Obsessive compulsive disorder (OCD)

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OCD is an anxiety disorder. People living with OCD are troubled by recurring unwanted thoughts, images, or impulses, as well as obsessions and repetitive rituals. People with OCD are usually aware that their symptoms are irrational and excessive, but they find the obsessions uncontrollable and the compulsions impossible to resist.

OCD is an easily misunderstood condition, and can be highly distressing for both the person affected and their family and friends.

OCD facts

  • There is no ‘typical’ OCD behaviour. The symptoms and features of OCD can vary greatly.
  • Around 2% of people in Australia have OCD.
  • Obsessive or compulsive thoughts and behaviours often appear in childhood or adolescence. More people are diagnosed by their late teens.
  • People living with OCD have a higher risk of having another mental illness such as depression, bipolar disorder, borderline personality disorder and schizophrenia.
  • The causes of OCD are not fully understood, but are likely to be a combination of biological and lifestyle factors.

OCD myths

  • Myth: 'I like to be clean and tidy. I must have OCD’
  • Reality: Obsessions and compulsions are more than just a need for cleanliness. They can be exhausting, take up a lot of time, and can significantly reduce a person's quality of life.
  • Myth: ‘People with OCD cannot get better.’
  • Reality: With good treatment and support, people with OCD can recover well.
  • Myth: ‘People with OCD just need to get over it.’
  • Reality: Obsessive and compulsive behaviours are not just a character trait. A person with OCD cannot control their repetitive thoughts and behaviour.

Related: Tim Hellier on living with OCDWhat I wish people knew about OCD - Busting the myths about OCD

Symptoms

People with OCD typically experience some, but not necessarily all, of these symptoms. A mental health professional will be able to give you a proper diagnosis. Compulsions and obsessions can take up hours of a person’s day and can interfere with relationships. They can also impact on education and employment.

Obsessions

The nature and severity of obsessions can change over time. They are often exaggerated versions of concerns and worries that many people have at some time. Common obsessions include:

  • Fear of contamination from germs, dirt, toxins and other substances
  • Fears of harm to self or others
  • Intrusive sexual or violent thoughts
  • Concerns with symmetry, order and routine
  • Concerns about illness or religious issues
  • An intense, irrational fear of everyday objects and situations (phobia).

Compulsions

Compulsions can involve both actions and thoughts. They often include repetitive actions, performed to prevent an obsessive threat from happening or to reduce anxiety. Common compulsions include:

  • Excessive handwashing or cleaning the body
  • Repeated counting and ordering of objects
  • Excessive checking of locks, electrical appliances, and other things associated with safety
  • Touching, tapping, counting or moving in a certain way or a certain number of times
  • Mentally repeating words or numbers a certain number of times.

Some people with OCD also have a tic disorder. Tics are sudden, brief movements or actions such as blinking, facial grimacing, jerking body parts or throat clearing.

‘I felt I had to keep my family safe,’ says Julie, ‘but I didn't know why. If I made a mistake at school I had to rip the pages out and start again, or I felt something terrible would happen to someone I loved.’

Related: What is trichotillomania? - Five tips to help someone who hoards –The anxiety continuum

Help for people with OCD

Treatments for OCD can help people manage their obsessions and compulsions, and reduce or eliminate their symptoms.

Psychological therapy

A doctor, psychologist or other health professional talks with the person about their symptoms, and discusses alternative ways of thinking about and coping with them. This may involve anxiety management techniques such as mindfulness and breathing training.

Medication

Certain medications assist the brain to restore its usual chemical balance and help control the obsessions and compulsions. When symptoms are particularly resistant to psychological therapy, medication may be prescribed.

Community support programs

Support groups provide an environment where people with OCD and their families can meet to give and receive support. Information is provided, along with self-help and coping strategies. Understanding and acceptance by the community is also very important.

Related: Support for young people and children - Busting the myths on anxiety

SANE factsheets provide brief, introductory information about mental health.

Content last reviewed: 7 December, 2017
This guide provides an in-depth exploration of OCD, its causes and treatments, coping strategies and support for people living with OCD and their families, friends and carers.
OCD is defined by the presence of obsessions, compulsions, or both. Obsessions can take the form of unwanted recurring and persistent thoughts, urges or impulses. This can cause significant anxiety and distress.

Compulsions are actions or behaviours which the person feels they must complete in order to manage the obsession. These actions or behaviours are aimed at preventing a dreaded event or situation, or to reduce anxiety.

It is common for healthy people to have obsessive thoughts or compulsions at some stage in their lives. However, for people with OCD, obsessions and compulsions can be extremely upsetting, time consuming and impact on daily activities.

People with OCD may experience some, but not all, of these symptoms. See a mental health professional for a proper diagnosis.

Obsessions

Obsessions are more than just worries about real life problems. They are excessive and illogical, and can cause distress to both the person affected and those caring for them.

Common obsessions include:

  • fear of causing harm to yourself or others. This is the most common obsession in people with OCD
  • fear that you or someone or something is contaminated
  • unwanted and intrusive sexual thoughts and feelings, including those about sexuality or fear of acting inappropriately towards children
  • unwanted and intrusive violent thoughts, including about harming yourself or others
  • fear of or fixation on illness
  • fixation on religious issues or morality
  • a need to save, remember or collect things.

Compulsions

Many people have certain rituals or behaviours which they may perform repeatedly. However, compulsions are often rigidly adhered to and are aimed at preventing a dreaded event or neutralising obsessive thoughts. Completing compulsive behaviours may take a long time and greatly impact on relationships, work or education, and personal care.

Common compulsions include:

  • saying out loud (or quietly) specific words in response to other words (for example, to prevent a disaster happening)
  • avoidance of kitchen knives and other such instruments (for example, locking them in a drawer) to prevent coming into contact with them
  • excessive washing of hands or body
  • excessive cleaning of clothes or rooms in the house
  • checking that items are arranged ‘just right’ and constantly adjusting inconsequential items, such as pens on a table, until they are aligned to feel ‘just right’ as opposed to looking aligned
  • mental rituals or thought patterns such as saying a particular phrase, counting to a certain number, or imagining a particular imagery to ‘neutralise’ an obsessional thought
  • constant checking of light switches, handles, taps, and locks to prevent perceived danger from flooding, break in, gas leak or fire. Checking can be a set number of times to a special or ‘magical’ number, and often takes hours at a time to the point where sufferers often avoid going out so they don’t have to go through the rituals again
  • touching, tapping, counting or moving in a certain way or a certain number of times, often until something feels ‘just right’
  • repeating specific prayers or actions related to religious obsessions
  • replacing a ‘bad’ thought with a ‘good’ thought
  • difficulty in throwing things away, such as old newspapers, magazines, books or clothes
  • a desire to confess or ask questions about ‘bad’ things a person has done
  • excessive list-making or recording daily activities, either in writing or verbally.

Other conditions can be closely related to OCD, such as:

Body dysmorphic disorder

People with BDD may have excessive concern over a body part, and believe it looks or feels abnormal in some way. They may compare the appearance of their concerning body part to that of other people’s, worry that they are physically flawed and spend a lot of time in front of a mirror concealing what they believe is a defect.

Trichotillomania

Also known as hair pulling disorder, trichotillomania involves repetitively pulling out one’s own hair from places like the scalp, eyebrows, eyelashes or body. People with trichotillomania have great difficulty stopping their hair pulling behaviour, to the point of causing hair loss and personal distress.

Excoriation disorder

Also known as skin picking disorder, people with excoriation disorder repetitively pick at their skin, leading to sores and wounds. Picking at the face, neck, chest, arms and legs is common. People with excoriation disorder have great difficulties stopping their skin picking, which causes significant distress.

Health anxiety disorder

Also called hypochondriasis, people with this disorder obsess over developing a serious but undiagnosed physical illness. A person may frequently visit or switch doctors and worry that minor symptoms indicate a serious medical condition.

Tourette’s disorder

People with tic disorders, such as Tourette’s disorder, experience involuntary, sudden, and brief vocalisations, movements or actions called tics. These can include blinking, facial grimacing, jerking body parts or certain verbal sounds.

Hoarding disorder

People with hoarding disorder have trouble discarding or letting go of personal belongings and household items as they feel a strong need to save or store items. This can lead to an extremely cluttered living environment, which can negatively impact the health and wellbeing of the person and others living in the environment. Treatment can include cognitive behavioural therapy, exposure therapy, and medication.

Despite a lot of research, scientists have not been able to identify a clear cause for a person developing OCD. It is likely to be a combination of neurological, genetic, behavioural and cognitive factors. There is no evidence that stress or trauma causes OCD, although stressful situations such as witnessing a car accident, may trigger its onset.

There is also no evidence that parenting styles, or the way a person interacted with his or her parents during childhood, causes OCD. 

How common is OCD?

In Australia, at least 2% of people have OCD. It affects more than 500,000 Australians. Globally, OCD has been recognized as the fourth most common psychiatric disorder, after phobias, substance abuse and major depression.

Most people who have OCD developed it by their late teens. Obsessive-compulsive symptoms in childhood are a predictor of OCD in adulthood. OCD in adults can also be triggered by stressful factors such as work difficulties or becoming a parent. Again, there is no single known cause of OCD; it is more likely that situational factors may trigger the development of symptoms among people who are in some way biologically predisposed to OCD.

People living with OCD have a higher risk of having another mental illness such as depression, bipolar disorder, borderline personality disorder and schizophrenia. Obsessions and compulsions are common in people with other mental illnesses other than OCD.

If you think that you are experiencing symptoms of OCD, the first step is to see your GP. They will assess your symptoms and refer you to a mental health professional.

A GP can also provide recommendations or provide referrals to other health professionals who may be able to assist, including psychologists, occupational therapists, psychiatrists and community support workers.

For most people, a combination of medication and psychotherapy will give the best outcome. Building a toolbox of strategies will help you manage your obsessions and anxiety in the long run.

If you need urgent treatment to keep yourself or someone else safe from imminent danger, a GP can organise for a hospital admission. Many people with OCD have obsessions about harming themselves or others. While these distressing obsessions are common, they don’t equate to a person’s genuine desire to cause harm.

Exposure and response prevention therapy (ERP)

Exposure and response prevention therapy (ERP) is the most effective psychological treatment for OCD. A psychiatrist or psychologist can guide and support you through the process.

In ERP, you will make a list of activities that make you anxious, and order them on a scale from least anxiety-provoking to most anxiety-provoking. Starting with the activity you feel most capable of confronting, you go ahead and do it, with the help of a therapist.

During the activity, you will be encouraged to experience the anxiety, and avoid performing your compulsions while waiting for your anxiety level to slowly drop. You repeat the activity until you become used to it. You then move on to the next task or situation, gradually working your way up to confront more anxiety-provoking situations. ERP helps people with OCD to learn that they can confront their obsessions and fears without the need to do their compulsions.

Cognitive behavioural therapy (CBT)

By working with a qualified mental health professional, a person with OCD can learn to challenge and reframe their obsessive thoughts so that they have less influence on the person’s feeling and actions. During CBT, people with OCD also learn positive ways of coping with their symptoms (for example, breathing and relaxation strategies). The person may be gently encouraged to resist their compulsions, which can help to slow down or interrupt the connection between the obsessive thought and the compulsive behaviour. ERP is often integrated into CBT.

Medication

A GP or psychiatrist may prescribe medication to reduce intrusive thoughts and compulsions, or any co-occurring issues like depression. The most common type of medication used for OCD is a selective-serotonin reuptake inhibitor (SSRI) like fluoxetine, fluvoxamine or sertraline.

SSRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

Generally, medication is used to help someone with OCD to feel in a more positive frame of mind to tackle the ERP therapy.

Community support and recovery programs

OCD can be an isolating disorder. People with OCD and their families can benefit from support groups, where people share coping strategies and develop a support network. Family therapy may also be helpful. Community support and connection can play a vital role in overcoming the symptoms of OCD.

Once you begin to recover from OCD, there are things you can do to help yourself.

Find fun or relaxing activities to fill in your extra time. Social isolation can make OCD worse, so try to reach out to friends and family.

Simple measures such as getting enough sleep, eating good meals and finding ways to deal with everyday stress can make a big difference in how you feel. Ways to deal with stress may include exercise, mindfulness meditation or an enjoyable hobby.

Remember that relapses of OCD symptoms are common, and are a part of the journey to recovery. Have a plan ready to so you can act as soon as you notice yourself becoming unwell. Contact a trusted friend or your doctor to ensure you get the support you need as soon as possible.

Telling people about your OCD

Talking to family, friends or partners about your OCD can be daunting. OCD is still a misunderstood condition, and many people don’t realise how debilitating and intrusive it can be. Remember that the people who love you will be concerned and want to support you.

Try to be as honest and open as possible. The people you tell might have questions, so it can be helpful to have factsheets, guides or videos ready to show them what OCD is like.

Telling a loved one about your OCD takes courage. You should be proud of yourself for doing it. You may find that telling people feels like a weight is lifted off your shoulders. The sooner you reach out, the quicker you can get help to tackle your OCD and get your life on track.

Learning about OCD

As with any chronic illness, becoming an expert about your disorder will help you to cope with it more effectively.

There are many misconceptions and misunderstandings about OCD. These misconceptions can be a barrier to seeking treatment, so it is important to have a good understanding of OCD. Research has shown that some OCD symptoms, such as a fear of contamination or a need for symmetry, are more socially acceptable than experiencing intrusive taboo thoughts, such as graphic sexual or violent thoughts. It is important to understand that experiencing the more taboo obsessions, while upsetting, is not a reflection of your true self; they are symptoms of OCD that can be treated.

Coping with isolation

Many people with OCD become socially and emotionally isolated. Time spent performing compulsive behaviours and constant intrusive thoughts can make it difficult to interact with others, leading to isolation and loneliness.

Reading stories about other people with OCD and joining groups, forums or networks of people with OCD can help you feel less alone, and understand that there are other people out there who may be feeling like you.

Reaching out to other people is an important part of recovery. If your compulsions make it difficult to leave the house, online forums and social networks can be a way build your skills in making friends and reaching out, which will help you to connect with people in the real world.

Understanding the illness

It can be difficult and exhausting to live with a person with OCD. OCD behaviours can seem irrational and excessive, but it’s important to remember that your loved one is likely to be just as distressed by their symptoms as you are. By becoming more informed about the disorder, it may be easier to be supportive and understanding. 

Common misconceptions include that OCD is caused by laziness, lack of willpower, bad parenting or trauma. Assumptions like these lead to blame and guilt. Many OCD behaviours that are irritating and demanding are actually symptoms of the condition.

There are many OCD resources available that can help resolve misunderstandings and concerns about the illness.

Listening and validating

It is important to let the person know that you understand the difference between the behavioural symptoms of OCD and the person: ‘I know this is not you, this is your OCD.’ This will help to diminish the person’s feelings of guilt and low self-worth and reduce their levels of stress and anxiety.

It can also help to encourage discussion about OCD as a common and treatable anxiety condition that is nothing to be embarrassed or ashamed of. Support the person with OCD to share their experiences with family and friends – this will help to break the secrecy about OCD.

Encouraging recovery

Recovery from OCD is a long process. People with OCD may be frustrated at their progress, and feel like giving up. Try to support them through their recovery, and acknowledge improvements, however small, and encourage the person to reward themselves for their progress.

Try to be patient and maintain a non-judgmental attitude – this will support the person to focus their efforts on recovery rather than dealing with anger and resentment.

If their motivation wanes and they consider stopping treatment, remind them of the gains they have made.

Looking after yourself

Living with someone with OCD can be exhausting and isolating. It is important to maintain your connections with other family and friends. Take time out for yourself whenever possible and try to maintain hobbies and outside interests.

Avoid reinforcing behaviour

It’s important not to reinforce obsessive and compulsive behaviours. Often, a person with OCD can get very distressed if they are unable to complete their compulsive behaviour, and it may feel like complying with their request is the only way to reduce their distress.

The motives behind reinforcing compulsive behaviours are often well-meaning. Family, friends and carers want to reduce the individual’s distress or anxiety because they love them and want to help them cope. However, avoiding triggering situations or helping the person perform their rituals can encourage compulsive behaviours in the long term.

Helping a person with OCD with their rituals, responding to requests for reassurance or undertaking tasks that they want to avoid, are all behaviour patterns that maintain OCD and may create an obstacle to the person’s recovery.

It can be very difficult to reduce this type of involvement in a person’s OCD, especially if it has been going on for a long time. It is important to ‘normalise’ family or household routines and refuse to participate in reinforcing OCD behaviours. This should be done in a gradual way and preferably as part of a cognitive behavioural treatment program. 

Suddenly stopping all involvement in a person’s OCD could trigger overwhelming distress for the person with OCD and lead to increased symptoms, high agitation, anxiety and depression.

Finding support

The ARCVIC OCD and Anxiety Helpline on 1300 269 438 can give advice and support, and connect you with other community resources such as support groups available for family and friends in a similar situation.

If your own mental health is suffering, seek professional help. Counselling and support can be found through your GP, community health centre or a private psychologist.

OCD

Anxiety Recovery Centre of Victoria (ARCVIC)

A state-based organization focussed on providing support groups, resources and information on OCD and anxiety disorders.

This Way Up

A virtual mental health clinic that offers an online, evidence-based course for adults with OCD.

Mental Health Online ‘OCDStop!’

A virtual mental health clinic that offers a free online, evidence-based 12-week program for adults with OCD.

OCD? Not Me!

An online evidence-based program for young people aged 12-18 who have OCD, and their parents or caregivers.

Raising Children Network - OCD in Children

Provides information on what to do if you suspect your child has OCD, and what to look out for.

Mental health information & advice

SANE Forums

Online peer support for people living with mental illness, and for family, friends, and other carers.

SANE Help Centre

Talk to a mental health professional for information, guidance, and referral — by telephone, online chat, or email.

Beyond Blue

Information on signs and symptoms of OCD, and forms of support.

Crisis resources

Kids Helpline 1800 55 1800

Lifeline 13 11 14

Suicide Callback Service 1300 659 467

Call 000 for urgent medical attention or police attendance.

Advice and review were provided by Dr Imogen Rehm from RMIT University, and the SANE Help Centre.

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SANE guides provide in-depth information about mental health. For a quick summary of OCD, read SANE’s OCD Factsheet.

This SANE guide was reviewed in 2017 by industry professionals, carers and people with lived experience of OCD.

This SANE resource was created with support from The Vizard Foundation.

Content last reviewed: 7 December, 2017

Busting the myths about OCD

Media representations of obsessive compulsive disorder are pretty misleading. Let's bust the myths with the facts about OCD.

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