Obsessive-compulsive disorder (OCD)
Recurrent unwanted thoughts, images or urges (obsessions) that cause intense distress, and repetitive actions or mental rituals (compulsions) performed to neutralise them. Themes include contamination, harm, sexual or religious taboo, symmetry and doubt.
What drives it
Compulsions buy short-term relief from anxiety, guilt or a sense of things being 'not right', which reinforces them. The person treats an intrusive thought as dangerous or meaningful and takes on excessive responsibility for preventing harm.
How it shows
Work
Rereading an email many times before sending, checking locks, stoves or files repeatedly, needing documents formatted 'just right', seeking reassurance ('Are you sure that's OK?'). Tasks take far longer than they should. Often secretive and deeply embarrassed, so colleagues see only slowness or indecision.
Relationships
Rituals at home (washing, checking, ordering), repeated questions about whether they upset someone or whether the relationship is right ('relationship OCD'), family members drawn into reassurance and accommodation. The person usually knows the fear is excessive and hates the ritual.
Self
A thought arrives that horrifies you (that you might harm someone, that you have contaminated something) and you cannot let it go until you perform a check or a mental counter-thought. You know it does not make sense, and that is part of the torment.
What tells it apart
Obsessive-compulsive personality (OCPD): OCD is ego-dystonic: the person hates the thoughts and rituals and feels them as intrusions. OCPD is ego-syntonic: the person endorses their rules, order and control as correct and thinks others are sloppy, and there are no intrusive thoughts or neutralising rituals.
Generalised anxiety: Worry in generalised anxiety is about realistic everyday matters and is felt as problem-solving; OCD obsessions are often bizarre, taboo or out of character and are followed by specific rituals.
Perfectionism: Perfectionists pursue high standards they value; in OCD the 'just right' feeling is a discomfort to be relieved, unrelated to quality, and the rituals often make work worse.
A test
Ask whether the thought feels alien and unwanted and whether they do something to cancel it out; if rituals or reassurance-seeking take more than an hour a day or distort work and relationships, recommend assessment for exposure and response prevention.
Questions to carry
- After the unwanted thought arrives, what is done to cancel it, and how much of the day does that take?
- Which thought of mine feels so dangerous that I have to undo it, and what do I fear it says about me?
How strong the research is
strong
Where it comes from
Jean-Étienne Esquirol, 1838; Pierre Janet, 1903; exposure and response prevention by Victor Meyer, 1966; cognitive models by Stanley Rachman and Paul Salkovskis, 1980s–90s