OCD

What is OCD?

Obsessive-compulsive disorder, or OCD, is a mental health condition in which unwanted intrusive thoughts, images or urges create intense anxiety, and a person responds with repeated behaviours or mental rituals aimed at reducing that anxiety.

The thoughts themselves are called obsessions, and the repeated actions used to manage them are called compulsions. OCD affects people of all backgrounds and can develop at any age, though it often starts in the teenage or early adult years. It is a recognised clinical condition, not a personality trait or a quirk about liking things tidy, and it can range from mild to severe in how much it affects daily life. Many people manage OCD privately for years before seeking support, partly because the content of the thoughts can feel embarrassing or frightening to say aloud.

Symptoms of OCD

OCD symptoms usually fall into two connected parts: obsessions and compulsions. Obsessions are thoughts, images or urges that arrive uninvited and cause distress, for example a fear of contamination, a worry about having caused harm, or a need for things to feel exactly right. Compulsions are the actions a person takes to reduce that distress or to prevent a feared event, such as washing, checking, counting, repeating phrases, seeking reassurance or mentally reviewing events.

Compulsions can be visible, like repeated handwashing or checking locks, or entirely internal, like silently repeating a phrase or replaying a memory to check it was safe. Over time the compulsions tend to increase rather than settle the anxiety, because they teach the brain that the obsession was a real threat that needed managing. Symptoms often take up more than an hour a day and can interfere with work, study or relationships, which is one of the clinical markers used to describe OCD as opposed to everyday worry.

Common themes in OCD

OCD can attach to almost any subject, but some themes come up often. Contamination fears involve worry about dirt, germs or illness, and washing or cleaning rituals to manage them. Checking themes involve repeated checking of locks, appliances or messages, often alongside a fear of having caused harm through carelessness. Symmetry and order themes involve a need for things to feel even, correct or complete, sometimes with mental counting or arranging.

Intrusive thought themes, sometimes called Pure O, involve distressing unwanted thoughts about harm, taboo subjects or morality, managed through mental rituals rather than visible actions. Relationship themes involve doubt and reassurance-seeking about a partner or relationship. Whatever the theme, the underlying pattern is similar: an intrusive thought triggers anxiety, and a ritual is used to reduce it, which keeps the cycle going.

How therapy can help

Therapy for OCD works by interrupting the cycle between obsessions and compulsions, rather than by trying to stop intrusive thoughts from occurring at all. Cognitive behavioural therapy, and specifically a technique within it called exposure and response prevention, is recommended by the National Institute for Health and Care Excellence for OCD.

Exposure and response prevention involves gradually facing the situations or thoughts that trigger anxiety, while resisting the urge to carry out the usual compulsion, so the brain has the chance to learn that the feared outcome does not happen and the anxiety settles on its own. This is done at a pace agreed between therapist and client, building from less distressing situations towards harder ones. Therapy also looks at the beliefs that keep OCD going, such as an inflated sense of responsibility for preventing harm, or the idea that having a thought makes an action more likely.

Our approach

We are clinical psychologists for Maidstone and Kent, working online with adults, providing OCD therapy without travel to an appointment, so sessions fit around work and family life for people across Maidstone and the surrounding areas, including Bearsted, Allington, Barming, Loose, Penenden Heath and Tovil.

Assessment starts with an honest conversation about the thoughts, rituals and themes involved, since OCD often looks different from one person to the next. From there, a plan is built collaboratively, drawing on exposure and response prevention and cognitive behavioural therapy, and adjusted as things progress. We take intrusive thoughts seriously without judgement. Thoughts about harm, taboo subjects or morality are common in OCD and do not reflect what a person wants or intends to do, and naming that clearly is often part of what makes it possible to talk about them at all.

What does OCD therapy involve?

Sessions usually begin with understanding the specific pattern of obsessions and compulsions, including what triggers them, what the compulsion is meant to prevent, and how much time and distress they involve day to day. From there, therapy typically involves building a shared list of situations or thoughts ranked by how much anxiety they provoke, then working through them gradually using exposure and response prevention, starting with more manageable ones.

Between sessions, practising outside the therapy room is usually part of the work, since the aim is for change to hold in daily life, not just in conversation. The pace is set collaboratively and can be adjusted if a step feels too difficult. Therapy also covers relapse prevention, so that if symptoms increase in future, there is a clear plan for what to do.

Frequently asked questions

People often want to know whether online sessions can really address OCD in the same way as face-to-face ones, and the answer, based on the evidence base for online cognitive behavioural therapy, is that structured, video-based sessions work well for this kind of skills-based work.

Others ask whether OCD is the same as being especially tidy or particular. OCD involves distressing, unwanted thoughts and compulsions that a person feels driven to carry out even when they know they do not make sense, so tidiness or a preference for order is a different thing entirely.

When to seek help

It is worth seeking support if intrusive thoughts or rituals are taking up significant time, causing distress, or getting in the way of work, study or relationships, even if the thoughts feel difficult to describe to someone else. OCD tends not to improve without support, and it can also travel alongside anxiety or low mood, so it is worth having help for.

If a difficulty feels linked to thoughts of harming yourself or someone else, contact a GP, NHS 111, or the Samaritans on 116 123, or go to A&E if there is immediate risk. We will update this site as the practice develops.