Understanding Obsessive
Compulsive Disorder (OCD)

See also: What is Anxiety?

Obsessive compulsive disorder (OCD) is a mental health condition characterised by obsessive thoughts and compulsive behaviours. This means that you have unwanted and often unpleasant thoughts, images or ideas that recur repeatedly, and which are hard to banish. These are accompanied by an urge to carry out a particular behaviour or behaviours to relieve the unpleasant feelings brought on by the thoughts.

OCD can be very distressing, and can also have a significant impact on life. However, with the right treatment and support, you can learn to keep it under control. This page explains more.

What is OCD?

OCD as a condition is distinguished by having obsessive thoughts and carrying out compulsive behaviours.

In practice this means that people with OCD have:

  • Unwanted and usually unpleasant thoughts, ideas or images that keep entering their mind, and which are hard to banish. These differ from everyday ‘unpleasant thoughts’ in the degree of their intrusiveness: obsessive thoughts generally make it hard to think about anything else.

  • Unpleasant feelings such as disgust or fear, which are caused by the obsessive thoughts, and often give rise to distress or anxiety;

  • A strong urge to carry out certain repetitive behaviours as a way to relieve or get rid of the feelings induced by the obsessive thoughts. However, the relief is usually only temporary, meaning that the cycle keeps repeating.

Generally, people with OCD experience both the obsessive thoughts and the need to carry out the compulsive behaviours. However, one or the other may be more obvious to them and others.

The thoughts or ideas vary considerably between people, but there are some common patterns. Many people worrying about harming themselves or someone else such as a child. Fear of harming people by mistake is also quite common, as is fear of disease or germs, and a need for order.

The behaviours are often superficially connected to the thoughts, but in reality, either excessive, or only peripherally a genuine solution. For example, people who have obsessive thoughts about infections or germs may feel the need to wash their hands a lot, particularly when they come into contact with anything that they think may be dirty, such as a pet. This handwashing is often excessive.

Compulsive behaviours also fall into distinct and common categories, like the thoughts. They include checking, ordering items, seeking reassurance, hoarding, cleaning or handwashing, counting, and thinking other thoughts to neutralise the obsessive ones.

OCD can affect anyone: adults, children, men and women. Sometimes symptoms can start from as young as about 6 years old, but more often they first appear during puberty or in early adulthood. The label OCD is only used if the obsessive thoughts cause distress or affect your quality of life. However, even within that description, OCD can be more or less severe. Many people also find that the symptoms get worse when they are under stress or pressure, and the thoughts and behaviours may also change over time.

No joke!


People often joke about OCD, describing themselves as ‘a little bit OCD about hand-washing’ or similar.

However, OCD is no laughing matter. It is a serious mental health condition, and can have severe effects on your well-being, as well as your general ability to function. If you think that you may have OCD, it is a good idea to see a GP and talk to them. They can refer you to specialist mental health services.

Causes of OCD

As with many mental health conditions including depression and anxiety, we do not know very much about what causes OCD. However, we do know that there are various factors that may make developing OCD more or less likely, including:

  • A family history of OCD. If there are other people in your family with OCD, you are more likely to develop it. This may be learned behaviour, or it may have a genetic element.

  • Particular patterns of brain chemistry. Some people who have OCD seem to have unusual areas of high activity in their brain, and also low levels of serotonin, a brain chemical.

  • Particular life events. OCD often starts after particular life events, such as having a baby, or being bereaved. It may also be more likely in people who have been bullied, abused or neglected.

  • Certain personality traits. People who are very neat and tidy, meticulous and methodical, and who have high personal standards are more likely to develop OCD. It is also more likely in people who are generally a bit anxious or have a strong sense of responsibility.

OCD can come and go at different stages of life. For example, women sometimes develop OCD after having a baby, with obsessions often centring around keeping the baby safe, checking that they are still breathing or repeatedly sterilising bottles.

Treatments for OCD

There are two main treatments for OCD:

  • Talking therapy, usually cognitive behavioural therapy, which focuses on helping you to manage your fears and thoughts without the use of the compulsive behaviours; and

  • Medication, particularly antidepressants called selective serotonin reuptake inhibitors (SSRIs), which help to rebalance the chemicals in your brain. There are also other antidepressants that may be used if SSRIs are not effective.

Possibly surprisingly, the effects of cognitive behavioural therapy are likely to be seen fairly quickly. However, it may take up to three months before the effects of the medication appear. Most people eventually receive benefit from one or the other, or possibly a combination of the two.

It is important to get effective treatment as early as possible. People with OCD who do not get treatment may develop other, more severe, mental health conditions such as anxiety, depression, an eating disorder, or a hoarding disorder. If you are worried about someone with OCD, it is important to encourage them to seek professional help.



Supporting People with OCD

Mental health charities such as MIND suggest several ways that friends and families can support people with OCD. These include:

  • Finding out more about OCD. Ignorance is definitely not bliss when it comes to OCD. It is a good idea to educate yourself to find out more about it if you are concerned about a friend or family member. However, it is important to be aware that each person’s experience of OCD will be slightly different.

  • Talking to the person about their OCD. You can educate yourself about the condition in a general way, but only the person concerned can tell you about their personal experience. Talk to them about it, and more importantly, listen to what they say without judgement. Ask them how you can best help them to overcome their OCD, and what will best support them. However, it is a good idea to do this when they are calm, as they will be better able to make rational suggestions and requests then.

  • Don’t accommodate or support their compulsions. This may sound counter-intuitive, but you should not give in to or support compulsive behaviour. For example, resist the temptation to check things for them, reassure them repeatedly, or help them avoid distressing activities. Over time, this can make the compulsions stronger, because they feel that if someone helps them, they must be in need of help, which validates both the thoughts and compulsive behaviours.

  • Instead, help them to manage their compulsions. Agree on an approach (for example, saying “We’ve agreed I won’t do that to help you manage your OCD”). Encourage them to challenge their compulsions where this is appropriate. Try to not give reassurance, including through logic. This may be effective in the short term, but will be counter-productive in the longer term.

  • Find distractions to help them to overcome compulsions. Suggest doing something, such as going for a walk together, or doing some cooking. You may need to start and let them join in.

  • Acknowledge their feelings but don’t support the compulsive behaviour. This can be very powerful, because it makes clear that you recognise how they feel, but you won’t help with the compulsion. It can help them to ‘sit with’ their distress and accept (and therefore overcome) it.

  • Be kind—to both them and you. OCD is hard on everyone, and it is important to be compassionate to the person more directly affected as well as to yourself, as someone around them. Don’t beat yourself up if you give in to the urge to help them by feeding the compulsion, and don’t get cross with them when they can’t overcome the compulsion either.

If you are worried about someone you know who you think may have OCD, you may find it helpful to read our guest post on supporting someone with OCD.

And Finally...

OCD is a difficult and challenging mental health condition.

It is hard for the person affected, and it is also hard for those around them. It is really important to seek help—and that includes support for friends and family members too, if they are affected by someone else’s OCD.


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