Obsessive Compulsive Disorder: key facts
What is Obsessive Compulsive Disorder?
We can all be obsessive about certain things
at times, but if:
- you get awful thoughts coming into your mind,
even when you try to keep them out
- you have to touch or count things or repeat
the same action like washing over and over
you may have Obsessive Compulsive Disorder
Who gets OCD?
About one in 50 people have OCD at some point
in their lives. OCD usually starts in the teens or early twenties.
It tends to get better and worse over time, but people often don't
seek help for many years.
What are the signs and symptoms of
- Recurring thoughts - 'obsessions' - that make
you anxious. These can be unpleasant words or phrases, pictures in
your mind or doubts.
- The things you do over and over again -
'compulsions' - that help you to feel less anxious. You may
try to correct or ‘neutralise’ obsessional thoughts by
counting, saying a special word, checking or doing a ritual,
over and over again.
What causes OCD?
Many factors might play a part:
- OCD is sometimes inherited, so it can run in
- Stressful life events bring it on in about
one in three cases.
- Life changes - when you have to take on more
responsibility, such as puberty, the birth of a child, or a new
- If you have OCD for a long time, some experts
think that an imbalance of a brain chemical called 'serotonin'
(also known as 5HT) may be involved.
- You are a neat, meticulous, methodical person
– but go too far.
- If you have particularly high standards of
morality and responsibility, you may feel bad when you have
unpleasant thoughts. So, you watch out for them – which makes
them more likely to happen.
- You may be able to control the troubling
thoughts if you record them, with a microphone or on paper, and
then listen back to them or re-read them. You need to do this
regularly for around half an hour every day. At the same time,
try to resist the compulsive behaviour you feel like doing.
- Don't use alcohol to control your
- If your thoughts involve worries about your
faith or religion, talk it over with a religious leader to help you
work out if it is an OCD problem.
- Try a self help book.
- Exposure and Response Prevention
This helps to stop compulsive behaviours and
anxieties from strengthening each other.
We know that if you stay in a stressful
situation long enough, you gradually become used to it and your
anxiety goes away. With this type of therapy, you will
gradually face the situation you fear (exposure), but stop yourself
from doing your usual compulsive rituals, checking or cleaning
(response prevention), and wait for your anxiety to go away. You
may find that learning to use relaxation techniques can help you
to resist the rituals and reduce your anxiety. This type of
therapy woks best for the mild OCD, and can also be done without a
therapist, using a self-help book if you are motivated and prepared
for some hard work.
Instead of trying to get rid of your thoughts,
it helps you to change your reaction to them. It particularly
targets unrealistic self-critical thoughts. This is useful if
you have obsessional thoughts, but do not perform any rituals or
actions to make yourself feel better. It can be used with exposure
and response prevention (ERP).
SSRI antidepressants can help even if you are
not depressed. Medications can be useful in combination
with CBT if your OCD is severe, or you have not felt better
with one type of treatment on its own. If medication treatment
has not helped at all after three months, you can change to a
different SSRI or to a medication called 'clomipramine'.
How effective is the treatment?
About 3 out of 4 people who complete this are helped a lot,
but 1 in 4 will get symptoms again and will need extra
treatment. About 1 in 4 people are not able to cope with
Cognitive Behavioural Therapy (CBT) as they feel it's too
About 6 out of 10 people improve with
medication and their symptoms reduce roughly by half. Medication
does help to prevent OCD coming back for as long as it is taken,
even after several years. Unfortunately, about half of those who
stop medication will get symptoms again in the months
afterwards. This is less likely when medication is combined
For more in-depth information see our main
leaflet: Obsessive Compulsive
This leaflet reflects the most up-to-date evidence at the time
Produced by the RCPsych Public Education Editorial Board.
Series Editor: Dr Philip Timms
Reviewed by Dr Amy Green
© January 2014. Due for review: January 2016. Royal College of
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