What is obsessive compulsive disorder (OCD)?
Obsessive compulsive disorder (OCD) is a mental health condition involving obsessions, compulsions and anxiety.
Obsessions are thoughts, images or urges that you don’t want, but can’t stop thinking about. These are also called intrusive thoughts. When you experience these thoughts, you might feel very anxious, fearful, or sometimes disgusted.
Examples of obsessions include:
- imagining loved ones getting hurt
- being scared of getting sick from touching door handles
- feeling that something terrible will happen if something isn’t in the right order.
Compulsions are things you feel you must do often (but not always) in response to an obsession. Compulsions might also be referred to as ‘rituals’. Sometimes you might not know why you feel and behave this way. Your compulsions might relieve your anxiety in the short term, but can lead to a cycle that keeps the OCD going, and in the longer term makes things worse.
Some examples of compulsions include:
- washing your hands repeatedly because you are worried about germs
- repeatedly checking things, such as if a door is locked
- a need to arrange things in a set way.
All of us have intrusive thoughts from time to time. As children most of us go through a stage of being more obsessional, and this is a normal part of growing up. For example, you might want your bedtime routine to be exactly the same every night.
OCD is different to this, as your unwanted thoughts or compulsions last longer (usually more than 6 months), and cause you severe distress and/or interfere with your everyday life. OCD usually starts in the early teenage years, but is often not diagnosed until adulthood. This can sometimes happen if a young person is good at hiding that there is a problem.
Children and young people with OCD often also have phobias. Phobias are extreme fears which cause you a lot of distress and have a significant impact on your life (please see the Phobias dropdown on our anxiety section for more information).
We don’t know exactly what causes OCD, but there are some evidence based treatment options to help with OCD symptoms.
- Family involvement in OCD
Often, parents, carers or other family members can become involved in your OCD symptoms. For example, they might repeatedly reassure you that what you’re worried about won’t happen. Or they might get involved in particular rituals, or might help you to avoid things that you fear. They often do this because they think it will help with your distress, but while this might reduce your anxiety in the short term, it can actually make things worse in the longer term.
- Other mental health conditions
It is common to have other mental health conditions alongside OCD, including:
- other anxiety disorders and phobias
- body dysmorphic disorder
- oppositional defiant disorder
- autism, where it can be hard to know whether the symptoms are part of OCD, or a core feature of autism
- Tourette's syndrome
- eating disorders, such as anorexia nervosa, bulimia nervosa and binge eating disorder
- Paediatric acute-onset neuropsychiatric syndrome (PANS)
Rarely, obsessive compulsive symptoms can be brought on or made worse by a common bacterial infection called Group A streptococcus (GAS). This infection can give you a sore throat or chest infection, before quickly causing you to develop tics and/or obsessive compulsive behaviour.
This is different to OCD, where the obsessive compulsive symptoms worsen more gradually. This condition is known as paediatric acute-onset neuropsychiatric syndrome (PANS), or by the older term paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
- How can I get help?
If you are worried that you might have OCD then you should talk to a professional who could make a referral for you to child and adolescent mental health services (CAMHS). You can do this by:
- seeing your GP
- (in some areas) asking for a referral from your school
- (in some areas) contacting the CAMHS teams directly
OCD Action is a UK based charity which is run for and by people with OCD. They provide information and advice on how to get help, and also run a helpline.
- Planning treatment
The first step in starting treatment is to have an assessment. Your assessment will include talking to a professional about how OCD affects you. They will also ask whether you have any other mental or physical health conditions, and think about whether your obsessive-compulsive symptoms are purely part of OCD, or whether they may be part of another problem (e.g. Tourette syndrome, or an eating disorder such as anorexia nervosa, bulimia nervosa or binge eating disorder).
As your family might have become involved in your obsessive-compulsive symptoms, it is also important to look at how the OCD is affecting them. It can be useful to look at how your family might be involved in treatment and how they might be able to help you.
If your OCD symptoms interfere with your education, your professional might also need to work with your school, college or university.
The first step in treatment for OCD is psychoeducation for you and your family. The professional treating you should talk to you about how they think your OCD is affecting you, and what can be done to help. There are also useful resources such as the OCD Action website.
Guided self-help or OCD specific group therapy
If your symptoms are very mild, you are highly motivated and well supported, and are able to participate independently, then you might be offered guided self-help or OCD specific group therapy.
If you are offered guided self-help or group therapy, it is important that a professional keeps track of whether your symptoms are improving. If they aren't then you should be offered cognitive behaviour therapy (CBT) which includes exposure and response prevention (CBT-ERP).
It’s important to know that it’s your choice whether to use guided self-help or OCD specific group therapy instead of individual CBT-ERP. This decision shouldn’t be made for you.
Cognitive behaviour therapy which includes exposure and response prevention (CBT-ERP)
Cognitive behavioural therapy (CBT) is a type of therapy where your professional helps you to learn about how your feelings, thoughts, and behaviours affect each other and keep you stuck in unnecessary, upsetting cycles. Your professional will also help you to find ways to change this.
When treating OCD, the therapy must include exposure and response prevention (ERP), which is an approach that works directly on the OCD cycle. CBT-ERP is the only evidence-based psychological therapy for OCD.
Although CBT-ERP is usually an individual therapy for children and young people, it can often be helpful to involve your parents or carers.
If CBT-ERP has not helped after 3 months it is important to check whether anything is getting in the way of your recovery. This is sometimes called a full multidisciplinary review, which means your professionals will meet with you and your parents or carers to talk through your recovery. After this you might be offered treatment with medication.
You professional could suggest that you take medication called Fluvoxamine or Sertraline at the same time as continuing CBT-ERP. These medications are selective serotonin reuptake inhibitors (SSRIs), which are a type of anti-depressant that can help with OCD symptoms.
Your professional might recommend other SSRIs if they would suit your circumstances better.
You might also be prescribed medication if you do not want CBT with ERP. Occasionally, if your symptoms are very severe then your professional might prescribe you medication combined with CBT-ERP from the start of your treatment.
Referral to hospital
You might be referred to a specialist OCD service for children and young people at the Maudsley Hospital in London which is a national outpatient-based service.
Your professional might suggest that you have treatment in hospital if your OCD is very severe. For example if:
- it’s having a big effect on your day-to-day life, and you are not able to do much else other than the compulsions/rituals
- you are not able to manage activities such as washing, dressing, and eating and drinking enough
- you are a risk to yourself or others.
The hospital should be able to offer you intensive CBT-ERP.
- What about my parents or carers?
Your professional should give your parents or carers information about OCD and your treatment options. If appropriate, your professional should work together with you and your parents or carers to make decisions about your care. Treatment for OCD is often more effective if parents or carers are involved so your professional will talk to you about how this might work.
OCD can also have an impact on your parents or carers, and your assessments might look at the effect of your compulsions on your family, including how much they are involved in supporting or carrying out your compulsions. Your parents or carers should be offered an assessment of their own needs, to look at any support that might help them.
- Transitions between services
Transitioning from CAMHS to adult services can be a worrying time. To help it go smoothly, your professional should leave plenty of time to work with you to plan the change. You should get clear information about what to expect from adult services and it can be helpful to involve your parents or carers in the process.
You may also transition to another CAMHS service (e.g., if you move house). If this happens, your professional should work with you to make sure that your treatment can continue smoothly, and that your new service has all the information they need.
For more information about transitioning between services, please see Moving on.
- Additional support
The below organisations offer OCD specific support for children, young people and their families:
- ADHD Foundation: UK charity offering support for those living with ADHD, Autism, Dyslexia, DCD, Dyscalculia, OCD, and Tourette’s Syndrome
- AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258
- Child and Adolescent Obsessive Compulsive Disorder Service: NHS service supporting young people with OCD and related conditions including body BDD, tic conditions and Tourette’s syndrome.
- Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you.
- No panic: charity that helps and supports those living with Panic Attacks, Phobias, Obsessive Compulsive Disorders and other related anxiety disorders
- OCD Action: national charity offering support to those with OCD and their families
- OCD-UK: charity offering support for children, young people and adults affected by obsessive compulsive disorder
- OCD Youth: OCD Youth aims to increase awareness and access to support for anyone under 25 affected by OCD.
- The Mix: support and advice for children and young people under 25
Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.