What is OCD? Obsessions, compulsions and the cycle
OCD is not a quirk or a love of tidiness. It is a cycle of unwanted thoughts and rituals that can take hours out of every day.
Obsessions
Obsessions are unwanted thoughts, images, urges or doubts that keep coming back and cause distress. Common themes include:
- contamination by dirt, germs or impurity;
- fear of causing harm, by accident or on purpose;
- doubts about whether something was done properly, such as locking the door or completing a prayer;
- unwanted sexual or violent thoughts;
- religious or blasphemous thoughts;
- needing things to feel "just right".
Compulsions
Compulsions are actions or mental rituals done to reduce the anxiety or prevent something bad happening:
- washing or cleaning;
- checking locks, switches or appliances;
- repeating actions, prayers or words;
- counting or arranging;
- seeking reassurance;
- mentally reviewing or "cancelling" thoughts.
The OCD cycle
- An intrusive thought appears: "Did I wash properly?"
- It brings anxiety or a feeling of wrongness.
- You do a compulsion: wash again.
- You feel relief, briefly.
- The relief teaches your brain the compulsion was needed, so the next doubt feels stronger.
Over time the cycle can take hours a day.
Why people hide it
People with OCD often know their fears do not quite make sense, and feel ashamed. Those with harm, sexual or religious thoughts may fear they will be judged or reported. In reality, these thoughts are common in OCD and professionals understand them well.
What causes OCD?
A mix of genetics, brain chemistry, temperament and life events. Stress, life changes or having a baby can trigger or worsen it. It is not caused by bad parenting or lack of faith.
Treatment works
CBT with exposure and response prevention is the main treatment and helps most people significantly. Medication can also help. For religious OCD, see our guide to waswasa.
Questions people ask
What are the signs of OCD?
Frequent unwanted thoughts or doubts that cause distress, plus repeated behaviours or mental rituals to reduce that distress, taking up significant time.
What are the types of OCD?
Common types include contamination, checking, harm-related, sexual intrusive thoughts, religious OCD (scrupulosity) and needing things to feel just right.
Do people with OCD know their fears are irrational?
Many do, at least some of the time, which can add to the shame. Insight varies and can drop when anxiety is high.
Can OCD be purely mental?
Yes. Some people's compulsions are mostly mental, such as reviewing, praying a phrase or neutralising thoughts, with little visible behaviour.
Is OCD a form of anxiety?
OCD is closely related to anxiety and treated with similar approaches, though it is classified separately.
Can OCD start in adulthood?
Yes, though it often begins in childhood or adolescence. Life changes such as pregnancy can trigger it in adults.
Can OCD get worse with stress?
Yes. Stress, tiredness and big life changes often make OCD symptoms stronger.
Is OCD hereditary?
OCD can run in families, suggesting a genetic component, but it is not guaranteed to pass on.
How much time does OCD take up?
For it to be diagnosed, obsessions and compulsions usually take more than an hour a day or cause significant distress.
Can OCD be cured?
Many people recover substantially with ERP and some become symptom-free. Others learn to manage it so it no longer controls their life.