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What is obsessive compulsive disorder (OCD)?
Obsessive compulsive disorder (OCD) is a specific type of anxiety disorder that involves obsessions and compulsions.
Obsessions can be thoughts, feelings, and/or urges. Most people (including people without OCD or any other anxiety disorder) have intrusive thoughts, feelings, or urges sometimes – including ones that are violent or upsetting. It’s very common and not something anyone needs to feel guilty or ashamed about.
But for people with OCD, these unwanted ‘obsessions’ are especially distressing or anxiety-inducing. This might be because they’re very repetitive, or because the person with OCD worries about whether their obsession means something about them (for example, whether they’re ‘dangerous’ or ‘mad’ or ‘bad’).
People with OCD usually try to help themselves cope with the distress their obsessions cause by doing (or thinking) something that brings relief. These actions and thoughts are called compulsions. When someone has OCD, their ‘compulsions’ become something they feel like they have to do – even if they’re getting in the way of their everyday life or hurting them.
Compulsions can be visible and obvious to other people, but some people with OCD keep their compulsions private, and they can also be invisible (for example, if they’re carried out entirely in someone’s head). Some people with OCD know that their compulsions don’t make logical sense, but they still feel that they have to do them.
Examples of obsessions and compulsions
Some people might find it difficult to read about specific examples of obsessions and compulsions, so take care of yourself and close this box if you don’t want to read further.
This list contains some common obsessions and compulsions, but they are just a few examples – it’s impossible to list all of the possibilities.
Obsessions might involve:
- Hurting other people – including having violent thoughts or images of yourself harming someone else, worrying you might hurt someone even though you don’t want to, or worrying that you’ve already hurt someone without realising
- Relationships – including worrying that people actually hate you, or worrying about whether a romantic relationship is ‘right’ or ‘real’
- Sexual thoughts – including ones related to children, family members, or sexually aggressive behaviour
- Contamination – including being physically contaminated by dirt, illness, dangerous chemicals or food poisoning (or spreading this to other people), or your thoughts becoming ‘contaminated’ and wrong
- Your identity – including your gender identity and sexuality, as well as being a ‘bad person’ or being discriminatory (for example, racist, homophobic, or transphobic)
- Your body – including obsessions about how you look, as well as obsessions around physical sensations like swallowing
- Bad things happening to you or someone else – including general bad things (like accidents and illnesses) as well as a general sense or feeling that something bad is going to happen
Compulsions might involve:
- Rituals – like doing something specific in the ‘right’ way or a certain order, using a specific pen (or colour of pen), or not being able to cross out a mistake and move on when you’re writing something
- Checking – like checking switches are turned off or use-by dates are ‘right’, checking how your body responds to a thought, checking for a memory of something, or trying to check how you feel
- Thoughts – like repeating something in your head, counting in your head, or trying to ‘replace’ thoughts
- Seeking reassurance – like repeatedly asking someone else to tell you if everything’s OK or if you’ve done something wrong, or apologising a lot
- Going over things in your head (rumination) – like trying to find the ‘real meaning’ of intrusive thoughts or researching OCD (or your experience of obsessions and compulsions) online
- Avoiding things – like removing sharp things from your house, not driving a car, or not visiting people who have babies
Some people who have OCD also doubt that they ‘really’ have OCD and worry that they’re actually a terrible person. Their compulsions around this obsession might involve seeking reassurance from their friends (or medical professionals), trying to ‘check’ their other obsessions, or spending lots of time researching OCD online, for example.
You can find more examples of obsessions and compulsions on the charity Mind’s website.
Mind – types and examples of obsessions
People with OCD often start to believe that compulsions might get rid of the anxiety they feel because of their obsessions, make the obsessive thoughts, feelings or urges go away altogether, or even stop things they worry about from happening.
While compulsions can temporarily reduce feelings of anxiety or distress, we know that the obsession comes back afterwards, and people’s feelings of anxiety and distress often return more intensely too.
This means that people can end up feeling ‘stuck’ in a loop or cycle where they feel unable to stop doing the same compulsions over and over again to cope with the distress and anxiety of their obsessions. This ‘stuck’ feeling is often scary or distressing in itself – and can add more anxiety to a situation that’s already difficult.
Symptoms and signs of OCD
It’s really common for everyone (including people without OCD or any other mental health condition) to experience intrusive thoughts, including ones that are violent or upsetting. This means that intrusive thoughts on their own are not a sign of OCD.
The symptoms of OCD are that you experience obsessive thoughts and compulsions. Your compulsions can be visible physical actions, or things you do inside your own head.
Is OCD about germs, tidying, or cleaning?
Despite common misconceptions, OCD is not about tidying or cleaning, or about putting things in order.
Some people with OCD do have obsessions and compulsions related to tidying and cleaning, but many people with OCD do not experience any distressing obsessions (or feel they need to carry out any compulsions) around tidiness or cleanliness.
And not everyone who spends a lot of time cleaning has OCD. Some people find mess or dirt stressful, but this is not the same as having OCD – and some people just like to be tidy.
How does OCD impact someone’s life?
How OCD affects day-to-day life
OCD is a really distressing mental health condition that can have a big impact on people’s day-to-day lives.
Obsessions can be scary, upsetting, and anxiety provoking. They can include people’s biggest fears, as well as things they find horrifying and disgusting. It can also be really isolating if you feel ashamed of your compulsions, or if it doesn’t feel safe to talk about them.
Obsessions (and the urge to carry out compulsions) can also make it really hard to concentrate at school, university, or work, as well as when you’re talking to other people.
Compulsions can be distressing, for example, when people feel like they have to do something over and over again until it feels ‘right’. They are often disruptive and take up lots of time that people would rather spend on doing other things and they can mean it takes longer for people to get ready or leave the house (and can make people late for things they care about).
Compulsions can also get in the way of people doing everyday things like spending time with friends, eating, sleeping or driving.
And sometimes compulsions can cause harm, for example, if someone feels they need to wash their hands even if their skin is dry and sore, or if they feel they have to seek reassurance from someone even though their reassurance-seeking is causing difficulties in the friendship.
How OCD affects relationships
OCD can affect your relationships with the people around you, including your parents or carers, other family members, teachers, or friends. The people who care about you often want to help you feel better – but if they help you engage in compulsions or avoid triggers, it often means they unintentionally reinforce your OCD and keep the cycle of obsessions and compulsions going.
This is understandable, especially if you’re really distressed or if they do not know much about OCD. It is not anyone’s fault – but recovery often involves talking to the people in your life about how they can support you without encouraging any OCD thoughts and behaviours.
How might someone who cares about you behave in ways that maintain your OCD without meaning to?
Some people might find it difficult to read about specific examples of obsessions and compulsions, so take care of yourself and close this box if you don’t want to read further.
If you have OCD, there are lots of ways in which someone trying to help you might (without realising it) encourage the OCD to get stronger. For example:
- If you’re worried about food poisoning, a carer might get into the habit of showing you the best before or use-by dates on all of your food before you eat. They might think this will help you to feel calmer and safer but without meaning to, they’re offering short-term relief while encouraging your focus on getting ill and the idea that you can stop this by checking things.
- If you’re worried about friendships, you might ask people for a lot of reassurance that they’re not angry with you or that you’re still friends. Your friends might want to reassure you everything is OK, because they think this will help you to feel calmer and safer but without meaning to, they’re offering temporary relief while encouraging you to keep worrying about your friendships and relying on other people to help you manage these worries.
- If you’re worried about causing harm when you use sharp things, a parent or partner might get into the habit of cooking for you or cutting your food up. They might think this will help you to feel calmer and safer but without meaning to, they’re encouraging the idea that you using a knife to chop food will lead to something bad or dangerous happening.
These are just examples and will not apply to everyone in the same way – there might be other reasons, not related to OCD, that some people need support with reading food labels or using sharp objects, for example.
How do you know if you have OCD?
People are diagnosed with OCD by a medical professional. Who this is can depend on things like your age, as well as your specific experiences.
Diagnosing mental health conditions in young people is often more complex than diagnosis in adults. Generally, young people are referred to a more specialist service, where professionals can spend a bit more time getting to know them and understanding everything that’s going on in their life.
Whichever medical professionals you speak to, they diagnose people using diagnostic criteria – specific guidelines about the signs and symptoms that mean someone has OCD, rather than any other mental health condition.
To do this, they will talk to you about your symptoms – they might ask you to fill out some questionnaires that ask you about how often you experience certain symptoms too. You might also talk about anything you think might be contributing to your obsessions or compulsions.
You can use a lot of the information on self-care for OCD regardless of whether you have a diagnosis. Lots of techniques for managing OCD can be helpful for everyone who struggles with obsessions and compulsions, whether they have a diagnosis or not.
What causes OCD?
There is no simple explanation about what causes OCD. Most of the time, it’s likely that a combination of different things contribute to someone developing OCD.
Childhood experiences
Going through difficult experiences when you’re a child or young person, and the distress that they cause, might be part of the reason someone develops OCD. People often think of ‘difficult experiences’ as a big, traumatic event. But going through multiple smaller difficult experiences can also have a big impact.
Life events
Almost everyone will experience some things that are stressful or upsetting (like a relationship ending, work stress, or someone they love dying) at some point. For some people, these stressful situations may trigger OCD or make it harder to manage symptoms that they already have.
Family history
Research suggests that people with a close family member with OCD are more likely (but not certain) to develop it too. We don’t know how much of this is due to biology (like genes inherited from your parents) and how much is due to your family being around you as you grow up and learn how to cope with the world. If genes are involved, it’s likely that it’s much more complex than one single gene causing OCD.
Treatment and looking after yourself if you have OCD
Treatment for OCD
Treatment for OCD might include talking therapies such as cognitive behavioural therapy (CBT) with exposure and response prevention. For some people, it might include medication.
Why does therapy for OCD involve facing your fears?
Firstly, therapists and counsellors don’t expect people to ‘just’ stop carrying out compulsions – and they don’t force people into their worst-case scenarios.
In therapy, people can gradually build up to allow their obsessions to exist without carrying out compulsions. If you experience multiple obsessions and compulsions, you’ll usually start with the one that feels least distressing.
If someone’s compulsion is around doing something in the same way until it feels ‘right’, for example, they might start by slightly changing the thing they’re doing or limiting how many times they do it (even if it doesn’t feel ‘right’).
With support (and time), people can reduce or limit their compulsions while experiencing a lower level of anxiety or distress that doesn’t last as long. They can then move on to the next step (for example, trying to avoid doing the compulsion altogether).
At the same time, people might talk about their obsessions and compulsions with their therapist. They often learn and practise skills (like grounding techniques or breathing exercises) to help them cope as well.
Looking after yourself if you have OCD
As well as getting professional support (or while you’re waiting for support) there are things people can try to help them cope with having OCD.
Remember that intrusive thoughts are common
It can be helpful to remind yourself that most people experience intrusive thoughts, including ones they find distressing. Your thoughts do not reflect who you are or what you believe, and having a thought does not mean you will act on it.
Try to accept your thoughts
We can’t control our thoughts, so while it’s understandable to want to ‘get rid of’ thoughts that are upsetting or distressing, it often just makes them stick around or feel ‘louder’. Some people find it helpful to label these thoughts as intrusive thoughts, or to imagine them as coming from an unhelpful character they’re going to ignore.
Talk to someone you trust
It can make a big difference for a trusted adult to understand how you’re feeling. They might be able to help you use some of the other tips on this list, for example, helping distract you or suggesting a grounding exercise.
Take care of yourself and your body
Often, people find it harder to cope with obsessive thoughts (and avoid compulsions) if they’re tired or hungry. It can be difficult to focus on self-care if you’re struggling with OCD, but even small changes can make a difference to how you feel.
Breathing and grounding exercises
There are lots of different breathing and grounding exercises, so you can experiment and find one that works for you. It’s a good idea to practise them before you feel anxious or distressed.
The five ways to wellbeing
Adding activities based on the five ways to wellbeing to your life can be a positive distraction, as well as giving you opportunities to challenge your anxiety and prove it wrong.
Explore safe distractions
Some people find that it’s helpful to have ways of distracting themselves from difficult obsessions or the urge to carry out compulsions. You might need to try different things to see what works for you, like arts and crafts, exercise, or watching a favourite TV show.
Be mindful about researching OCD
If you’re struggling with obsessions or compulsions, it’s understandable to want to find out more about OCD – and it can be helpful to be informed. But some people find that spending lots of time reading about OCD (or other people’s experiences) makes it more difficult to manage their own symptoms.
Self-soothe boxes
Self-soothe boxes are full of items that help you feel calmer so you can think about your options and choose a healthier way of coping.
How to get more help if you have OCD
Emergency?
If anyone is in immediate danger, call 999 now.
If you need urgent help for mental or physical health, call NHS 111 or get help from NHS 111 online.
If you think you may have OCD (or have a diagnosis but are struggling to manage), the first step is to speak to an adult you trust. This might be a parent or carer, teacher, youth worker, or GP.
Together, you can make a plan so that you get the support you need to cope.
The charity OCD UK has made a free leaflet you can use to help you speak to your GP. Because obsessions of a violent or sexual nature can be especially difficult to talk about, there is also a version of the document that focuses on these sorts of obsessions to help people speak to their GP and get the help they need and deserve.
OCD UK – Support for talking to a GP about OCD
If you’re not sure where to start or want to practise talking about OCD before you have a conversation with an adult in your life, you might find it helpful to contact NATTER.
Text NATTER for help
Anyone can text ‘NATTER’ to 85258 to seek
help, wherever they are in the UK. It’s a free, anonymous service and available 24/7.
More about NATTER
How to help someone else with OCD
Emergency?
If anyone is in immediate danger, call 999 now.
If you need urgent help for mental or physical health, call NHS 111 or get help from NHS 111 online.
If someone you care about has OCD, it can be difficult to know how to support them. As well as being a good friend and including them in the things you do, there are some things you could try to help them.
Learn about OCD
If you learn more about OCD, people with OCD don’t have to spend as much time raising awareness. It also means you can better understand what’s going on for them, which can be helpful if they do something you find difficult, like often asking you for reassurance.
Listen to what they tell you
Everyone has their own experience of OCD, so it’s really important to listen to people if they want to tell you what it’s like for them. You don’t have to understand their OCD (or their feelings) to know that their experience is very real for them. It’s OK to ask how you can help, too, or if there’s anything you need to know about how they communicate.
Help them to be kind to themselves
If someone with OCD is struggling with something, you can show them that you understand it’s hard, while encouraging them to use any strategies they have to take care of themselves. Celebrating their ‘little wins’ is also a great way to show support.
Do normal ‘friend stuff’
When someone’s struggling with their mental health, spending time together talking about shared interests (or doing a hobby you both enjoy) can help them feel more like themselves again. This might mean continuing to invite someone to do stuff, even if they’re not always able to say yes, or choosing to spend time doing activities that they find less stressful.
Support them to get more help
You could offer to go with them to speak to a trusted adult or help them decide who they could talk to. It can be difficult for people to open up, but speaking to an adult they trust is often the first step towards them getting the help they need.
Should I reassure someone with OCD or help them to check things?
Sometimes, people with OCD ask the people around them to help them carry out compulsions, for example by asking them to check things or asking them over and over again for reassurance.
It can be really difficult to know how to manage this, as it’s natural to want to help someone you care about when they’re anxious or distressed, while not wanting to feed into the obsessive-compulsive cycle of OCD.
Lots of people find it helpful to talk to their friend or family member with OCD when things are calmer, to agree how you’ll manage these situations together. For example, you might agree that you’ll say: ‘I care about you, and I understand you’re struggling, but I’m not going to answer that because I want to help you recover from OCD’.
You could also agree that you’ll take a different approach – for example, suggesting a distraction you could do together, or reminding them of ways of coping they find helpful.
You might need to work towards being able to do this, especially if it’s a change to how you’ve responded before. This might mean reducing how often you give them reassurance, how long you spend reassuring them, or waiting a set amount of time before you offer any reassurance.
It’s also understandable if you sometimes support their compulsions, especially if things are very stressful, you’re really worried about them, or if you do it without realising. If this happens, it can be helpful for you to then show your friend that you’re there to help them continue to work towards recovery after a setback.
Supporting other people
Find more information about supporting others, including how to ask someone if they’re OK, how to listen, and understanding boundaries and responsibility.
There’s also support if you’re a young carer, and tips for looking after yourself while supporting someone else.
