Obsessive compulsive disorder (OCD)

Overview

OCD involves obsessions, which are unwanted and distressing thoughts, images or urges, and compulsions, which are repeated behaviours or mental acts done to ease the anxiety they cause. OCD can affect men, women and children. Symptoms can start from as early as age 6, but they often begin around puberty and early adulthood. The main treatments are talking therapy, usually cognitive behavioural therapy (CBT), and medicine, usually a type of antidepressant called an SSRI.

Symptoms

What a clinician may find

• Repeated behaviours such as excessive handwashing, checking or counting, which NHS trust pages list as examples.
• Mental compulsions, such as silently repeating a word or phrase, which are not obvious to other people.
• Anxiety, disgust or unease linked to unwanted thoughts, images or urges.
• Repeatedly asking other people for reassurance, which Mind describes as a very common compulsion.

Complications

• The NHS says obsessive thoughts and compulsions can affect daily life.
• Mind describes relief from a compulsion as short-lived: the thought returns and the cycle repeats.

Diagnosis

The NHS says a person who is affected can see a GP, who will ask about symptoms. A GP can refer to a local talking therapies service, or to a specialist mental health team if needed. A person can also refer themselves directly to an NHS Talking Therapies service.

Treatment

The NHS describes two main treatments: talking therapy, usually CBT, and medicine, usually an SSRI. CBT for OCD usually includes exposure and response prevention (ERP), in which a person faces an obsessive thought while holding back from the usual compulsion. Medicine may be needed if talking therapy does not help or if OCD is fairly severe. NICE public information says combined treatment of CBT with an SSRI should be offered in some cases.

Prevention

The NHS says that if obsessive thoughts and compulsions affect daily life, it is worth speaking to a GP, and that a person can also refer themselves to an NHS Talking Therapies service.

Key facts

What is OCD and how does it feel?

Obsessive compulsive disorder (OCD) is a mental health condition in which a person has obsessive thoughts and compulsive behaviours. The NHS describes an obsession as an unwanted and unpleasant thought, image or urge that keeps coming into the mind and can cause feelings of anxiety, disgust or unease. A compulsion is a repetitive behaviour or mental act that a person feels they need to do to ease the distress an obsession brings.

Mind describes obsessions as starting with an unwelcome thought or feeling, often called an intrusive thought. It says the relief from a compulsion does not last: the thought pops back into the mind and the person repeats the compulsion, so the cycle repeats. OCD-UK says that symptoms can wax and wane over time. The NHS says OCD can affect men, women and children, and that women can sometimes have OCD during pregnancy or after a baby is born.

What do obsessions and compulsions look like?

Compulsions differ from person to person. The Royal College of Psychiatrists gives examples including washing, checking, touching, ordering or lining things up, counting, and thinking certain thoughts. Pages from NHS trusts also list excessive handwashing, repeated checking, excessive cleaning, counting or repeating words, and excessive praying. One NHS trust gives fears of contamination by germs or dirt as a typical theme.

Mind says compulsions can be things a person does physically, such as repeatedly checking that a door is locked, things done in the head, such as repeating a specific word, or things that involve other people, such as asking for reassurance. Mind describes asking for reassurance as a very common compulsion. NHS inform notes that not all compulsive behaviours are obvious to other people. Mind adds that people whose compulsions are mostly internal, sometimes described as having Pure O, still carry out compulsions even though they cannot be seen.

What causes OCD and who is affected?

MedlinePlus says the cause of OCD is unknown, although genetics, brain biology and chemistry, and the environment may all play a role. Mind says there are different theories about why someone develops OCD, and that no theory can fully explain every person's experience. It points to personal experiences and biological factors.

The NHS says a person is more likely to develop OCD if a family member has it. It also says OCD may be more common in people who have been bullied, abused or neglected, and that it sometimes starts after an important life event, such as childbirth or a bereavement. The NHS adds that people who are neat, meticulous and methodical, with high personal standards, or who have a very strong sense of responsibility for themselves and others, may be more likely to develop OCD.

The NHS says OCD can affect men, women and children. People can have symptoms from as early as age 6, but it often begins around puberty and early adulthood.

How is OCD diagnosed and where can you get help?

The NHS says that if obsessive thoughts and compulsive behaviours affect daily life, it is worth speaking to a GP. The NHS describes two routes to help. One is to refer yourself directly to an NHS Talking Therapies service in England. The other is to see a GP, who will ask about symptoms and can refer to a local talking therapies service if necessary. A GP may also refer to a specialist mental health team if needed.

The NHS also says that some people with severe, long-term OCD that has been difficult to treat may be referred to a national specialist OCD service.

For children and young people, NHS child and adolescent mental health services (CAMHS) are another route, and a GP can explain how to reach them. Scotland and Wales use different services from England, so a person living there can ask a GP or local NHS service about the local route.

How is OCD treated?

The NHS describes talking therapy, usually cognitive behavioural therapy (CBT), and medicine, usually a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant, as the main treatments. Therapy for OCD is usually CBT with exposure and response prevention (ERP). In ERP a person faces an obsessive thought or feared situation while holding back from the usual compulsion. The Royal College of Psychiatrists gives the example of a therapist challenging someone not to wash their hands as much.

The NHS says medicine may be needed if talking therapy does not help or if OCD is fairly severe. It also says an SSRI can take up to 12 weeks before any benefit is noticed. NHS guidance says stopping an SSRI suddenly can cause side effects, so treatment is stopped gradually with a doctor's advice.

NICE public information says combined treatment of CBT with an SSRI should be offered in some cases. A GP or specialist team can explain which options suit a particular person.

OCD in children and young people

NICE guideline CG31 covers OCD in adults, young people and children aged 8 years and older. For children and young people it says psychological treatments should be collaborative and should engage the family or carers. It also says an SSRI should be combined with concurrent CBT including ERP, and should be prescribed only after assessment and diagnosis by a child and adolescent psychiatrist.

NICE is developing an update to this guideline. Its project page lists an expected publication date of 16 February 2027, and the update is planned to remove the current lower age limit of 8 years. Until then CG31 remains the published guideline.

Healthier Together, an NHS site for families, says that if rituals take up a lot of time, cause distress, or make it hard to do things like sleeping, studying and being with friends, the first step is an appointment with a GP. OCD-UK says that giving reassurance, although well meant, can make OCD escalate over time, and that it is still important to seek help if symptoms wax and wane.

When should you get help, and where can you find support?

For OCD that keeps coming back and affects daily life, the NHS suggests speaking to a GP or referring yourself to an NHS Talking Therapies service. This is a routine appointment rather than an emergency.

If someone is in immediate danger, or cannot keep themselves or someone else safe, the NHS says to call 999 or go to A&E. For urgent help that is not an emergency, the NHS lists NHS 111 (mental health option), where a person may be able to speak to a trained professional. Samaritans can be called free on 116 123, 24 hours a day.

The NHS says the charities OCD Action, OCD-UK and TOP UK may be useful sources of support and can tell people about local groups. OCD Action and OCD-UK both run online support groups, and Mind lists TOP UK as offering self-help therapy groups for OCD, phobias and related anxiety disorders.

Frequently asked questions