Obsessive compulsive disorder

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.

Many people have what could be called obsessional tendencies but do not have OCD. They may be very careful and check things more thoroughly than most others. They may be a perfectionist and have very high standards about certain things. Usually these tendencies do not cause great problems. 

Likewise, many people use prayer, mantras or rituals as part of their religious or spiritual practice. Superstitious behaviours – wishing on a star, knocking on wood, carrying a lucky charm and so on – are also common and usually cause no distress to the person doing them.   

OCD is very different. Typically, OCD starts gradually and can be a minor irritation for years, eventually getting to the point where symptoms can no longer be denied. You may, for example, deal with the obsessional thought of being dirty by washing a bit more and keeping things cleaner. Taking a shower two or three times a day might not affect anyone much. If this increases so that you spend an hour in the bathroom each morning, it becomes quite inconvenient for the household. If it increases to three hours in the bathroom each day, your life has really changed.

OCD is an unusual and sometimes frightening condition. Many people with OCD are afraid that they are “going mad” and worry about completely losing control of themselves. This does not happen. OCD also does not lead to other severe illnesses, but for some it can be just as disabling.

If you think you may have OCD, it is most important to seek help. It is difficult to tackle OCD on your own, especially if it is severe, but professional treatments have high success rates.

OCD usually starts during childhood, adolescence or early adulthood. It is unusual for OCD to begin after the age of 30. However, due to prejudice, lack of awareness in the community and among health professionals, it is quite common for someone’s experience of OCD to go unrecognised for years and even decades. 

You may experience OCD for the first time, or have a flare-up of existing symptoms, while pregnant or caring for a baby. This is called perinatal OCD. In these cases, the unwanted repetitive thoughts are often about your baby being harmed in some way. For example, you might have persistent distressing thoughts that your baby has stopped breathing and so check your baby again and again.

Some people develop OCD after experiencing a traumatic event, but many people with OCD have not experienced a trauma.

There is a genetic (inherited) factor in OCD. If you have OCD, your children have more risk than other people of developing the condition.

The exact cause of OCD is unknown, but there is strong evidence that it has a physical cause in the brain. For people with OCD, the parts of the brain responsible for starting and stopping thoughts and actions and responding to new information work differently. By learning more about this, scientists may in time be able to develop better treatments. 

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 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 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. 

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. 

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.