Symptoms of obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thought and behaviour.

Most people with OCD tend to follow a set pattern of thought and behaviour. This pattern has four main steps:

• obsession – where your mind is overwhelmed by a constant obsessive fear or concern, such as the fear your house will be burgled
• anxiety – the obsession provokes a feeling of intense anxiety and distress
• compulsion – you then adopt a pattern of compulsive behaviour to reduce your anxiety and distress, such as checking all the windows and doors are locked at least three times before you leave your house
• temporary relief – the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the pattern or cycle to begin again

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point in their life, such as a nagging worry that their job may not be secure, or a brief suspicion their partner has been unfaithful.

Most people are able to put these types of thoughts and concerns into context, and they can carry on with their day-to-day life. They do not repeatedly think about worries they know have little substance.

However, if you have a persistent, unwanted and unpleasant thought that dominates your thinking to the extent it interrupts other thoughts, you may have developed an obsession.

Some common obsessions that affect people with OCD include:

• fear of deliberately harming yourself or others – for example, fear you may attack someone else, even though this type of behaviour disgusts you
• fear of harming yourself or others by mistake or accident – for example, fear you may set the house on fire by accidentally leaving the cooker on, which leads you to repeatedly check kitchen appliances are off
• fear of contamination by disease, infection or an unpleasant substance
• a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way
• fear of committing an act that would seriously offend your religious beliefs

Compulsive behaviour

Compulsions arise as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not realistically connected at all.

For example, a person who fears becoming contaminated with dirt and germs may wash their hands 50 times a day, or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to “neutralise” the thought of harm. This latter type of compulsive behaviour is particularly common in children with OCD.

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on their compulsion.

Some common types of compulsive behaviour that affect people with OCD include:

• cleaning
• handwashing
• checking (such as checking doors are locked, or that the gas or a tap is off) 
• counting
• ordering and arranging
• hoarding 
• asking for reassurance
• needing to confess
• repeating words silently
• prolonged thoughts about the same subject
• “neutralising” thoughts (to counter the obsessive thoughts)