How is Obsessive-compulsive disorder (OCD) diagnosed?

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If you are concerned that you have OCD, and you want to seek professional help, the first step would normally be to visit your GP.

Your GP can provide an assessment and diagnosis, and help you access appropriate treatment.

If you visit a doctor to talk about OCD, they are likely to ask you direct questions about possible symptoms. For example:

  • Do you wash or clean a lot?
  • Do you check things a lot?
  • Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
  • Do your daily activities take a long time to finish?
  • Are you concerned about putting things in a special order or do you find mess very upsetting?
  • Do these issues trouble you?
  • How are they affecting your everyday life?

A doctor will then consider your answers against a list of medical criteria in order to make a diagnosis. If you receive a diagnosis of OCD, it should also say how severe your OCD is; for example, if you have mild, moderate or severe OCD.

It can be extremely difficult to discuss your experiences with a doctor, particularly if you experience distressing thoughts about issues such as religion, sex or violence. However, it is important to try and talk as honestly as you can, so your GP can suggest the right type of help for you.

If you find it difficult talking about your OCD, you may find it useful to prepare beforehand. You could think about how you would answer the questions above and write down the answers to take with you. Then if you start to feel embarrassed or overwhelmed when you are with your GP, you can refer to your notes – or even hand them to the doctor.

What treatments are available?

Before you have any treatment, your doctor should discuss all your
treatment options with you, and your views and wishes should be taken
into account.

NICE’s ‘stepped’ model

If you access help on the NHS, your treatment should be in line with
NICE (National Institute for Health and Care Excellence) guidelines.
NICE recommends ‘stepped’ treatment for OCD. This means that you
should receive different types of treatment depending on how severe
your symptoms are and how you responded to any previous treatment.

The diagram below is adapted from NICE’s guidelines.

OCD Pg11

However, the treatments recommended in the NICE guidelines are not appropriate for everyone. There are a number of options available to treat OCD and different things work for different people. You may find that a combination of approaches is most helpful for you, and different approaches may help you at different times.

Cognitive behavioural therapy (CBT)

CBT techniques helped me to see the intrusive thoughts for what they are, and put  them in their place. Cognitive behavioural therapy (CBT) is a talking treatment which aims to identify connections between your thoughts, feelings and behaviour. It aims to help you develop practical skills to manage any negative patterns of thinking or behaviour that may be causing you difficulties. It can be done one-to-one, or in a group. There is considerable evidence to suggest that this therapy is especially effective in dealing with OCD.

The behavioural element (also known as Exposure Response Prevention – ERP) is strongly recommended for treating OCD. ERP works by helping you to confront your obsessions and resist the urge to carry out compulsions. The aim is to help  you feel less anxious about obsessive thoughts over time, and make you less likely to engage in compulsive behaviour. For example, if you fear that you will harm someone and avoid sharp objects as a result, you might build up to a therapy session where you hold a knife while sitting in a room with other people. This technique needs to be carefully managed to avoid causing distress and anxiety, so it is important that you understand the treatment fully and feel comfortable with your therapist.

“It’s hugely frustrating and exhausting trying to break out of patterns that you know aren’t helpful or healthy. It can feel hopeless. But by challenging the behaviours, thoughts or compulsion you can eventually achieve fresh change that seemed impossible.”

You are entitled to receive free CBT on the NHS, and your GP should be able to  refer you to a local practitioner. However, waiting times for talking treatments on the NHS can be long. If you feel that you don’t want to wait or that you would like more support than is being offered, you may choose to see a therapist privately. The British Association for Behavioural and Cognitive Psychotherapies maintains a register of accredited CBT therapists.


Some people find drug treatment helpful for OCD, either alone or combined with talking treatments, such as cognitive behaviour therapy (CBT).

“I’ve been on meds for the last three years and my OCD is so much more controllable. Before taking any medication, it is important to read the patient information leaflet (that comes with the medicine) and discuss possible benefits and side effects with your doctor.”


The drugs prescribed most commonly are SSRI antidepressants, such as fluoxetine (Prozac), fluvoxamine (Faverin), paroxetine (Seroxat), citalopram (Cipramil) and sertraline (Lustral). These drugs are all recommended by NICE for the treatment of OCD. These drugs may have side effects, including nausea, headache, sleep disturbance, gastric upsets and increased anxiety. They may also cause sexual problems. The tricyclic antidepressant clomipramine (Anafranil) is also licensed for the treatment of obsessional states in adults. This should  normally only be prescribed if an SSRI antidepressant has already been tried and not been effective. The side effects of clomipramine can include a dry mouth, blurred vision, constipation, drowsiness and dizziness.


If you are experiencing very severe anxiety as a result of OCD, you may be offered tranquillising drugs, such as diazepam (Valium). This type of medication should only be used for short periods of treatment because of the risk of addiction. The side effects of tranquillisers can include drowsiness, confusion, unsteadiness and nausea.


Beta-blockers are occasionally given to people to treat the immediate symptoms of severe anxiety. They don’t treat the anxiety itself, but act on the heart and blood pressure to reduce physical symptoms, such as palpitations. The beta-blocker  most commonly used for anxiety is propranolol (Inderal). The main side effects include a slow heartbeat, diarrhoea and nausea, cold fingers, tiredness and sleep problems.

Neurosurgery for mental disorder

Neurosurgery (previously known as psychosurgery) is surgery on the brain. It is not recommended for treating OCD, but is very occasionally offered in severe cases, when other treatments have been unsuccessful. Neurosurgery is strictly regulated under the Mental Health Act, and can’t be given without consent.

Community mental health and social care

If your OCD is severe or complex, your GP may refer you to a community mental health team (CMHT). A CMHT is usually made up of range of professionals, such as psychiatrists, psychologists, social workers and occupational therapists. The team can offer medication, basic counselling or other mental health treatments like cognitive behaviour therapy (CBT). They should also be able to help with you with wider issues you have as a result of your OCD, such as difficulties around housing, benefits or everyday living. Even if you are not referred to a CMHT, or if you feel you are not receiving the support you need, you may be entitled to have a social care assessment to see if you are eligible for social care support.

Specialist OCD services

If you require more intensive support, it is recommended that you are referred to a specialist OCD service in your area. However, in reality, access to specialist  services across the country is patchy and you may need to travel outside your  local area.

If you feel you are not getting access to the treatment you require, you may find it useful to have an advocate. This is someone who can support you and speak up for you, so you can get the help you need. You can find an advocate by contacting your local Patient Advice and Liaison Service (PALS) via NHS Choices. Some local Minds also run advocacy services.


What is Obsessive-compulsive disorder (OCD)?

Original article:


Obsessive-compulsive disorder (OCD) is described as an anxiety disorder. The condition has two main parts: obsessions and compulsions.


Obsessions are unwelcome thoughts, images, urges or doubts that repeatedly appear in your mind; for example, thinking that you have been contaminated by dirt and germs, or experiencing a sudden urge to hurt someone.

These obsessions are often frightening or seem so horrible that you can’t share them with others. The obsession interrupts your other thoughts and makes you feel very anxious.

I get unwanted thoughts all through the day, which is very distressing and affects my ability to interact with others and concentrate on my studies and work.


Compulsions are repetitive activities that you feel you have to do. This could be something like repeatedly checking a door to make sure it is locked or repeating a specific phrase in your head to prevent harm coming to a loved one.

The aim of a compulsion is to try and deal with the distress caused by the obsessive thoughts and relieve the anxiety you are feeling. However, the process of repeating these compulsions is often distressing and any relief you feel is often short-lived.

Getting ready for each day involves so much hand washing, mental rituals, and doing things in the same order everyday… Sometimes, I feel like staying in bed and avoiding the day.

The OCD cycle

The diagram below shows how obsessions and compulsions are connected
in an OCD cycle.


Living with OCD

Although many people experience minor obsessions (e.g. worrying about leaving the gas on, or if the door is locked) and compulsions (e.g. rituals, like avoiding the cracks in the pavement), these don’t significantly interfere with their daily lives, or are short-lived.

If you experience OCD, your obsessions and compulsions will cause you considerable fear and distress. They will also take up a significant amount of time, and disrupt your ability to carry on with your day-to-day to life, including doing daily chores, going to work, or maintaining relationships with friends and family.

Many people with OCD experience feelings of shame and loneliness which often stop them from seeking help, particularly if they experience distressing thoughts about subjects such as religion, sex or violence.

This means that many people try to cope with OCD alone, until the symptoms are so severe they can’t hide them anymore.

OCD is also known to have a close association with depression, and some people find obsessions appear or get worse when they are depressed.

What’s it like living with OCD?

Watch James, Pat and Nicola talk about what living with OCD is like, and ways they have learned to cope.

What are the common signs of OCD?

Although everyone will have their own experiences, there are several
common obsessions and compulsions that occur as part of OCD.

Common obsessions

The three most common themes are:

  • unwanted thoughts about harm or aggression
  • unwanted sexual thoughts
  • unwanted blasphemous thoughts

Obsessions often appear closely linked to your individual situation. For example, if you are a loving parent, you may fear doing harm to a child and if you are religious, you may have blasphemous thoughts.

I have OCD harming thoughts and the compulsion to carry them out, which is absolutely terrifying to say the least.

Some examples of obsessions include:

• a fear of failing to prevent harm – e.g. worrying that you have left
the cooker on and might cause a fire
• imagining doing harm – e.g. thinking that you are going to push
someone in front of a train
• intrusive sexual thoughts – e.g. worrying about abusing a child
• religious or blasphemous thoughts – e.g. having thoughts that are
against your religious beliefs
• fear of contamination – e.g. from dirt and germs in a toilet
• an excessive concern with order or symmetry – e.g. worrying if objects
are not in order
• illness or physical symptoms – e.g. thinking that you have cancer
when you have no symptoms.

Common compulsions

Common compulsions include physical compulsions, e.g. washing or checking, or mental compulsions, e.g. repeating a specific word or phrase.

I have to keep checking things three times and have to have certain items on me to help me feel safe.

Some examples might be:

  • repeating actions – e.g. touching every light switch in the house every time you leave or enter the house
  • touching – e.g. only buying things in the supermarket that you have touched with both hands
  • focusing on a number – e.g. having to buy three of everything
  • washing or cleaning – e.g. having to wash your hands very frequently in  order to feel clean
  • checking – e.g. reading through an email ten times before sending it
  • ordering or arranging – e.g. keeping food organised by colour in the fridge
  • repeating a specific word or phrase – e.g. repeating someone’s name in order to prevent something bad happening to them
  • praying – e.g. repeating a prayer again and again whenever you hear about an accident
  • counteracting or neutralising a negative thought with a positive one – e.g. replacing a bad word with a good one.


You might find that some objects or experiences make your obsessions or
compulsions worse, and you try to avoid them as a result. For example,
if you fear contamination, you might avoid eating and drinking anywhere
except in your own home. Avoiding things can have a major impact on
your life.

OCD means that I miss out on things because I [stay in] to try to protect myself from the stress. It’s sunny outside and I want to go out, but I know I probably won’t.

Activities for Children With Behavioral Problems

by Jennifer Zimmerman, Demand Media

Behavioral problems have many causes. They can stem from neurological disorders such as attention-deficit/hyperactivity disorder, emotional issues such as abuse or family issues such as divorce. Regardless of the cause, though, some activities can help children with behavioral problems. Parents and teachers will need to determine which activities are most appropriate for a specific child.


No activities can eliminate behavior problems, but some can reduce the likelihood of them occurring. Exercise is recommended by both Kids Health and the American Academy of Pediatrics for help with behavioral problems. For children whose behavior problems have to do with anger, Kids Health recommends martial arts, wrestling and running as especially helpful forms of exercise.


Lack of self-control is often a cause of behavior problems, so the National Association of School Psychologists has suggested activities to help teach self-control. One idea is to use puppets to role-play wanting something that you can’t have. The organization suggests having your child write or draw something he’d like to do, then discussing it and sharing something you’d like to do, but can’t. Next, you and your child can use puppets to role-play scenarios that are typically frustrating for children such as wanting a toy that another child has or wanting to play with a friend who isn’t available. After acting out the scenarios, you and your child should discuss how he felt and what choices he made during the exercise.

Reading Aloud

Reading to your children is more than just an opportunity to settle down at bedtime and increase literacy skills; it can also be an opportunity to practice identifying feelings. Children who struggle to identify feelings, whether their own or others can have behavior problems. The National Association of School Psychologists suggests parents discuss character’s feelings with their children while they read and encourage children to draw pictures to illustrate those feelings.

Teach Problem-solving

Sometimes children misbehave because they don’t know how to handle a circumstance or a feeling correctly, according to the American Academy of Pediatrics. The National Association of School Psychologists suggests teaching children to deal with feeling angry. Have them recognize that they are angry by identifying characteristics such as clenched hands, then have them count to 10, then have them think about their choices. Discuss choices such as walking away, taking deep breaths or telling the person how you feel in a calm voice. Finally, children should act on their best choice.


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Emotional child abuse may be just as bad as physical harm

Read more at Reuters

When it comes to psychological and behavioral health, both physical and emotional abuse can be equally damaging to children, a new study suggests.

Even though doctors and parents often believe physical or sexual abuse is more harmful than emotional mistreatment or neglect, the study found children suffered similar problems regardless of the type of maltreatment endured, researchers report in the journal JAMA Psychiatry.

“The abused children had all types of problems, from anxiety and depression to rule-breaking and aggression,” lead study author David Vachon, of McGill University in Montreal, said by email.

His team was surprised, he said, that “different types of abuse had similar consequences; physically abused children and emotionally abused children had very similar problems.”

To compare the impact of different forms of child abuse on mental health, Vachon and colleagues studied almost 2,300 kids who attended a summer camp for low-income children between 1986 and 2012.

Roughly 1,200 children – slightly more than half – had experienced maltreatment.

Campers were assigned to groups of children their age, with about half the kids in each group having a history of maltreatment. The kids didn’t know which of their fellow campers had experienced abuse.

Counselors and other campers assessed each child’s behavior during camp, and every kid also completed a self-evaluation.

Overall, children with a history of abuse and neglect had much higher rates of depression, withdrawal, anxiety, and neuroticism than campers who hadn’t been mistreated.

This difference held true for kids who were victims of all types of abuse, including neglect as well as physical, sexual or emotional mistreatment.

The effect was most profound for children who suffered from all four types of abuse, or from the most severe forms of maltreatment.

Results were similar for boys and girls and across racial groups.

Shortcomings of the study include its reliance on official documentation of abuse and the lack of data on psychological disorders children may have had prior to experiencing maltreatment, the authors acknowledge.

Even so, the psychological and behavioral effects of abuse may be similar because both physical and emotional mistreatment – whether it happens within a family or among peers – can have common elements, said Dr. William Copeland, a psychiatry researcher at Duke University in Durham, North Carolina.

“This study is about righting a longstanding error and prejudice about the differences between these common childhood adversities,” Copeland, who wasn’t involved in the study, said by email.

“It suggests that whether we are talking about prevention, screening or treatment, our notions of childhood mistreatment need to be broader and more holistic than they have been,” Copeland added. “There are no hierarchies when it comes to child maltreatment.”
Read more at Reuters

OCD Explained


Obsessive-compulsive disorder (OCD) is characterized by repetitive thoughts, impulses, or images that are intrusive and inappropriate and cause anxiety or distress, or repetitive behaviors that the person feels driven to perform in response to an obsession or rigid rules that must be applied. Those suffering from this condition recognize that the obsessions are a product of their own mind. The obsessions or compulsions are time consuming or interfere with role functioning.

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