As its name implies, obsessive compulsive disorder (OCD) incorporates two important aspects: obsessions and compulsions with the former leading to the latter. The way they interrelate is important but, although the link is obvious when it is explained, it is often hard for outsiders to understand the cause of the symptoms because those symptoms are so dominant.

In our earlier post we explained that we all experience some aspects of OCD to a degree. We all have intrusive thoughts but fleetingly and dismissively. They become a problem, and this is when OCD is diagnosed, when they:

  • take up an unusual and unreasonable amount of time
  • cause a high level of anxiety or distress
  • interfere with daily life.

There are four principal ways in which OCD is expressed:

  • checking
  • contamination (which might be physical or mental)
  • hoarding
  • thoughts

We hope this chart helps explain what many people with OCD experience (and we are grateful to OCD UK for providing the core information).


Obsessive fears or worries (which you might want to avoid or be reassured about) Compulsive behaviours (can be overt or covert)
Someone, something or somewhere will be contaminated

Repeatedly, or ritually, washing your hands or body to prevent passing on the contamination

Catching an illness, usually high profile, because you think you have come into contact with germs

Excessive cleaning (not only of rooms) to remove the perceived contaminants

Something bad might happen (to you or someone important to you) if things (often inconsequential) are not arranged symmetrically/in order/at angles

Checking, constantly adjusting, realigning objects until they feel they are right (as opposed to looking right) to prevent something bad happening

Causing physical harm to someone or yourself; causing sexual harm to someone or yourself; behaving inappropriately towards children

Avoiding situations or locations which trigger the thoughts; repeatedly asking partners or significant others if you did/said something wrong

A disaster (flood, gas leak, break-in, fire) might happen

Checking taps, switches, locks constantly and perhaps for a specified (by you) number of times

Writing something offensive or inappropriate in a letter or card

Repeatedly (perhaps hundreds of times) re-opening and re-sealing a letter or card to check

Harming someone with a knife or other dangerous implement

Locking everyday kitchen knives in a drawer so you don’t come into contact with them

Something bad might happen to you or someone important to you

Repeatedly saying (out loud or silently) a word or phrase, or counting up to a fixed (by you) number, believing it will prevent the occurrence

The focus should not, however, only be on the obsessions and compulsions. Just as important are the feelings of people with OCD, including: depression, embarrassment, exasperated, exhaustion, frustration, hopelessness, secretive, ashamed. And they feel these feelings unusually intensely.

These lists are not exhaustive; some people will experience OCD differently and if you, or someone you know, has other fears/worries or behaviours that you think might be evidence of OCD and want advice and/or treatment, do get in touch. We usually recommend cognitive behavioural therapy (CBT) as it is the most effective treatment for OCD.

And keep an eye out for articles about OCD during the first-ever OCD Awareness Week (it runs from 10th to 16th October this year).