Obsessive compulsive disorder (OCD)

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

Obsessions

Obsessions are more than just worries about real life problems. They are excessive and intrusive, and can cause distress to both the person affected and those caring for them. A person can have obsessions that do not reflect their values, interests or intentions.

Common obsessions include:

• fear of causing harm to yourself or others
• 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.

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, and reducing anxiety. 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 particular imagery.
• 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.

Not all of my compulsions, when I perform them, are noticeable. So people around me can think that I’m fine when I’m struggling. 
- Tim

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.

Tic disorders

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. 

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 (Abramowitz, 2009). Many people with OCD have experienced traumatic events, and stressful situations may trigger its onset (Dykshoorn, 2014). 

How common is OCD?

In Australia, at least 2% of people have OCD (ABS, 2008). 

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.

People living with OCD have a slightly higher risk of experiencing another mental health issue, most commonly anxiety disorders and depressive disorders (Abramowitz, 2009). This doesn't mean, however, that if you have OCD you will definitely experience another mental health issue, just that the likelihood is higher. 

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 such as a psychologists, occupational therapists, psychiatrists and or community support workers. 

For most  people, a combination of medication and psychotherapy will give the best outcome, although you can receive benefits from either medication or psychotherapy alone. 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. But if you need urgent treatment to keep yourself or someone else safe from imminent danger, a GP can organise for a hospital admission, or you can call 000.  

If life is not in danger, but you feel you might hurt yourself, you can get support from Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467.  

Exposure and response prevention therapy (ERP)

Exposure and response prevention therapy (ERP) is the most effective psychological treatment for OCD (Rosa-Alcazar et al., 2008). A psychiatrist or psychologist can guide and support you through the process.

In ERP, with the help of a therapist, 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 Depending on the activity, this might happen with your 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. This is called cognitive restructuring. 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 to obsessions and compulsions. 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. Evidence supports the use of selective-serotonin reuptake inhibitors (SSRI) like fluoxetine, fluvoxamine or sertraline, so these medications are often recommended to try first. 

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

Sometimes, people are prescribed medication alone, or in combination with therapy. Often, medication is used to help someone with OCD to feel in a more positive frame of mind to tackle ERP therapy. 

Community support and recovery programs

OCD can be an isolating disorder. You and your family might 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.

Another key to staying well is sharing intrusive thoughts with family and friends, without judgment. This has been an enormous help to me.
- Tim

Learning about OCD

As with any chronic health issue, 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. Having intrusive thoughts about harming others, does not mean that you plan to act on them, or that you will act on them. And these thoughts do not make you a bad person.

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 OCD

The symptoms of OCD can be challenging for family and friends to understand. OCD thoughts and 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, or bad parenting. 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. 

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 can be a long process, and lapses are common. People with OCD may be frustrated at their progress, and feel like giving up. Try to support them by checking in with them and staying hopeful and positive about their recovery. Acknowledge hard work or improvements (however small) and encourage the person to reward themselves for their progress and to keep trying when there are challenges.

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. People may also seek reassurance from others, and struggle to reassure themselves. 

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.

It can be helpful to ask the person you care about how you can support them without encouraging their compulsive behaviours. You can also ask if you can attend a therapy session and talk to the therapist about what might be helpful. Therapy can be hard work, and it may be that you can assist your loved one in putting what they are learning in therapy into practice. 

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's free counselling service

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.

Australian Bureau of Statistics (2008). National Survey of Mental Health and Wellbeing: Summary of Results 2007. 

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491–499.

Dykshoorn, K. L. (2014). Trauma-related obsessive–compulsive disorder: a review. Health Psychology and Behavioral Medicine: an Open Access Journal, 2(1), 517-528.