between late childhood and young adulthood ^[2]. MedlinePlus stresses that OCD is more than a liking for neatness ^[3].

2. Obsessions and compulsions

• Obsessions are unwanted, unpleasant thoughts, images or urges that keep returning and cause anxiety, disgust or unease ^[1].
• Compulsions are repeated actions or mental acts that a person feels driven to do to ease the distress caused by an obsession. The relief is only temporary ^[1]. An example from the NHS is checking doors and windows many times before leaving home ^[1].

MedlinePlus lists common obsessions such as fear of germs, fear of losing things, worry about harm coming to oneself or others, unwanted thoughts about sex or religion and a need for things to be lined up exactly. Common compulsions include excessive cleaning or handwashing, repeated checking of locks and appliances, counting and arranging items ^[3].

The NHS also describes perinatal OCD, which can start in pregnancy or after birth, for example fears of harming the baby and repeated checking that the baby is breathing ^[1].

3. How doctors recognise OCD

MedlinePlus says symptoms usually count as OCD when a person cannot control the thoughts or actions even though they know they are excessive, spends at least an hour a day on them, gets no pleasure from the behaviour and has significant problems in daily life ^[3]. Many people with OCD also have a mood or anxiety disorder ^[2]. OCD can be hard to tell apart from other conditions, so a health professional assesses it ^[3].

4. Causes and risk factors

The exact cause is unknown. The NHS lists possible contributors ^[1]:

• family history, which may reflect genes or learned behaviour
• differences in brain activity or low levels of serotonin, a brain chemical messenger
• life events such as bullying, abuse, neglect, childbirth or bereavement
• personality traits such as high standards or a strong sense of responsibility

MedlinePlus adds a close relative with OCD, especially one who developed it in childhood or the teens, and childhood trauma as risk factors. It also describes PANDAS, in which OCD-like symptoms follow a streptococcal infection in some children ^[3].

5. Diagnosis

According to MedlinePlus, a provider usually starts with a discussion, a physical examination and a review of medical history to rule out other causes, and may refer you to a mental health specialist ^[3]. The NHS says you can refer yourself to a talking therapies service or see a GP, who can refer you to a specialist mental health team if needed ^[1].

6. Treatment and management

The National Institute of Mental Health says available treatments can help people manage symptoms, take part in daily activities and improve quality of life ^[2]. Your doctor will advise what suits you.

• Cognitive behavioural therapy (CBT). The NHS says CBT helps people face their fears and obsessive thoughts without carrying out compulsions, and that it often works fairly quickly ^[1]. MedlinePlus describes exposure and response prevention, a form of CBT that gradually exposes a person to feared situations while they learn healthy ways to cope with the anxiety ^[3].
• Medicines. The NHS says selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are usually used. They can take up to 12 weeks to show effects, and most people eventually benefit ^[1]. If the first choice does not help, your doctor may try another option or a combination ^{[1, 3]}. Never stop a medicine without medical advice.
• Brain stimulation. MedlinePlus says repetitive transcranial magnetic stimulation, which uses magnetic pulses on brain areas linked to OCD, may be suggested for severe OCD that does not improve with other treatments ^[3]. The National Institute of Mental Health lists brain stimulation among current treatments ^[2].

The NHS notes that OCD is unlikely to get better without proper treatment and support ^[1].

7. Self-help and support

The NHS suggests joining a support group, talking to others with OCD and using charities that can help you find local groups. If you are worried about someone, you can encourage them to seek help, since OCD is a health condition and there is nothing to be ashamed of ^[1].

8. When to see a doctor

See a doctor if unwanted thoughts or compulsions keep happening and affect your daily life ^[1]. For people under 18, the NHS points to separate mental health support for children and young people. For perinatal OCD, speak with your doctor or health visitor ^[1]. People with OCD often also have a mood or anxiety disorder ^[2], so tell your doctor if you feel hopeless or very low. If you are in distress or having thoughts of suicide or self-harm, reach out for help right now. In India, call Tele-MANAS on 14416. In the United States, call or text 988. You do not have to cope alone. In the United States, the National Institute of Mental Health also advises calling 911 in life-threatening situations ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

OCD is a health condition made up of obsessions, compulsions or both. Talking therapy, especially CBT, and medicines are the main options, guided by a doctor. Asking for help is nothing to be ashamed of.