Obsessive-Compulsive Disorder (OCD)
What is obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder (OCD) is a mental health condition that is categorised as a type of anxiety disorder.
People with OCD often go through cycles of obsessive or intrusive thoughts, followed by repetitive behaviours called compulsions.
What are obsessive or intrusive thoughts?
Obsessive or intrusive thoughts are unwanted thoughts that repeatedly enter your head. They can be difficult or even impossible to ignore and may completely occupy your mind, preventing you from thinking about other things.
Having these thoughts may be stressful, upsetting or disturbing. They can cause a great deal of anxiety, guilt, shame, or other negative feelings.
What are compulsions?
Compulsions are actions and behaviours that someone performs repeatedly in order to relieve the negative feelings they have from their obsessive thoughts.
Compulsions may be thoughts or actions such as:
- Replaying certain memories in their mind to make them feel better
- Repeatedly checking something
- Performing certain rituals to maintain extremely high levels of cleanliness
False-beliefs about obsessive-compulsive disorder (OCD)
False belief: “A person with high standards of hygiene or tidiness must have OCD”
OCD is poorly-understood by many people. It is commonly portrayed in the media as a condition where a person has high standards of hygiene or tidiness.1 However, this is not an accurate representation of OCD.
False belief: “Everyone with OCD is obsessed with germs and tidiness”
A person with OCD may have severe symptoms that aren’t in any way related to germs or tidiness. OCD is actually often highly distressing for the person who is experiencing it. Therefore, it should never be belittled or treated as a joke.
False belief: The term “OCD” can be used as an adjective
It is also common to use “OCD” as an adjective to describe personal preferences. For example, someone may casually say “I’m OCD about handwriting” if their handwriting is quite neat. However, this is an incorrect use of the term “OCD”.1
False belief: “People with OCD just don’t know how to cope with anxiety”
Another common misconception is that people with OCD simply haven’t learned to live with normal levels of anxiety in life. However, people with OCD experience far higher than normal levels of anxiety, and cannot just “snap out of it”.
OCD is a mental illness that often requires therapy, support and sometimes medication. Without treatment, sufferers may experience a significant impact on their lives.
What does OCD feel like?
A person who has OCD becomes very fixated on their worries or intrusive thoughts. The obsessive thoughts they have are followed by compulsions, which are certain actions they perform to reduce the anxiety caused by their obsessive thoughts.
After someone performs an action to address their worries or intrusive thoughts, their mind feels temporarily reassured and relieved. However this does not usually last long. The anxiety they felt before often comes back and casts doubt on the short period of reassurance they had. This causes their obsessive thoughts to come back over and over again, and continue through a cycle of reassurance and worry, as shown below:
As the cycles of obsessions and compulsions repeat themselves, the anxiety can become worse. It may reach a point where the intrusive thoughts feel very real to the person experiencing them, and reassurance becomes more of a struggle to achieve.
In severe cases, it can be difficult or impossible for the person with OCD to distinguish reality from the OCD-driven thoughts.7
OCD & Stigma
People who have OCD often feel that their condition is heavily stigmatised. This is due to the fact that:
- OCD is poorly-understood in general, and is often portrayed inaccurately in the media.1
- Friends and family may not understand the levels of anxiety being experienced by the person who has OCD.
- People who have OCD symptoms relating to themes such as sexual imagery or violent thoughts may feel too ashamed to seek help.8 This can result in feelings of loneliness.
For all of the above reasons, it is important to raise awareness of OCD as a condition. This will help those who are experiencing symptoms to recognise that they may be suffering from OCD, and encourage them to seek support and treatment.
What are the different types of obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder is a complex illness, with a number of different subtypes.
People with OCD may have symptoms of only one subtype, or they may have symptoms of many. It is very common for people with OCD to have symptoms of more than one subtype of OCD.7
The disease can also change across a person’s lifetime.
Many people believe that OCD focuses on cleanliness – but this is not true. OCD can focus on anything a person’s mind can think of. Some of the different subtypes of OCD are detailed below:
People with checking OCD repeatedly, or compulsively, check things such as door locks, light switches or appliances.
The impulse to repeatedly check things is driven by cycles of anxiety and doubt over whether or not a necessary action has been performed. For example, a person with checking OCD might go through the following cycle:
- They lock the front door as they leave the house.
- They may then begin to question whether or not they actually remember locking the door.
- They may then feel the need to return to check if they locked the front door.
This triggers an obsessive-compulsive thought cycle around locking the door, which results in repeated checking of a specific action, potentially over a long period of time.7
Checking OCD can cause significant anxiety and take up a large amount of the sufferer’s time or energy. A person with these symptoms may be late to work regularly due to checking and rechecking something hundreds of times.
People with symptoms of contamination OCD may perform rituals to maintain extremely high levels of cleanliness. This is often driven by an obsessive fear of becoming ill from germs.
People with this subtype of OCD may clean themselves and their environment to an extreme and unhealthy degree. For example, they may:
- Wash their hands excessively
- Refrain from shaking other people’s hands
Avoid places or situations that they believe may pose a risk of contamination, for example, using public toilets or eating food prepared by other people.10
This is a subtype of OCD that also revolves around an internal feeling of uncleanliness.
Sufferers of mental contamination OCD may feel the compulsive urge to wash or decontaminate themselves in response to an emotional trigger, rather than a physical one. For example, a person with mental contamination OCD may ritualistically take a shower after they experience something stressful such as conflict at work.
People with hoarding OCD find it difficult or are unable to throw away old, worthless items such as magazines, empty packaging and even food. Items that people with hoarding OCD hold on to may be kept in a very disorganised, cluttered manner.10
This type of OCD can cause discomfort and disruption in the person’s home. In severe cases, the person’s home may even become a safety hazard.
With rumination OCD, a person may become lost in chains of thoughts that are unproductive but are anxiety-driven.
These thoughts may include things like continuously going through mental checklists to ensure tasks are completed, or spending extended periods of time replaying past events and scrutinising details of memories.
Rumination generally occurs in all forms of OCD, but people with rumination OCD may experience it as their main symptom.7 It can take up a significant amount of mental energy and time, leaving the person exhausted and drained.7
A person with intrusive thoughts will experience unwanted, distressing and often vivid thoughts. They can involve any topic, but many people with intrusive thoughts find that they centre around “taboo” or distressing topics. Some of the more widely recognised types of intrusive thoughts may focus on:
- Romantic relationships
- Believing that their thoughts may influence real-world events.
A person with intrusive thoughts OCD may experience vivid fears that their own intrusive thoughts may influence real-world events. For example, they may fear that if they imagine their car crashing, it will crash. This is sometimes called magical thinking.
A person with intrusive thoughts relating to violence might imagine themselves losing control of the car and harming themselves or someone they love (sometimes these are described as “killer thoughts”). In reality, these thoughts are unwanted and the person does not have the intention or desire to harm anyone.
Other common themes of obsessive-compulsive disorder
Whilst OCD may focus on anything, there are certain themes people commonly experience. For example, some people experience symptoms revolving around:
- Their health
- Clothing-related discomfort
- Counting numbers
- Or even monitoring their own breathing.
Difficult or distressing themes of OCD
Sometimes your OCD may fixate on more “taboo” themes that may be difficult to talk about. For example, some people experience “religious OCD”. This might involve having obsessive religious doubts, or intrusive blasphemous images. This might cause someone to start excessively praying to deal with the guilt associated with these unwanted thoughts.7,10
Some people may even have OCD symptoms that are sexual in nature. The person may experience intrusive sexual thoughts or images, which can be highly explicit in nature.
This can result in intense fear that they may become sexually aroused against their will. Some people may check their genitals regularly, to ensure they are not showing physical arousal to the intrusive thoughts. This is sometimes known as a “groinal response”.9
How can distressing themes of obsessive-compulsive disorder affect someone?
Understandably, when OCD focuses on a distressing theme, it can cause a person significant feelings of unease, shame and loneliness.8 They may feel unable to seek help or tell anyone about what they’re going through. It is important that people with these symptoms understand that they are caused by OCD, and that trained professionals will be able to help.
Does everyone with obsessive-compulsive disorder feel fear & anxiety?
It’s also important to understand that there is a lot of variability in OCD. For example, “Pure-O” is a subtype of OCD where the person does not experience compulsions. There are also some people with OCD that may not experience intrusive thoughts.
How is obsessive-compulsive disorder (OCD) diagnosed?
Obsessive-compulsive disorder should only be diagnosed by trained healthcare professionals.They make the diagnosis by considering the presence or absence of the following symptoms:
- Obsessive or intrusive thoughts
- Taking repetitive actions (“compulsions”) to relieve the anxiety from the obsessive thoughts
A diagnosis of OCD can be difficult to reach. Therefore it should always be made by a suitably-trained healthcare professional.10
Which type of OCD do I have?
It is common for a person with symptoms of OCD to have more than one type of OCD. It is also common for a person with OCD to develop a different kind of OCD later in life.
If you are worried that you may be suffering with OCD, you should speak to a trained healthcare professional such as a psychologist.
A psychologist or psychiatrist can perform a psychological assessment to help identify which types of OCD you have, and can teach you how to manage them.
Who usually gets obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder does not discriminate – it can affect anyone.
It affects up to 4.6% of the population of Iraq17 and usually develops around early adulthood, although it can develop at any stage in life.
Certain people are at higher risk of developing OCD. These include:
- People with a family history of OCD
- People who are naturally meticulous and organised
- People who have a history of anxiety
- People who have experienced difficult life events
- People who have specific brain characteristics, such as lower levels of a hormone called serotonin
Can children develop obsessive-compulsive disorder?
Children can develop OCD, although it is uncommon.
Young children such as toddlers frequently show repetitive behaviours as part of their normal learning and development. However, if the rituals seem to be causing the child anxiety, it is important to seek help from a child psychology expert so that the child can be properly assessed.
In younger children, OCD can be triggered by bacterial infection in rare cases. It is therefore important to seek medical attention if you think that your child is experiencing OCD symptoms as they may need antibiotic treatment.7
The prevalence of OCD does increase as children get older.
What causes obsessive-compulsive disorder (OCD) to develop?
OCD can develop for a number of different reasons. Research tells us that the brains of people who have OCD are often different from the brains of people who don’t have OCD.
For example, people with OCD usually have a lower level of a hormone called serotonin in their brain. It is believed that this may cause them to have a natural tendency to fall into obsessive-compulsive thought loops.
Researchers also believe that in OCD, certain parts of the brain do not function properly. It is unclear, however, whether this is a cause or effect of OCD.
What are the symptoms of obsessive-compulsive disorder (OCD)?
There are two main symptoms of OCD:
- Obsessive or intrusive thoughts
- Taking repetitive actions (“compulsions”) to relieve the anxiety from the obsessive thoughts.
These symptoms can take many different forms, depending on what type (or types) of OCD the person has.
The intrusive or repetitive thoughts caused by OCD are usually not reflective of reality. However, a person with OCD may find it difficult to reassure themselves that the thoughts are false, which can leave them feeling incredibly distressed.
If the OCD symptoms are very severe, some people may find it difficult to distinguish them from delusions (which are very strong thoughts and beliefs that are not real).
Being unable to distinguish between reality and OCD induced thoughts can lead to a severe mental health illness called psychosis.
If someone develops psychosis, they need to seek urgent medical help as soon as possible.
It’s also important to consider that some people who have delusions might also have symptoms of OCD, which can make the two conditions difficult to distinguish.7
If left untreated, OCD can worsen to a point where a person’s life is controlled by the illness. For example, a person who has symptoms of OCD relating to germs or infections may find themselves unable to leave their home for fear of exposure to germs.
They may spend all of their time cleaning and thinking about potential hygiene risks, and they may avoid seeing friends and family.
It is important to take steps to manage OCD before it progresses to a severe state. If you or someone you know is experiencing severe symptoms of OCD, it is important to seek urgent psychological support as soon as you can.
OCD can be exhausting. People with OCD find that, when they are experiencing symptoms, their mind is in a highly aware, energy-consuming state. Due to the anxiety that is felt for long periods of time during an OCD flare-up, adrenaline levels in the body remain high. Many people find this very tiring, and find they have little energy left for anything except for OCD management during a flare-up. If someone with OCD also has depression, the lack of energy can be even worse.
One frightening symptom that may be experienced with OCD is false memories, or false feelings. This is a symptom that is not talked about often, and causes significant distress to the person experiencing it.15
People who are experiencing false memories may start to worry that they have done something wrong. They may then start to replay a certain memory or interaction over and over again in their head to try to convince themselves that they didn’t do anything wrong.
As they continue to do this, their brain starts to cast more doubt on the memory each time.
Over time, some intrusive thoughts begin to plant extra details into that person’s memories, leading to the creation of false memories that are difficult to distinguish from true memories.15
Some people with OCD or OCD-like tendencies experience tics. These are compulsive movements or sounds. These may include skin-picking, hair-pulling or throat-clearing, amongst many other things.
What does OCD feel like?
Many people with OCD describe it as a feeling of uncontrollable anxiety, or like your thoughts and fears are out of your control. Some people describe it as a sense of “constant mental unease”.
Some people with OCD describe it as feeling like an addiction to particular thoughts or fears.
Can having OCD kill you?
Leaving symptoms of OCD untreated does come with significant health risks. The anxiety from OCD, over a long period of time, can leave a person with increased risk of other physical illnesses such as:
- High blood pressure
- Heart disease
- Other health conditions
When OCD is triggered, people with severe, intense anxiety can become overwhelmed with thoughts that something terrible has happened, or that they have done something terrible that has ruined their life. Although this is not real, they still believe it with full conviction.
People with severe, symptoms such as this are at risk of self-harm or suicide, and they should seek medical attention immediately to protect them until they are feeling better.
Can OCD go away by itself?
Some people may wonder if OCD thoughts will go away by themselves, or if you can grow out of OCD. In reality, OCD is a condition that often gets worse if it is not treated properly.
This means that a person with OCD symptoms should not be told that they will grow out of it, and should not be advised to wait until their symptoms go away. Psychological support should be sought before their symptoms start to worsen.
How can obsessive-compulsive disorder (OCD) affect someone’s quality of life?
OCD can have a significant impact on a person’s quality of life.
Ruminations and compulsions can consume huge amounts of mental energy and time.
When severe, symptoms of OCD can become debilitating. They can affect both work and home life, for example, it can make a person inefficient and withdrawn at work, which may jeopardise their employment.2
People with severe symptoms may also feel as though the disease is killing them, or ruining their life. They may develop paranoia.2
How does OCD affect relationships?
OCD can also have a major impact on family members and loved ones, depending on the symptoms someone has.4
For example, a person with OCD symptoms fixating on hygiene may demand that other members of their household maintain unreasonable or unrealistic standards of hygiene. These demands can cause conflict in the home, and put stress on personal relationships.3
Although this may be difficult for family and friends to cope with at times, it’s important to remember that these demands are being driven by the fear and anxiety that is felt by the person with OCD.
The person with OCD may also feel intense guilt and may feel they are a burden on their loved ones, but they also feel little control over the situation.
It is important that families and loved ones affected by OCD learn as much about the illness as possible, as the person with OCD is likely to be experiencing extreme levels of stress and needs support to manage their condition.
Which other conditions have similar symptoms to obsessive-compulsive disorder (OCD)?
A number of conditions may share signs and symptoms with OCD, and this may cause difficulty or delays in getting an accurate diagnosis. Some of these conditions are detailed below:
- Have difficulty concentrating
- Frequently feel agitated
- Experience periods of “hyperfocusing”5
Some of the medications prescribed for ADHD, particularly stimulant medications, may make the symptoms of OCD worse. Therefore, it is important to accurately diagnose people experiencing the symptoms described above.5
Anxiety is a feeling of unease, fear or worrying that can be difficult to overcome.
At reasonable levels, anxiety can be a normal response to stress. However, it is also common for it to worsen and turn into a mental illness.
It is common for people with OCD to also suffer with anxiety.
Post-traumatic stress disorder is a mental health condition that a person may develop after experiencing trauma.
Some symptoms of PTSD can be similar to those seen in OCD, for example:
- Debilitating anxiety and intrusive thoughts
- Avoidance of certain triggers.
Schizophrenia is a complex and serious mental health illness. It is a type of psychosis, which means it involves a loss of touch with reality. Up to 12% of individuals with schizophrenia have symptoms of OCD.13
It is possible for a person to have both schizophrenia and OCD at the same time.
People with schizophrenia or psychosis may experience delusions - this means they believe something that is untrue, and they cannot be convinced that it is untrue.
Obsessions or intrusive thoughts associated with OCD may be difficult to distinguish from delusions. However, in OCD the individual will usually still have an understanding that their thoughts are irrational and untrue, whereas in psychosis they usually lack this insight.
Another feature of OCD is that the irrational beliefs are usually at least a little plausible - whereas delusions can be extremely bizarre and out of touch with reality.
Bipolar affective disorder is a mental illness that causes significant changes in mood and energy. It has symptoms similar to those seen in OCD.17 It is also possible to have both bipolar disorder and OCD at the same time.6
For example, people with OCD may feel energised and agitated, and anxious. These symptoms can be similar to the symptoms experienced in the periods of “mania” that develop in bipolar affective disorder.6
However, the recurring cycles of obsessive or intrusive thoughts and compulsions is a key factor that differentiates OCD from bipolar disorder.
Professional psychological support should be sought to get an accurate diagnosis, as the treatments for the two disorders are very different.10
Autism is a complex neurological condition that affects social skills.
People with OCD are 4 times more likely to be diagnosed with autism than the general population are.
Some symptoms of autism may be similar to those seen in OCD. For example, people with autism may engage in ritualistic behaviours much like some people with OCD do. However, there are some differences in the drive behind ritualistic behaviours in these two conditions. A highly-trained mental health professional would be able to differentiate them.10
Obsessive-compulsive personality disorder (OCPD) is a type of personality disorder.
In OCPD, the person exhibits traits similar to OCD. For example, they may adhere to rigid hygiene rules. They may find that these traits cause them difficulty in their day-to-day lives. However, the patterns of behaviour usually manifest at a young age and the person with OCPD does not feel they have a mental health problem.
In contrast, people with OCD usually develop symptoms slightly later in life than those with OCPD, and they strongly feel that they have a psychological problem.7
People with OCPD are far more likely to develop severe OCD than the rest of the population are.7
There are a number of other mental health conditions that share symptoms with OCD. Some examples are:
- Body dysmorphia
- Illness anxiety disorder (health anxiety).
These conditions can significantly impact quality of life, and professional support should be sought if anyone is experiencing symptoms of these disorders.10
Some people with OCD may have symptoms so severe that they may not realise they have a mental illness. This is called “poor insight”.
People with poor insight must have their diagnosis differentiated from other conditions such as psychosis. It is strongly advised that people with poor insight seek medical care so they can be properly assessed.10
OCD & neurodiversity
“Neurodiversity” describes a theory that there is natural variation in how the brain works from person to person. Neurodivergent conditions include autism, some learning difficulties such as dyslexia, ADHD and OCD amongst others.
People with neurodivergent conditions may have symptoms similar to OCD.5
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat obsessive-compulsive disorder (OCD)?
Whilst OCD can cause significant distress and disruption to a person’s life, it is usually highly treatable.
There are a number of different treatments available for OCD. These may include:
Things you can do at home
There are some things you can do at home to help control your symptoms, for example:
Social support is important for people with OCD.
It can be helpful to tell your family or friends what you’re experiencing, so they know you are in need of extra support. Some of the intrusive thoughts caused by OCD may be of a very sensitive nature, and may be difficult to share.
If you know someone who has an OCD diagnosis or you suspect is suffering from OCD, talking to them about how they are feeling can make a huge difference.
It may be helpful to keep a diary or journal of the symptoms you are experiencing, and describe the triggers.
For example, OCD symptoms may worsen in response to specific triggers, or to higher levels of overall stress from unrelated issues such as work or money.
Keeping a symptom diary may help you identify things that regularly worsen your symptoms, and help you manage them in the future.
Cognitive Behavioural Therapy (CBT)
You may also be referred for a kind of therapy called Cognitive Behavioural Therapy (CBT).
CBT is particularly effective in OCD. It teaches you to think and act in ways that reduce the severity of the symptoms.
CBT is usually done in a clinic with a psychologist. It usually involves working through thought exercises, which teach a person with OCD to challenge their irrational thoughts.
Thought exercise worksheets can be helpful in the management of OCD, and these are sometimes used by psychotherapists.
Worksheets can help people experiencing symptoms of OCD to identify specific thought processes and plan techniques to help manage these thoughts.12
Medications may also be prescribed in OCD.
The most commonly used medication in OCD is called a selective serotonin-reuptake inhibitor (SSRI), which is a type of antidepressant. Some examples of SSRIs used to treat OCD are citalopram and fluoxetine.
If you do start taking an SSRI, it is important to stay in close touch with your doctor for the first few weeks to monitor for side effects such as increased anxiety or risk of suicide.
Other medications or treatments
There is some weak evidence that says CBD (cannabidiol, a substance found in cannabis) may help alleviate some of the symptoms of OCD. In recent years, CBD has been approved for medicinal use for some medical conditions in a small number of countries. However, it is not legal in Iraq.
Some studies have shown that taking a zinc supplement can help with OCD symptoms, particularly when it is taken alongside an SSRI medication.
There is no evidence that zinc supplements alone can help with OCD symptoms. You can ask your doctor if they think zinc might be helpful and safe for you.16
Where can you get help if you are experiencing symptoms of OCD?
If you are experiencing symptoms of OCD, you should speak to your doctor, who can refer you to a specialist doctor called a psychiatrist, or to a psychologist for therapy.
Professional support is always recommended for those who are experiencing symptoms, and it is not recommended that you try to treat this condition on your own.
However, if professional care is unavailable or if there is a long waiting list, self-help can be beneficial. You can try taking online courses in CBT, or visit websites / read books that are specifically dedicated to helping people with OCD.
Is there a cure for obsessive-compulsive disorder (OCD)?
There is no cure for OCD, and the condition is unlikely to disappear on its own. Symptoms of OCD may come and go for periods of time throughout a person’s life, and if a person has previously had symptoms of OCD, then they have a high risk of the symptoms returning at some stage later in life. This is why OCD is not considered to be “curable”.
However, with appropriate management, many people who are diagnosed with OCD achieve good mental health and live normal, healthy lives.
How can you support someone who has obsessive-compulsive disorder (OCD)?
It is important to understand that OCD is a mental illness. A person who has OCD may be experiencing extreme anxiety and distress. You should try your best to be patient, kind and supportive as you help and encourage them towards seeking treatment.
Is there a test or quiz I can take for OCD?
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