Private ocd clinic in London, same-day mental health.

How it works

An obsession is an unwanted, intrusive thought, image or urge that causes intense anxiety. A compulsion is something done to neutralise it — a physical act or a mental one. The compulsion works briefly, which is exactly why the cycle strengthens: each time you perform it, your brain learns that the danger was real and the ritual prevented it.

The themes people do not mention

• Contamination — the well-known one, with washing and cleaning
• Checking — locks, appliances, that you have not harmed someone
• Harm obsessions — intrusive thoughts of hurting someone you love, or of losing control. These are the opposite of intent, and they are distressing precisely because they are abhorrent to you
• Sexual or 'taboo' intrusive thoughts, including thoughts about children, which cause enormous shame and are the least likely to be disclosed
• Religious or blasphemous obsessions (scrupulosity)
• Symmetry and 'just right' feelings
• Relationship or health obsessions

Mental compulsions count

Not all compulsions are visible. Mental reviewing, counting, praying, mentally checking whether you did something, arguing with the thought, or seeking reassurance are all compulsions, and they maintain OCD just as effectively as handwashing. People with purely mental compulsions are often told they do not have OCD, which is wrong.

Why reassurance backfires

Asking 'are you sure I locked it?' or 'do you think I'm a bad person?' relieves anxiety briefly, so the brain requires more of it next time. Reassurance-seeking is itself a compulsion. This is difficult for families, who naturally want to help — and the most helpful thing they can do is agree in advance, kindly, to stop providing it. Accommodation by family is one of the strongest predictors of poor outcome.

Treatment

• Exposure and response prevention (ERP) is the treatment. It means deliberately facing the trigger and not performing the compulsion, so anxiety rises and then falls on its own. It is uncomfortable, it works, and generic counselling or talking therapy does not.
• SSRIs are effective, generally at higher doses and for longer than in depression — often 12 weeks before full benefit. Many people are undertreated on a depression-level dose.
• Combining ERP and medication works better than either alone for moderate to severe OCD.
• Continue medication for at least a year after improvement to prevent relapse.
• Specialist services exist for severe or treatment-resistant OCD.