Obsessive compulsive disorder

About obsessive compulsive disorder

People with obsessive compulsive disorder (OCD) experience persistent unwanted thoughts (obsessions) and feel driven to do  mental or physical actions (compulsions) that provide temporary relief from these thoughts.

To have a few obsessional thoughts or minor compulsions is common, but the thoughts and actions of OCD can be highly distressing, time-consuming and disruptive to your life. 

Obsessions are repetitive and unwanted thoughts, images or impulses that cause anxiety and are hard to stop. In fact, trying to stop them causes more distress. You know these things come from your own mind, just like other thoughts and impulses, but you find them hard to control. The thoughts usually centre on something you care deeply about, for example, health, contamination, harm, sexuality, relationships, religion or morality. Or you may just have a troubling sensation that something is not right.

Compulsions are repeated actions or behaviours that you feel driven to do, even though you know they are unnecessary or don’t make sense. The compulsions are usually linked to the obsessional thoughts. They are your brain’s attempt to solve or cope with the anxiety caused by these obsessions.

Some actions become rigid or like a ritual. You may touch things, check things or wash your hands in an exact way or an exact number of times. You may avoid lines, cracks and doorways. Compulsions can also be unseen to others and may include counting or praying silently, or feeling that you must think particular thoughts or see particular mental images. You may avoid certain situations, repeatedly seek reassurance from others or spend a lot of time ruminating about the thoughts.

When you perform the compulsive action, you feel a little better initially, but then the anxiety returns. Remembering that brief feeling of relief can drive you to do more and more compulsive behaviours, in an attempt to control your rising levels of anxiety.

This cycle is extremely difficult to break on your own, and it can make you feel exhausted, sad, afraid, guilty and ashamed. You may feel embarrassed about performing actions linked to OCD in front of other people, which can make socialising and maintaining relationships challenging.

With the right treatment, though, it is very possible to find long-lasting relief from obsessions and compulsions – and the anxiety that comes with them – and develop new ways of thinking that support your wellbeing.

OCD is not a personality issue

OCD is often misunderstood in our society. It has become common to describe oneself or other people as having OCD when they simply like things to be clean or orderly. For people experiencing OCD, it can be upsetting and frustrating to hear these incorrect usages of the term.

Symptoms

Signs to look for (symptoms)

Symptoms of OCD may come and go. They are usually worse at times when you are stressed and better when you are relaxed and happy. Fatigue may also trigger OCD or make it worse, by making you generally more vulnerable and less able to cope.

The main symptoms of OCD are the obsessions and compulsions. These vary from person to person, but common themes are: 

• dirt and contamination, which leads to excessive washing and avoiding possible dirt
• doubt, leading to checking things have been done properly – like locks being locked and stoves turned off
• a sense that things just “aren’t right”, leading to behaviours like adjusting angles of objects, lining things up or doing an action a number of times until things feel right
• avoiding lines such as cracks in the footpath or lines on the tiles to reduce fears something bad will happen
• unusual or repulsive thoughts, feelings or images in your mind – these may be about religion, sex, violence or suicide and may raise unrealistic fears about your safety or the safety of your family or whānau.

Obsessions and compulsions are: 

• more than just excessive worries about real-life problems 
• severe enough to be time-consuming, that is, they take more than one hour a day, and cause significant distress 
• significant enough to interfere with normal daily activities and relationships.

An adult with OCD is usually aware the obsessional thoughts or impulses are unreasonable and are a product of their own mind (as opposed to feeling that someone or something else has put them there). 

OCD shares some symptoms with other conditions, such as autism. It is important to talk to an expert who can give you an accurate diagnosis and develop a treatment plan that is right for you. 

How a health professional determines if you have OCD (diagnosis)

If you’re concerned or suspect you (or a loved one) have OCD, it is important to get help. As a first step, you can talk to your GP or midwife. The links below provide information about OCD for GPs and midwives. You could print this out and show it to them.

The GP or midwife can then refer you to a mental health specialist, or you can search for a local clinical psychologist or psychiatrist and check if they list expertise in OCD on their website or bio.

You will spend some time talking with the specialist about your symptoms, and they will look for three things: 

• if you have obsessions
• if you have compulsive behaviours 
• how much the obsessions and compulsions get in the way of important daily activities you value, such as working, going to school or spending time with friends.

The specialist will answer any questions you have, and, together, you will develop an understanding of your OCD and a treatment plan.

Treatment options

Treatment of OCD involves two major components – psychological therapy and medication. Alone, each form of treatment is effective for 70% of those who have OCD. Used in combination, they will help 80–90% of people with OCD. For children and young people, therapy is usually the first treatment avenue.

Talking therapies and counselling (psychological treatments)

Talking therapies are effective in the treatment of OCD. Sessions may be held on a one-to-one basis, include partners or family, or be held in a group. 

The focus of psychological therapy or counselling is on education and support for you to understand what is happening to you, to learn coping strategies and to pursue a path of recovery and coping. Sessions help you regain the confidence and belief in yourself that is critical to recovery. 

Therapy is usually done by a clinical psychologist with experience in OCD, using techniques that have been proven to work. This is likely to include Exposure and Response Prevention, where you will practise being in situations that cause you some anxiety without using compulsions or rituals. The clinical psychologist will guide you and help you to learn new skills to manage the OCD-related stress as you gradually retrain your brain to start sending more rational, appropriate messages.

The type of therapy needed to effectively treat OCD is different from other therapies, so it’s important you find someone with specific experience in this area.

All types of therapy/counselling should be provided in a manner that is respectful to you and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices. 

Medication

The first line of medication for the treatment of OCD, particularly for adults, is a class of medicines known as selective serotonin reuptake inhibitors (SSRIs). Some people find that medication reduces the frequency and intensity of their obsessive thoughts, which then makes it easier to resist doing compulsions and so weakens the obsessive-compulsive thought cycle.

Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for and what their side effects are (short and long term)
• what the process of stopping taking them could look like.

Withdrawing from the medicine (i.e. stopping taking them) can have complex effects. Make sure you talk this through thoroughly with your doctor and are aware of supports that are available.

Even if you are pregnant or breastfeeding, medication might be an option. It is best to discuss with your health provider what might be on offer for you. 

Other strategies to support recovery

Psychoeducation (providing education) 

Education about OCD can be extremely important. Your health professional should give you information about your condition. They should suggest different ways to handle it, and discuss any complications which could occur.

There are many helpful, easy-to-navigate resources online (see below), and you might find it helpful to read, watch or listen to other people’s stories of having OCD.

It’s important that your family/whānau and supporters also learn about OCD. Partners or parents often go along with the compulsive behaviour as a way to ease their loved one’s distress. Even though their intentions are good, this actually strengthens the OCD in the long term. Knowing more about the condition will help them provide support that is both kind and helpful to recovery. 

Complementary therapies 

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it. 

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. 

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications. 

Physical health

It’s also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. Being in good physical health will also help your mental health.

Thanks to Dr Sarah Watson, senior clinical psychologist, members of the Thriving Madly peer support network in Christchurch, and Marion Maw, admin of the Facebook-based OCD community Fixate, for reviewing this content. Date last reviewed: September, 2022.

Thanks to Sutherland Self-Help Trust for making the 2022 updates possible.

Disclaimer

The information on this website is not a substitute for proper diagnosis, treatment or the provision of advice by an appropriate health professional. If you are seeking diagnosis or treatment, you should consult a GP or mental health professional.