Obsessive-compulsive disorder

Overview

Obsessive-compulsive disorder (OCD) is a mental health condition characterised by intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that a person feels driven to perform in response. OCD is not about being tidy or organised — it is a distressing, time-consuming condition that can severely impair daily functioning.

How common is it?

OCD can affect adults and children of any sex. It often starts around puberty or early adulthood, although symptoms can begin earlier. Effective treatment is available.

Causes and risk factors

OCD results from abnormal activity in frontal-striatal brain circuits, combined with genetic predisposition and psychological vulnerability.

Common risk factors

• Genetic factors (higher concordance in identical twins)
• Abnormal serotonin and glutamate neurotransmission
• Dysregulation of fronto-striato-thalamo-cortical circuits
• Psychological: perfectionism, inflated sense of responsibility, thought-action fusion
• Life stress and traumatic events
• Paediatric OCD: PANDAS (paediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections) — controversial but recognised subgroup

Symptoms

• Obsessions: persistent, intrusive thoughts, images, or urges causing marked anxiety (common themes: contamination, harm, symmetry, forbidden sexual or religious thoughts)
• Compulsions: repetitive behaviours (handwashing, checking, ordering, counting) or mental acts (praying, repeating phrases) performed to reduce distress from obsessions
• Recognition that obsessions and compulsions are excessive (usually)
• Symptoms are time-consuming or cause significant distress or impairment; help is appropriate even if they take less than an hour daily.
• Avoidance of situations that trigger obsessions

When to see a doctor

Seek help when OCD symptoms are taking more than an hour per day, causing distress, or interfering with work, relationships, or social life. OCD responds well to treatment — delay increases its grip.

Diagnosis

Clinical assessment using Y-BOCS (Yale-Brown Obsessive Compulsive Scale). Distinguish from normal intrusive thoughts (which all people experience), GAD, health anxiety, autism spectrum disorder, and psychosis.

Treatments

Self-care and lifestyle

• Work with your therapist on gradual exposure and reducing avoidance; keep appropriate medical and everyday safety precautions.
• Family members can offer emotional support while gradually reducing participation in rituals, using a plan agreed with the person and their therapist.
• Regular exercise reduces OCD symptom severity
• Mindfulness helps observers distance from intrusive thoughts without engaging

Prevention

There is no reliable way to prevent OCD. Seeking help early can reduce its impact and make compulsions easier to address.