What is obsessive compulsive disorder and what are its symptoms? Learn about intrusive thoughts, checking and cleaning compulsions, and how OCD therapy works.
Do you go back after leaving the house to make sure you locked the door, and then go back once more? After washing your hands, do you find yourself unable to stop washing them again because they still do not feel clean enough? Or do unwanted, horrifying thoughts enter your mind, so that you silently repeat certain phrases to push them away? These experiences may be linked to obsessive compulsive disorder. Commonly known as OCD, this condition is far more widespread than people assume, and it is often lived with for years without being told to anyone. In this article we explain what OCD is, its symptoms and causes, and how it is approached in therapy, in calm and clear language.
What Is Obsessive Compulsive Disorder?
Obsessive compulsive disorder is a mental health condition made up of two main components: obsessions and compulsions.
Obsessions are thoughts, images or urges that enter a person's mind unbidden, recur and cause intense distress. The person often knows these thoughts are irrational or excessive, but cannot get them out of their mind.
Compulsions are repetitive behaviours or mental acts performed to reduce the distress caused by obsessions or to prevent something feared from happening. Washing hands, checking, counting, arranging things in a certain order or silently repeating certain phrases are examples.
Compulsions bring short-term relief, but that relief leads the mind to conclude, "So that thought really was dangerous, and my behaviour protected me." In this way the obsession grows stronger and the cycle sustains itself. Over time, compulsions can take up hours of the day and seriously affect a person's work, relationships and quality of life.
In everyday language, people often say things like "I'm a bit OCD, I like my desk to be tidy." But liking order or being meticulous is not OCD. What defines OCD is that the thoughts and behaviours cause the person serious distress, take up time and restrict their life.
What Are the Symptoms of Obsessive Compulsive Disorder?
The symptoms of OCD vary greatly from person to person. The most common themes are as follows:
Contamination and Cleaning
Fear of catching or spreading germs, dirt, illness or harmful substances, frequent hand washing, long showers, avoiding touching certain objects, and cleaning the home constantly or in a set order are typical examples of this theme. Sometimes the person fears not for themselves but that they will pass something on to their loved ones.
Doubt and Checking
People check repeatedly out of a suspicion that they did not lock the door, left the stove on, did not unplug the iron or have harmed someone. Even after checking, the thought "What if I wasn't completely sure?" starts again.
Harm Thoughts
A person may have disturbing thoughts or images of accidentally harming someone they love, such as their baby or partner. Because these thoughts are completely at odds with the person's values, they cause great horror and guilt. One important point needs underlining here: Thoughts like these do not mean the person wants to or will act on them. On the contrary, the fact that the thought is so disturbing shows that it conflicts with the person's values.
Religious and Moral Obsessions
This theme, often called "vesvese" (religious scrupulosity) in Turkey, can appear as constant doubt about whether worship has been performed correctly, repeating ritual ablution over and over out of a thought that it has been invalidated, or a fear of having sinned or blasphemed unintentionally. The person feels deep guilt about these thoughts and often cannot share them with anyone.
Symmetry, Order and the "Just Right" Feeling
Things needing to be in a certain order, a task being repeated until it feels "just right", and attachment to particular numbers or sequences fall into this group.
Mental Compulsions
Not every compulsion can be seen from the outside. Praying silently, counting certain numbers, neutralising a "bad" thought with a "good" one, mentally reviewing past events over and over, or constantly seeking reassurance from those close to you can also serve as compulsions.
Experiencing a few of the symptoms listed here does not in itself amount to a diagnosis. A diagnosis can only be made through a comprehensive assessment by a professional.
What Causes OCD?
Obsessive compulsive disorder has no single cause; it is thought to develop through a combination of biological, psychological and environmental factors.
- Biological factors: Research shows that certain brain circuits and chemical messengers play a role in OCD. Having OCD in the family can increase vulnerability.
- The meaning attached to thoughts: Strange, disturbing thoughts come into everyone's mind from time to time. In OCD the difference lies in the meaning attached to these thoughts. Beliefs such as "If I thought it, I'm a bad person", "Thinking is the same as doing" and "If something happens, I'll be responsible" turn an ordinary thought into a major threat.
- Excessive responsibility and the need for certainty: Feeling overly responsible for preventing bad events, and being unable to tolerate uncertainty, feed OCD.
- Stressful life events: Symptoms often begin or increase during periods of intense stress. The postnatal period, taking on a new responsibility, moving house, loss or health problems are examples of such periods.
- Learning and the family environment: An overly rule-bound, critical or anxious family environment can contribute to the development of perfectionism and beliefs about excessive responsibility.
None of these factors alone causes OCD, and no parent or person is "to blame" for it. The purpose of trying to understand causes is not to look for someone to blame but to see how the cycle forms and how it can be changed. In therapy too, the focus is less on the details of the past than on the thoughts and behaviours that maintain the symptoms today.
How Does OCD Affect Daily Life?
OCD can affect almost every area of life. Leaving the house in the morning can take a long time because of checking rituals, checking the same document repeatedly at work can reduce productivity, and cleaning rituals can take hours. Over time the person may start avoiding certain places, people or objects.
Family relationships are affected too. Household members often take part in the rituals without realising: everyone who comes home changing their clothes immediately, certain objects not being touched, reassurance being given constantly... This is called family accommodation, and even when done with good intentions it can help keep the cycle going. For people living in an extended family, reactions such as "You're exaggerating, just drop it" can increase shame and concealment.
Say a woman who has just become a mother has an image come into her mind of harming her baby while bathing her. She was so frightened by this thought that she began avoiding bathing the baby alone and hiding the kitchen knives, and could not tell anyone, because she feared she would be seen as a "bad mother" if she did. Experiences like this are well known in OCD and can be addressed in therapy. Knowing that you are not alone and that these thoughts do not define you can make it easier to take the first step.
Why Is OCD Often Kept Secret for Years?
Many people with OCD seek support long after their symptoms begin. One of the most important reasons is shame. When the content of the thoughts that come to mind relates to harm, sexuality or religion in particular, the person thinks, "If I tell them, they'll judge me" or "No one else thinks like me." Another reason is that rituals become routine over time; a person may come to see forty minutes of checking every morning as an ordinary part of life. Yet these thoughts are experiences that mental health professionals know very well. In therapy they can be talked about in detail, without judgement.
A thought that comes to your mind does not show who you are; it only shows something your mind produced at that moment.
What You Can Do on Your Own to Cope with OCD
OCD generally needs professional support, but the suggestions below can help the process:
- Label the thought: When an obsessive thought comes, saying "This is an OCD thought" can help you put some distance between yourself and it.
- Do not try to suppress the thought: Trying to push a thought away by force can make it come more often, much as when you are told "Don't think of a pink elephant" and a pink elephant immediately appears in your mind.
- Try delaying the ritual: Instead of doing the compulsion straight away, try waiting a few minutes. You may notice that the anxiety eases on its own after a while.
- Reduce reassurance seeking: Constantly asking those close to you "Are you sure?" brings relief in the short term but feeds the cycle.
- Get informed, but set limits: Getting reliable information about OCD is useful, but spending hours online searching "Is this thought normal?" can itself turn into a kind of compulsion.
- Treat yourself with compassion: Remember that you did not choose these thoughts, and that you are not weak for struggling with them.
To learn about other forms of anxiety, you can take a look at our article on anxiety symptoms.
When Should You Seek Professional Support?
It is recommended that you consult a mental health professional in the following situations:
- If obsessive thoughts or rituals take up a significant part of your day,
- If these thoughts and behaviours cause you intense distress,
- If your work, school, relationships or daily tasks are suffering as a result,
- If you have started to avoid certain places, people or objects,
- If your family members have to take part in your rituals,
- If you have noticed behaviours in your child such as repeated washing, checking, counting or constantly asking for reassurance.
When the symptoms of obsessive compulsive disorder are severe, an assessment by a psychiatrist may be recommended alongside psychotherapy. OCD can sometimes be accompanied by depression; if you are having thoughts of harming yourself or ending your life, do not wait: call 112 (emergency services) or go to the nearest emergency department.
How Is Obsessive Compulsive Disorder Approached in Therapy?
The psychotherapy approach best supported by research in OCD is Cognitive Behavioural Therapy and its specialised application, Exposure and Response Prevention (ERP).
Assessment and Psychoeducation
In the first stage, obsessions, compulsions, avoidance behaviours and their impact on life are examined in detail. How the OCD cycle works is talked through together. Many clients feel relieved when they learn that what they are experiencing has a name and that others have similar experiences.
Exposure and Response Prevention
In this method, the person gradually and in a controlled way faces the thoughts, situations or objects that cause anxiety, while trying not to carry out the compulsion. For example, someone with a fear of contamination first touches an object that causes little anxiety and tries waiting without washing their hands immediately. Over time they experience that the anxiety fades on its own and that what they feared does not happen. The steps are planned together with the client and the process moves forward at their pace.
Cognitive Work
Work is done on the meanings attached to thoughts, beliefs about excessive responsibility and the need for certainty. Beliefs such as "Thinking is the same as doing" are questioned.
Working with the Family
Particularly with children and adolescents, but with adults too, sessions with the family can be held to reduce family members' participation in rituals and to develop a supportive stance. With children, this work is carried out using age-appropriate language and playful methods. For example, giving OCD a name and externalising it as a "boss in the head" can help a child create some distance between themselves and their obsessions.
How Does the Process Unfold?
Therapy usually begins with weekly sessions, and exposure exercises practised between sessions form an important part of the process. In the early stages anxiety may temporarily increase; this does not mean the process is going wrong, but rather that the person has begun to face their fears. Progress is reviewed together regularly and the plan is updated when needed. In the final stage, a personalised action plan is prepared for periods when symptoms may flare up again.
If you are curious about how we work with anxiety-related problems, you can find information on our anxiety and panic page.
Frequently Asked Questions
Does OCD go away completely?
With appropriate support, many people experience a marked reduction in their symptoms and a life that no longer revolves around OCD. The process varies from person to person; symptoms may increase again in difficult periods, but the skills learned in therapy help in coping with these times.
If I have harm thoughts, am I dangerous?
The harm thoughts seen in OCD are unwanted thoughts that horrify the person; having these thoughts does not mean the person wants to act on them. Even so, talking about this with a professional helps you understand the nature of the thoughts and feel relieved.
Does OCD occur in children?
Yes, OCD can also begin in childhood and adolescence. Children often hide their rituals or cannot explain them; behaviours such as frequent hand washing, arranging objects in a certain order or constantly seeking reassurance are signs to watch for.
Are "vesvese" and OCD the same thing?
Obsessive doubts about religious matters and the repetitive behaviours that accompany them can be a common form of OCD. This relates not to the person's faith but to doubt and the need for certainty; in therapy it is approached with respect for the person's values, and support is available.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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