All Conditions

Obsessive Compulsive Disorder.

Intrusive thoughts and rituals that can take over hours of the day.

Contrary to popular belief, obsessive compulsive disorder (OCD) is not necessarily associated with a need for cleanliness and order. This oft-misunderstood condition is marked by the presence of obsessions and subsequent compulsions. Obsessions are persistent intrusive thoughts, commonly centred around fears of contamination, losing control and harming oneself or others, disturbing religious or sexual thoughts, obsessive need for order and symmetry etc. People suffering from OCD are highly distressed by the content of their own intrusive thoughts. Compulsions, or repetitive behaviors, may be developed to reduce the excessive anxiety around these thoughts. Compulsions can look like checking locks and stoves a specific number of times, counting, knocking on something, seeking reassurance from other people and avoiding things that may trigger their obsessions. Compulsions can also be related to thoughts, so attempts to replace negative thoughts with positive thoughts, mentally reviewing/counting or silently chanting something that brings temporary relief can all be forms of compulsive behavior. Experiencing obsessions and having to perform compulsions can take up a lot of time, anywhere from an hour to multiple hours every day. When poorly managed, OCD can put a strain on relationships as well as all manners of daily activities.

When to seek help

A defining feature of OCD is that the obsessive thoughts are experienced as unwanted and highly intrusive, so professional help should be sought if the content of your thoughts is causing a lot of distress and you have to put in significant effort to avoid such thoughts or their unintended consequences. If thoughts do not cause anxiety or distress, it is likely that symptoms may be better explained by another mental health condition. OCD is typically managed with a combination of medication and a form of cognitive-behavioral therapy known as exposure and response prevention.

How we can help

Self-assessment scales

These are the same validated scales clinicians use. Your answers stay on your device and take a few minutes.

Common questions

What's the difference between OCD and being a perfectionist or "Type A"?
OCD is defined by intrusive, unwanted thoughts (obsessions) that cause real distress, and by repetitive actions or mental rituals (compulsions) the person feels driven to perform in order to manage that distress. Perfectionism and Type A traits, by contrast, are usually ego-syntonic, meaning the person identifies with them and largely values them. In OCD, the thoughts feel foreign and unwanted, and the rituals feel necessary but exhausting. Perfectionism that does not cause distress is generally not OCD.
Is exposure and response prevention (ERP) really worth doing? It sounds awful.
ERP is the most effective psychological treatment for OCD, with strong evidence behind it [1]. The principle is that, when you deliberately face a feared situation and do not perform the compulsion, your nervous system gradually learns that the feared catastrophe does not occur, and the urge weakens over time. The early sessions are uncomfortable, but most people find that exposures get easier as the brain updates. People who complete a full course of ERP often see substantial symptom reduction within twelve to twenty sessions. With a trained therapist, ERP is structured and paced. It is not the kind of therapy where you are simply pushed into your worst fear unprepared.
Are intrusive thoughts about harming others or about taboo topics a sign that I'm dangerous?
These thoughts are not a sign that you are dangerous. Intrusive thoughts about harm, sexuality, or religion are extremely common in OCD, and the fact that they distress you is precisely what marks them as OCD rather than as a reflection of intent. People who actually want to harm others do not experience these thoughts as horrifying or alien. Disclosing this kind of content to a clinician can feel impossible, but it is a recognised OCD subtype and clinicians who treat OCD have heard it many times before.
Does OCD respond to medication?
Yes. SSRIs are first-line for OCD, usually at higher doses than would be used for depression [2]. Common choices include fluoxetine, sertraline, and fluvoxamine. They take eight to twelve weeks to show their full effect for OCD, which is longer than the timeline for depression. Clomipramine, an older tricyclic antidepressant, is also effective and is sometimes used when SSRIs do not work well enough. Medication tends to reduce the intensity of urges, which makes ERP more accessible. For moderate to severe OCD, combining medication with ERP usually outperforms either approach on its own.