Obsessive compulsive disorder

Also called OCD

Intrusive thoughts and the rituals used to neutralise them. Nothing to do with liking things tidy.

What it is

Every time somebody says they are a bit OCD about their spice rack, a person with OCD gets slightly further from being understood.

OCD is a cycle. An intrusive thought arrives, usually about harm, contamination, or something morally repugnant. It causes intense distress. A compulsion, a ritual, checking, washing, counting, mental reviewing, relieves that distress temporarily. The relief teaches the brain that the thought was dangerous and the ritual necessary. So it happens again, harder.

It affects roughly 1 to 2% of the population. The average delay before someone gets effective help is around a decade, largely because the content of the thoughts is so frightening that people cannot bring themselves to describe them.

Signs you might notice

Rituals that must be completed, and severe distress when they are interrupted.

Checking: locks, hobs, taps, repeatedly, without the checking ever producing certainty.

Washing to the point of damaged skin.

Reassurance-seeking on the same question, over and over.

Mental compulsions, which are invisible: praying, counting, reviewing memories to check something did not happen. Pure O is not a separate condition, it is OCD where the compulsions are internal.

Intrusive thoughts about harming others or about taboo subjects, which cause enormous shame and are the opposite of intention.

How it can affect day-to-day life

Hours a day disappear. People are late for everything, or stop going.

Families get recruited into the rituals: asked to check, to reassure, to avoid words. Accommodating it relieves distress in the moment and strengthens the condition, which puts loved ones in an impossible position.

The shame around harm and taboo thoughts is what keeps people silent. It is worth saying plainly: having a thought about harming somebody is evidence of OCD, not of danger.

Supporting someone well

Stop giving reassurance. Kindly, consistently, and having explained why first. Reassurance is the compulsion when somebody else performs it.

Do not participate in rituals, and agree in advance how you will decline.

Support exposure and response prevention, which is the treatment with the evidence: facing the trigger and not performing the ritual, in graded steps.

Attack the compulsion, not the thought. You cannot argue somebody out of an intrusive thought and you can help them stop responding to it.

Name the illness, not the person. "That is OCD talking" is a useful sentence.

Fiducia Life records mood and daily function, which matters because ERP feels worse before it feels better and a record is what shows it working.

Where to get help

In England, self-refer to NHS Talking Therapies and ask for ERP by name.

OCD Action and OCD-UK both run helplines staffed by people who understand the taboo content and will not be shocked.

If OCD is severe, ask for referral to a specialist OCD service. They exist and few people are told.