Obsessive Compulsive Disorder
Written by Ada’s Medical Knowledge Team
What is OCD (obsessive compulsive disorder)?
Obsessive-compulsive disorder (OCD) is a mental health condition that affects between 1 and 4% of people worldwide. 1 2
OCD symptoms most commonly present in the late teens and early 20s, and men tend to develop symptoms earlier than women. Onset after the age of 35 is less common. Childhood OCD is possible, with 30-50% of adults with OCD experiencing symptoms as children. However, OCD in children does not always lead to OCD in later life, with around 40% of children with OCD symptoms having no symptoms by early adulthood. 3
OCD is characterized by 2 main features: 4
- Obsessions: thoughts, images, or urges that are repetitive, persistent, and intrusive
- Compulsions: repetitive behaviors that a person feels they have to carry out.
People with OCD tend to understand that these thoughts and behaviors are irrational, but they find that they cannot stop them. 5 This can be time-consuming and distressing for people with OCD. 6 If left untreated, OCD can interfere with many aspects of a person’s life, including work, school, and personal relationships. 7 However, certain OCD treatments, including psychological therapy and specific OCD medication, can be used to reduce the impact of OCD on a person’s day-to-day life. 8
What are the risk factors for developing OCD?
While OCD is a common condition, its exact causes are unknown. Several different factors are thought to play a part in the development of OCD:
- Family history and genetics: having a first-degree relative who has OCD increases a person’s risk of developing OCD 7
- Age: it is most common to develop OCD symptoms in the late teens or early 20s, while it is less common for people to develop the disorder after the age of 35 3
- Developmental factors: some studies have reported an association between childhood trauma and OCD symptoms, although further research into this is required 7
- Pregnancy: women can sometimes develop OCD during pregnancy or once their baby is born, obsessively worrying about harming the baby or compulsively checking that the baby is still breathing 8
While stress isn’t always the cause of OCD, symptoms can arise after a stressful life event or traumatic experience. 9 Stress can also worsen OCD symptoms that are already present. 10
What are the main OCD symptoms?
OCD can affect people in different ways, but most people with OCD experience a similar pattern of obsessive, intrusive thoughts, compulsive behaviors, or both. 5 These obsessions and compulsions are often associated with a cycle of intense anxiety: the compulsive behavior can temporarily relieve the anxiety, but the obsession and anxiety can quickly return. 5
These recurrent, persistent thoughts and repetitive behaviors can differ among individuals. Some common obsessions in people with OCD are: 11
- Fears of contamination
- A need for symmetry or exactness
- Fear of causing harm to someone
- Sexual obsessions
- Religious obsessions
- Fear of behaving unacceptably
- Fear of making a mistake.
Some common examples of compulsive behaviors in people with OCD are: 5
- Excessive cleaning and hand washing
- Checking things repeatedly
- Ordering and arranging things in particular ways
- Asking for reassurance from others.
How is OCD diagnosed?
Getting help is important if you think you have OCD. However, diagnosing OCD is not simply a case of taking an ‘OCD test.’
The main way to get help is to see your doctor. 5 They can conduct clinical interviews involving discussion of your symptoms and overall medical history. Your physician can then refer you to a mental health professional, such as a psychiatrist, for further evaluation and treatment if necessary.
Alternatively, you can refer yourself directly to a local psychological therapy service. 8
Are there treatments for OCD?
Once OCD has been diagnosed, it can be treated. There are 2 main types of OCD treatment that may be recommended: 12
- Psychological therapy: this involves working with a therapist to confront obsessions and compulsions and reduce the anxiety associated with them
- OCD medication: selective serotonin reuptake inhibitors (SSRIs) can be taken to increase the levels of serotonin in the brain, reducing OCD symptoms.
The type of treatment that is recommended will depend on how severe a person’s symptoms are. Mild cases of OCD can be treated with a short course of therapy, while longer courses of therapy and medicine may be used for more severe cases. 12
These courses of treatment can take time to be effective. People whose OCD symptoms do not improve may be referred to a national specialist OCD service, which can offer alternative assessments and OCD treatments. 12
How can relapses of OCD symptoms be prevented?
For many people, OCD support groups can also be helpful in preventing relapses by providing reassurance and advice to people with OCD. 12 Information on these support groups can be found with a quick web search. Just Google ‘OCD support group’ and your local area.
Q: Do I have OCD?
If you are experiencing obsessive thoughts or compulsive behaviors that you are struggling to control, you may have OCD. Consider discussing your symptoms with your doctor.
Q: What causes OCD to get worse?
OCD symptoms can be worsened by stress, often due to anxiety or fatigue, or by a life change such as moving house or getting a divorce.
Q: What is relationship OCD?
Relationship OCD is a particular type of OCD experienced by some people where their obsessions and compulsive behaviors are related to their relationship. They may obsess over their partner’s flaws or repeatedly doubt whether the relationship is good enough.
Q: Is obsessive cleaning a type of OCD?
OCD cleaning is a common obsession for people with OCD to experience. However, it is not the only symptom that someone with OCD may experience.
Q: What are examples of intrusive thoughts with OCD?
Common examples of intrusive thoughts include worrying that you may harm others or yourself, concern that you are not the right match for your partner, and fear that you have done something wrong when you haven’t.
BMJ Best Practice (2022). “Obsessive-compulsive disorder - Epidemiology”. Accessed July 25, 2022.
Nazeer A. et al. (2020). “Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management”. Accessed July 25, 2022.
World Health Organisation ICD-11 for Mortality and Morbidity Statistics (2022). “6B20 Obsessive-compulsive disorder”. Accessed August 10, 2022.
Stein D. et al. (2019). “Obsessive-compulsive disorder”. Accessed August 10, 2022.
NHS (2019). “Symptoms – Obsessive compulsive disorder (OCD)”. Accessed July 25, 2022.
BMJ Best Practice (2022). “Obsessive-compulsive disorder - Summary”. Accessed July 25, 2022.
National Institute of Mental Health (2019). “Obsessive-Compulsive Disorder”. Accessed July 25, 2022.
NHS (2019). “Overview – Obsessive compulsive disorder (OCD)”. Accessed July 25, 2022.
Murayama K. et al. (2020). “Impacts of Stressful Life Events and Traumatic Experiences on Onset of Obsessive-Compulsive Disorder”. Accessed July 25, 2022
Adams T. G. et al. (2018). “The role of stress in the pathogenesis and maintenance of obsessive-compulsive disorder”. Accessed July 25, 2022
BMJ Best Practice (2022). “Obsessive-compulsive disorder - History and exam”. Accessed July 25, 2022.
NHS (2019). “Treatment – Obsessive compulsive disorder (OCD)”. Accessed July 25, 2022.