Obsessive-compulsive disorder Dr Trisha Macnair Many people are prey to worries, doubts and even superstitious rituals from time to time. For those with obsessive-compulsive disorder (OCD), however, these take over their lives.

In this article

What is it? What causes it?

What are the symptoms? What's the treatment?

Advice and support

Imagine being so worried about cleanliness that simply popping out to the shop means having to wash your hands again and again before leaving your house. And immediately after you leave, having to go back to wash them again because you touched the door handle and may have picked up some microscopic germ.

Or only being able to settle down in the evening once every item in your kitchen was lined up in its correct position (and that includes every knife, fork and spoon in the cutlery drawer, every packet in every cupboard, and even every biscuit in every tin).

Life would rapidly grind to a standstill, and that is exactly what happens for many people with OCD.

OCD can start at any age, although it usually begins before middle age and in as many as one in three cases it starts in childhood.

The exact cause is not fully understood, but there is a genetic or inherited tendency. Biological changes seem to occur in the brain, particularly in the way information is handled.

Research suggests that in OCD communication between the front part of the brain and deeper structures is faulty. Serotonin is the major chemical messenger involved in this area, and insufficient levels are thought to play an important part in OCD.

In other words, OCD is not just a product of the affected person’s imagination, not simply 'all in the mind'.

Occasionally, there may be clues to a physical cause. Although unusual, the problem sometimes begins suddenly in childhood after a bad throat infection (with the streptococcus bacteria). An autoimmune mechanism may be to blame, and it is worth trying a course of antibiotics as these may help.

An obsession usually develops in the form of thoughts or impulses that occur over and over again. These obsessions may be about almost anything, although common ones revolve around dirt, germs, illness, and harming someone you love.

The feelings are generally traumatic for the person affected, and may be associated with other symptoms such as fear, panic, disgust and doubt.

Compulsions are small acts or rituals that a person performs over and over again in a desperate bid to make the obsessions go away. They may have to be performed in a certain way, following set rules, and can make the person’s life a misery – but they still have to be obeyed.

Common compulsions include:

• Grooming rituals
• Cleaning
• Tidying
• Checking switches and locks
• Counting and arranging
• Collecting objects
• Repeating the same action over and over until it feels just right

In recent years, great claims have been made for a treatment called cognitive behavioural therapy (CBT), which includes learning about the condition and learning to adapt behaviour to cope with obsessive feelings.

The therapy can help prevent other problems associated with OCD such as depression or – perhaps a more immediate problem - unemployment.

Other psychological techniques may be incorporated in this treatment. Those who complete a course of CBT (usually about a dozen sessions) can expect a 60 to 80 per cent reduction in symptoms.

Drugs that increase the brain concentration of serotonin may also help improve symptoms. These are known as selective serotonin reuptake inhibitors (SSRIs), and include well-known treatments such as Prozac (fluoxetine).

OCD Action
Helpline: 0845 390 6232
Email: info@ocdaction.org.uk
Website: www.ocdaction.org.uk

OCD-UK
Email: admin@ocduk.org
Website: www.ocduk.org

This article was last medically reviewed by Dr Rob Hicks in July 2006.