Obsessive Compulsive Disorder: key facts
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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.
- If you make yourself regularly think the
troubling thoughts, you can control them better. 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
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. So you 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.
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.
SSRI antidepressants can help even if you are
not depressed. They can be used alone, or with CBT, for moderate to
severe OCD. If treatment has not helped at all after three months,
you can change to a different SSRI or to a medication called
How effective is the treatment?
Exposure and Response Prevention
About three out of four people who complete this are helped a
lot, but one in four will get symptoms again and will need extra
treatment. About one in four people are not able to cope with CBT –
they feel it's too difficult.
About six 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
Which approach is best for me?
Exposure and Response Prevention can be tried
without professional help. It is effective and has no side-effects
– but you do feel more anxious for a while. You do need to be
motivated and prepared for some hard work.
Moderate or severe OCD
- You could choose either CBT (up to 10 hours
of contact with a therapist) or medication (for 12 weeks) first. If
you are no better, then you should try both treatments
- If your OCD is severe, it's probably best to
try medication and CBT together from the start.
- Medication alone is an option if you don't
feel you can face the anxiety of Exposure and Response Prevention –
but there is more chance that the OCD will return. Medication has
to be taken for about a year.
This leaflet is made available through the
generosity of the Charitable Monies Allocation Committee of the
mental health charity St Andrew's, Northampton.
This is an abridged version of our main leaflet on Obsessive Compulsive
© November 2012. Due for review: November 2014. Royal
College of Psychiatrists. You can link to, download, print,
photocopy and distribute this leaflet free of charge. But you must
not change it or repost it on a website.
For a catalogue of public education materials or copies of our
leaflets contact: Leaflets Department
Royal College of Psychiatrists, 21 Prescot
Street, London E1 8BB, Telephone: 020 7235
Charity registration number (England and
Wales) 228636 and in Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our
advice on getting help.
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