OCD: Obsessive-Compulsive Disorder

OCD cycle, signs, causes, impact of, treatment, children, remission, carers, suggestions for practice.

Three sections follow:

1. Background Material that provides the context for the topic

2. Suggestions for Practice

3. A list of Supporting Material / References

Feedback welcome!

Background Material

The OCD Cycle

Most people  have occasional intrusive thoughts - those unwanted thoughts that seem to come out of nowhere - and it’s common to behave in unnecessarily careful ways at times. But when these thoughts are causing distress, won’t go away and interrupt everyday life, and the thoughts are accompanied by compulsive actions, it’s known as obsessive compulsive disorder (Reach Out Content Team, 2025).

Obsessive-compulsive disorder (OCD) is a chronic mental health condition (a common anxiety disorder) that causes a cycle of obsessions and compulsive mental or physical behaviors.  OCD is having thoughts and images and urges that one feels must be neutralised with another thought or action, because if they are not neutralised with another thought or action it means the person has accepted the original thought, images and urges which will lead to adverse consequences if the urge is not attended to (Surles, 2025a).  For example, the thought ‘I may have left the iron on’ leads to checking to be sure that things are safe. But people with OCD will experience these intrusive thoughts more frequently, and the thoughts are extremely stubborn. Even after checking the iron is off, they might still find themselves thinking that they need to check again. This is what can lead to constant, repeated checking, and potentially other behaviours in response to those thoughts (Reach Out Content Team, 2025).

Signs and Symptoms of OCD

Some examples of obsessions that people with OCD may experience include:

• fear of illness or injury

• fears about harm coming to themselves or their family members

• fear of losing control and harming themselves or others

• fixations on spiritual or religious subjects, such as a fear of judgement from God or another deity

• fears that intrusive sexual thoughts which are immoral or taboo may be reflective of their actual desires (when that isn’t the case)

• fears about their sexual orientation

• excessive need for exactness and orderliness

• excessive concern about past events (Reach Out Content Team, 2025; Surles, 2025a)

Some examples of compulsions that people with OCD may experience as a result of the obsessive thoughts:

• Cleanliness - obsessive household cleaning or hand-washing to reduce fears of contamination.

• Order - obsession with symmetry, routine or order, with the compulsion to perform tasks or place objects in a particular place and/or pattern (and difficulties coping if this order or routine is disrupted).

• Safety/checking - obsessive fears about harm occurring to themselves or others, which can result in compulsive checking for things like the stove being turned off, or the doors and windows being locked.

• Religious matters - feeling constant compulsions to repeatedly perform religious or spiritual behaviours (like praying) to the extent that it interferes with day-to-day life.

• Sexual issues - refusal to engage in sexual behaviours due to fears about their sexuality, or be present around people they might have sexual thoughts about due to concerns about their own behaviour.

• Removing dangers - hiding objects that could be used to harm themselves or others.

• Cognitive habits - frequently reviewing lists, suppressing ‘bad’ thoughts, thinking special words or sayings, or excessively reviewing and analysing certain thoughts, doubts, or past situations (Reach Out Content Team, 2025).

Symptoms of OCD tend to develop in late childhood to early adolescence.  25% of cases start before the age of 14, with the average age of onset for symptoms being 19 years old.  It is less common for OCD symptoms to appear after the age of 35.  Women are 1.6 times more likely to be diagnosed with OCD than men.  Boys and men have a higher prevalence of harm and sex-related obsessions, with compulsions related to perfectionism and counting. In contrast, women are likelier to have obsessions tied to contamination and experience compulsions centered around cleanliness and orderliness (Surles, 2025a). 

To meet the diagnostic criteria for OCD, the individual must have obsessions or compulsions, or both.

Obsessions

1. Recurrent and persistent thoughts, urges, or impulses, that are experienced at some time during the disturbance as intrusive and unwanted, and often cause anxiety.

2. The individual attempts to ignore or suppress these thoughts, urges, or images, or to neutralise them with another thought or action.

Compulsions

1. Repetitive behaviors or mental acts that an individual feels driven to perform in response to their obsessions or in accordance with a rigid set of rules. These can include hand-washing, checking (such as repeatedly checking that a door is locked), counting, or repeating words silently.

2. The behaviors are intended to reduce anxiety, distress, or some dreaded event. However, the compulsive behaviors are not realistically connected to what they are trying to prevent, or they are excessive.

A diagnosis of OCD also requires that the obsessions and compulsions are time-consuming (for example, they require over 1 hour every day), distressing for the individual, or they cause impairment in an important area of functioning.  Finally, the symptoms of OCD cannot be better explained by another cause, such as a drug or medical condition (including other mental disorders) (Therapist Aid, n.d.).

Causes

It is not clear what causes OCD, but factors in the brain’s structure and chemistry, genetic factors, and environmental factors are thought to play a part.  Therefore people who experience OCD, are not at fault in any way – a variety of factors could have helped to create obsessions and compulsive behaviours (Reach Out Content Team, 2025).

Impact On Lives

OCD is one of the most chronic conditions that have a significant impact on the personal, social and occupational life of the individual afflicted by it. It is considered among one of the ten most disabling medical conditions worldwide.  People with OCD struggle more than others in accepting and regulating their emotions, in engaging in goal-directed behaviour, controlling their impulses, and tolerating negative emotion. This difficulty in regulating unwanted emotion can impact adversely on an individual’s ability cope with a situation.  Coping is the effort to prevent or diminish the threat, harm and loss or to reduce associated distress. It is a psychological pattern through which one manages thoughts, feelings and actions that are encountered during various stages of life, to promote positive psychological outcomes. Coping skills are necessary for every path of human life (Bakshi & Ganguly, 2021).

It is common for people with OCD to have difficulties with going to school or work, attending social events, or taking part in exercise or other regular hobbies.  It’s also common for people living with OCD to feel intense shame about their obsessions. These feelings can exacerbate the problem, and the secrecy involved in trying to hide OCD can delay help-seeking, diagnosis and treatment (Reach Out Content Team, 2025).

Treatments

In a study of 60 persons with OCD Bakshi and Ganguly (2021) suggest the higher the severity of OCD, the more wishful thinking (tendency to believe something will happen even when it is unlikely) and self-criticism are used as coping strategies.  They found that people who avoid the ‘wishful thinking’ and self-criticism approaches by using cognitive restructuring strategies (recognising and challenging negative thoughts, beliefs and assumptions) can more effectively manage OCD than those who intentionally conceal or reduce the expression of an emotion (e.g. smiling when feeling sad, aligning emotional behaviour with perceived expectations).  This approach seems to underly Exposure Response Therapy outlined below.

Getting professional help is the first step towards recovery.  The best first step is to see a GP, and talk with them about the issue (Reach Out Content Team, 2025).

The most effective treatment for OCD is exposure and response prevention (ERP) therapy.  ERP is a form of cognitive behavioral therapy (CBT) specially designed to treat all themes of OCD.  A therapist specializing in ERP will guide a person through exposures to confront fears head-on. People will then be taught response prevention techniques—exercises that help people refrain from engaging in compulsions (Surles, 2024a).

People with severe symptoms or co-occurring mental health conditions (such as depression and anxiety) may combine ERP therapy with medication as an effective treatment plan.  Medication that may be prescribed includes:

• Selective serotonin reuptake inhibitors (SSRIs):  SSRIs work as a tool to alleviate symptoms, but do not ‘cure’ OCD; hence the recommendation that its use be accompanied by a psychological therapy.

• Tricyclic antidepressants (TCAs): This could be used if SSRIs are not effective.

• Atypical antipsychotics: These are prescribed as an add-on or augmentation agent and are combined with an SSRI.

Medication is also a viable option for treating children and adolescents with moderate to severe OCD (Surles, 2025c).

Exposure Response Therapy (ERP)

For a detailed approach to practising exposure therapy, see Creating an Exposure Hierarchy (Therapist Aid, 2025).

ERP is now seen as one of the first-line treatments for managing every OCD subtype such as contamination, harm and relationships.  ERP breaks the OCD cycle by intentionally exposing the person to their obsessions and teaching them how to handle them without engaging in compulsive behaviors.  At the beginning the therapist will help organize obsessions and triggers into a hierarchy based on how much distress they cause—this is known as an exposure hierarchy or “fear ladder.” Fears are ranked on a simple scale ranging from 1 (minimal distress) to 10 (extreme distress) using the Subjective Units of Distress Scale (SUDS).  Then the therapist and person set treatment goals and start working through exposures and response prevention techniques.  The therapist will start with the triggers that cause least distress and work up the person’s hierarchy.  As one works up this hierarchy, one gains confidence in facing difficulties.  Research reveals that it takes about two months to see a significant change in symptoms (Surles, 2025b).

There are three types of exposure therapy:

1. Imaginal—the person vividly imagines the fears in the safety of a therapy session or at home using a script or audio recording.

2. In vivo (in life)—the person confronts the fears in real life in a structured way guided by the therapist.

3. Combination—many therapists use a combination of these techniques depending on the fears and needs to be addressed (Therapist Aid, 2022).

An example of ERP in action (Therapist Aid, 2022):

OCD In Children

Obsessions and compulsions can be a part of child and adolescent development, but OCD is not common in children and teenagers. For example, a child might go through a stage of wanting their bedtime ritual to be exactly the same every night. Or a child might worry about something bad happening to a family member.  Obsessions and compulsions that don’t get in the way of a child’s or family’s life aren’t usually anything to worry about.  Children and teenagers might have OCD if they have unwanted thoughts or compulsive behaviour or both, and these don’t go away, are distressing, and interfere with daily life.  For example:

• Severe obsessions that make them feel upset, anxious or disgusted

• Obsessive thoughts or compulsive behaviour that interfere with life or stop them from enjoying life

• Obsessive thoughts and/or compulsive behaviour that lasts for more than 6 months (Raising Children Network, 2024).

Obsessive thoughts and compulsive behaviour affect children’s ability to relax and enjoy life. So if a child has OCD, they might also have challenges like:

• problems at school, e.g. difficulty paying attention or doing homework

• disrupted routines, e.g. difficulty going to school or getting to sleep unless their rituals are done

• physical problems from feeling stressed or lack of sleep

• social problems, e.g. avoiding social situations or spending more time on their obsessions and compulsions than with their friends

• negative feelings, e.g. worrying that they are different from friends and family or that they are not in control of their behaviour

• other mental health problems, e.g. anxiety or depression.

Obsessive compulsive disorder is a mental health disorder that won’t go away on its own. Therefore it is important to get professional treatment via a GP referral to a paediatrician, psychiatrist or psychologist.  A child diagnosed with OCD will be offered treatment usually with CBT or ERP.  As with adults, medicine combined with therapy is sometimes recommended to treat moderate to severe OCD. Treatment is most successful when therapy and medicines are used together (Raising Children Network, 2024).

See the ‘Suggestions for Practice’ section below for approaches to assist children with OCD.

Living With OCD—Remission

Remission occurs when OCD symptoms take a backseat or are quieter. During this phase, most people recognize that OCD is a chronic condition and that they have the appropriate tools and abilities to cope with it.  This awareness helps the individual to identify and address triggers or stressors that may lead to an increase in symptoms, and deal with them effectively. Remission doesn’t mean a person is cured or have completely stopped engaging in compulsions. It just shows OCD is being managed. Recovery is not a destination—it’s a process.

See the ‘Suggestions for Practice’ section below for strategies to manage symptoms when in remission.

Impact On Carers

OCD generates an additional burden for relatives, which may, in turn, affect the family dynamics of caregivers (parents, spouse, and other family members) who often become involved in the individual’s ritualistic behaviors either through enabling avoidance or assisting these behaviors.  Understandably, the family may find it difficult to cope with the exaggerated behavior seen in members with OCD and may not know how to handle the situation.

Severe cases of OCD can cause an extreme amount of socio occupational dysfunction, and it can dramatically interfere with a caregiver’s daily life. Severe OCD has been associated with significant disability, poor quality of life, and high family burden, often comparable to schizophrenia. Therefore, the role of the primary caregivers can be stressful. They are unable to balance between providing care for a loved one and maintaining their own health status. The long duration of caregiving leads to loss of friends, social isolation, loss of intimacy, anxiety, and depression of the caregivers.  

Managing OCD requires a focus on day-to-day coping rather than on an ultimate cure. Implementation of ERP, CBT, and other behavioral therapy techniques by caregivers is not easy in the home context. Focusing on resilience in caregivers appears to be one way forward.  Resilience can help carers manage family accommodative behavior necessary for the implementation of behaviour therapy techniques.  Building resilience in caregivers may help them to improve their psychosocial functioning. Resilient coping styles can diminish the risk of socio-occupational dysfunction and promote adaptation in the caregiver (Murthy et al., 2020).

The post on Carers: Looking After Others (Social Work Graduate, 2020) elsewhere on this website suggests resilience in carers can be promoted in three ways: improving physical and mental wellbeing, prioritising sleep and building social connections.  Some of the specific recommendations include:

• Eating a balanced diet rich in nutrients

• Exercising regularly to boost endorphins

• Reducing alcohol consumption

• Relaxing in in ways that personally resonate

• Creating a regular sleep schedule and bedtime routine

• Limiting caffeine, especially in the evening

• Joining local community groups and online forums for carers

• Taking time to socialise with friends and family, even if it is just a quick coffee catchup

Suggestions for Practice

Social workers should be aware of the diagnostic criteria for OCD: A diagnosis of OCD also requires that the obsessions and compulsions are time-consuming (for example, they require over 1 hour every day), distressing for the individual, or they cause impairment in an important area of functioning.  Finally, the symptoms of OCD cannot be better explained by another cause, such as a drug or medical condition (including other mental disorders) (Therapist Aid, n.d.).

If suspected the first course of action is probably to refer the person to a GP for a formal diagnosis and to check the person’s issues cannot be better explained by another cause.  If the diagnosis is indeed OCD, then ERP or CBT appears to be the best way forward.  Unless the social worker is trained in these procedures the person should be referred elsewhere.  However the principles and approach of ERP may be appropriate for people who are inconvenienced by a form of OCD that doesn’t meet the diagnostic criteria but is causing distress to the client.  In this case the social worker could explain the ERP approach, its rationale and the client and worker could work together to plan an approach to address the client’s problem.

As outlined in Therapist Aid (n.d.) it is important that the client is educated is the approach to be used, i.e. resisting compulsions (starting with the easiest to resist), keeping at it until the anxiety associated with resistance starts to diminish, and then noting that compulsion to do something is gradually fading.  Explaining the way the brain learns is important as part of any introduction to dealing with OCD.  The client is actually educating the brain that something that causes anxiety need not do that.  Over time the brain will learn, adapt and the urge to act in a compulsive way will diminish. 

Compiling an exposure hierarchy is essential, ranking triggers from most to least distressing.  Taking each trigger, the social worker and client will decide the approach to use—imaginal, in vivo or combinational, as described in the treatments section above.  A problem-solving approach may be a useful approach to use in planning the approach, response, likely scenarios and how to manage the compulsion that will occur (e.g. distract, set a time before giving into the compulsion and gradually extend this time). 

Therapist Aid (n.d.) suggests commencing exposure in a session and asking the client to practise everyday at home before returning to the next appointment.  Using a timer (set at two to three hours after the compulsion) can help the client manage the compulsion.

A more detailed explanation of the above approach can be found at https://www.therapistaid.com/therapy-guide/creating-an-exposure-hierarchy-guide .  This outlines the ‘down arrow technique’ where the client is guided to move from a surface feat to the underlying core fear or belief.  If there is a much deeper fear than the reasons for engaging in compulsive behaviour initially suggests, it may be time to refer to an experienced practitioner in OCD.

Managing symptoms while in recovery/remission 

• Living in the moment. Stay present. Practice the art of not reviewing the past and not trying to predict the future.

• Identify, but don’t avoid triggers. Part of the OCD cycle can be avoiding the trigger and this is not advised. Instead, face it and keep teaching the brain these urges can be managed.

• Taking care of mind and body. Eat healthily, exercise, sleep well, and do enjoyable things with others. Having a hobby can be vital to well-being. 

• Being self-compassionate; celebrate successes.  People with OCD tend to be very hard on themselves. They need to remember that humans make mistakes, are imperfect beings. Celebrate success while recognising there are still areas where growth is needed. 

• Seeking out support. Find a place, person, or community that enables relaxation and feeling comfortable. It may be an online support group. It may be a friend or family member (Quick, 2023). 

Helping children

Strategies that can be used with children include:

• Listen, reassure them that anxiety is natural and be positive about supporting them to overcome OCD.

• Teach breathing exercises or muscle relaxation exercises, meditation or mindfulness exercises.

• Encourage the child to practise saying ‘I can stop doing this’ or ‘I will be OK if I don’t do this’.

• Distract the child with something enjoyable, e.g. reading a book or playing basketball.

• Use a worry box to ‘put aside’ worries—write or draw the worries and put them in a box (Raising Children Network, 2024). 

Summerhill and Ranger (2010) suggest the following strategies for young people.  One could question whether they will work if OCD is an entrenched habit, but they could be used if OCD is in its early stages.  The authors suggest the best way to beat OCD is to talk about it.  The more one talks about OCD with people who are trusted, the faster one will beat OCD.  Give OCD a nickname and call it by that name when talking about it, .e.g. “Worry wart told me something bad might happen if I don’t wash my hands.”  Summerhill and Ranger (2010) also suggest the following table be used to break the OCD cycle:

The authors suggest the person lists all their compulsions with the easiest at the top and then works through each compulsion starting with the easiest.  If, during this process OCD invents new compulsions, these should be dealt with immediately.  As well as the above approach one should enlist the help of family and friends:

1. Ask family and friends to stop telling you that you are going to be okay, i.e. to stop saying things to make you feel better.

2. Ask family and friends to praise you for not carrying out the compulsion that you are trying to stop.

3. Keep talking to friends and family about OCD and how you are managing.

References / Supporting Material

(available on request)

Bakshi, P., & Ganguly, O. (2021).  Relationship between coping strategies and emotion regulation among persons with obsessive compulsive disorder.  National Journal of Professional Social Work, 22(2), 120-127.  https://doi.org/10.51333/njpsw.2021.v22.i2.282  

Murthy, N. S., Nirmala, B. P., Pandian, R. D., & Reddy, J.  (2020). Resilience and socio occupational functioning among caregivers of obsessive-compulsive disorder. Archives of Mental Health, 21(2), 59-64.  doi: 10.4103/AMH.AMH_25_20

Quick, S. (2023). Living with OCD: Practical tips for everyday life.  https://www.treatmyocd.com/blog/living-with-ocd-practical-tips-for-everyday-life

Raising Children Network. (2024). Obsessive compulsive disorder in children and teenagers.  https://raisingchildren.net.au/for-professionals/mental-health-resources/adhd-ocd-odd/ocd 

Reach Out Content Team. (2025). How to deal with OCD.  https://au.reachout.com/mental-health-issues/anxiety/how-to-deal-with-ocd

Social Work Graduate.  (2020). Carers: Looking after others.  https://www.thesocialworkgraduate.com/post/carers-looking-after-others 

Summerhill, L., & Ranger, J. (2010). Obsessive compulsive disorder: A young person’s self help guide.  Coventry CAMHS.  https://www.anxietyuk.org.uk/wp-content/uploads/2010/06/Obsessive-Compulsive-Disorder-A-young-persons-self-help-guide.pdf

Surles, T. (2025a). What are the symptoms of OCD?  https://www.treatmyocd.com/blog/ocd-symptoms 

Surles, T.  (2025b). The most effective OCD treatments.  https://www.treatmyocd.com/education/treatment-of-ocd

Surles, T. (2025c). Medication for OCD.  https://www.treatmyocd.com/medication

Therapist Aid. (2022). What is exposure therapy.  https://www.therapistaid.com/therapy-worksheet/exposure-therapy-info-sheet

Therapist Aid. (n.d.).  OCD treatment overview.  https://www.therapistaid.com/therapy-guide/ocd-treatment-overview

Therapist Aid.  (2025).  Creating an exposure hierarchy.  https://www.therapistaid.com/therapy-guide/creating-an-exposure-hierarchy-guide