Obsessive Compulsive Disorder

What is OCD?

OCD is characterised by a pattern of unwanted, intrusive thoughts that arrive uninvited, often vividly, and feel impossible to dismiss. These intrusions can take the form of thoughts, images, urges, or doubts. To manage the distress they cause, people develop repetitive behaviours called compulsions, and over time the cycle between the two starts to interfere with daily life.

The intrusive thoughts (the obsessions) tend to cluster around themes. Common ones include:

• Contamination: fears of germs, illness, or being made unclean

• Harm: fears of harming yourself or others, accidentally or deliberately

• "Just right" or perfectionism: a strong need for order, symmetry, or balance

• Moral or religious themes: fears of having done something wrong, sinful, or immoral

• Sexual themes: intrusive thoughts about sexuality, sexual orientation, or fears about being attracted to children

• Relationship: persistent doubts about whether you really love your partner, or they love you

• Identity: doubts about who you are, your values, or your sense of self

• Existential: unanswerable questions about reality, consciousness, or meaning

• Real event or false memory: going over a past event repeatedly, doubting whether something bad happened or whether you did something wrong

• Hoarding: difficulty letting go of possessions

Compulsions are the behaviours you feel driven to carry out, either to reduce the distress an intrusion causes or to try to prevent something bad from happening. They can be visible actions, like checking, counting, ordering, washing, or following a strict routine, but they can also be entirely internal, like mentally reviewing, checking, praying, or repeatedly seeking reassurance.

It's important to note that OCD isn't the same as liking things clean or tidy and being preoccupied with something doesn't mean you have it. You can be obsessed with a song or a hobby in a positive way. With OCD, the intrusions are unwanted, unpleasant, and trigger real anxiety. 

A useful thing to know is that everyone gets intrusive thoughts. The difference with OCD isn't the thoughts themselves, it's that they get stuck and feel as though they demand a response.

Co-occurring difficulties

OCD often shows up alongside other things, including depression, generalised anxiety, health anxiety, or the impact of past difficult experiences. We work with the whole picture rather than treating any single symptom in isolation, and we'll shape therapy around what's most important for you.

How OCD is assessed

Assessment begins in your first session. We'll talk through what you're experiencing, what the intrusions and compulsions look like for you, how long they've been there, the impact they're having on your day-to-day life, and what you'd like to change.

We may also use established OCD screening tools to build a clearer picture and give us a baseline to track progress against.

How we treat OCD

The goal of therapy for OCD at Harper is often to break the cycle of obsessions and compulsions, reduce distress, and build coping skills that last.

In line with NICE guidelines, OCD is most often treated with Cognitive Behavioural Therapy (CBT), with a particular focus on exposure and response prevention (ERP).

ERP works by gradually and deliberately exposing you to the things that trigger your intrusive thoughts, while supporting you not to carry out the compulsion. Short-term, this may increase anxiety. This is essential as over time, it teaches your brai that the thoughts aren't dangerous, that you don't need to act on them, and that distress passes on its own. It's a powerful approach with strong evidence, and it works best with practice both inside and outside sessions. Avoidance is addressed in the same way, by gently building up exposure to the situations OCD has narrowed you away from.

Alongside ERP, CBT for OCD also draws on several other elements:

• Psychoeducation, so you understand how OCD works and why it has the grip it does

• Cognitive strategies such as the "3 Rs" (relabel, revalue, refocus), which help retrain the brain to recognise intrusive thoughts as "junk thoughts" rather than meaningful signals

• Working with thought-action fusion, a common pattern in OCD where it feels as though thinking about something is as bad as doing it, or where thinking about a bad event makes it more likely to happen

• Looking at responsibility, since OCD often comes with an inflated sense of being personally responsible for preventing harm

• Building coping skills that replace compulsions with more helpful ways of managing distress

What does a typical course of treatment look like?

How long therapy takes depends on you and on the severity of the OCD. NICE guidelines recommend around 8 to 12 sessions for milder OCD, with more sessions for more severe presentations. In practice, it varies from person to person.

The direction of therapy at Harper is goal-led. Your first session is about meeting your therapist, talking through your history, and getting clear on what you'd like therapy to help with. From there, sessions are often a mixture of discussion, psychoeducation, ERP work, and skills practice, shaped by your goals. You'll usually have things to try between sessions too, since ERP and CBT for OCD work best when the practice extends into everyday life.

Throughout the course of therapy, we'll check in on how it's going and keep the focus on what matters to you, and we'll talk openly about when ending feels right. Before we finish, we'll consolidate the skills you've built and put together a plan to help you handle future triggers with confidence.

What might I expect to see?

OCD isn't usually something that disappears entirely, but with the right therapy it can become manageable. Results vary from person to person, and we won't promise a fixed outcome. What we work towards is a better quality of life, a greater sense of mastery over your OCD, and improved day-to-day functioning, so that the intrusions and compulsions take up less space, and you feel more in control.

For extra information on OCD please see the following blogs as well as the resources page on our website: 

Obsessive-Compulsive Disorder: When Your Brain Gets Stuck

Understanding Anxiety: The Power of Facing Your Fears

The importance of separating a Person from a mental Health Problem