Obsessive compulsive disorder - Treating obsessive compulsive disorder

Treatment for obsessive compulsive disorder (OCD) depends on the how much the condition is affecting your daily life.

The two main treatments are:

cognitive behavioural therapy (CBT) involving graded exposure and response prevention (ERP) – therapy that encourages you to face your fear and let the obsessive thoughts occur without "putting them right" or "neutralising" them with compulsions
medication – to control your symptoms by altering the balance of chemicals in your brain

OCD that has a relatively minor impact on your daily life is usually treated with a short course of CBT involving ERP.

If you have OCD that has a more significant impact on your daily life, a more intensive course of CBT with ERP or a type of medication known as selective serotonin reuptake inhibitors (SSRIs) may be recommended instead. You may also be referred to a specialist mental health service.

If your OCD has a severe impact on your daily life, you will usually be referred to a specialist mental health service for a combination of intensive CBT and a course of SSRIs.

Children with OCD are usually referred to a healthcare professional with experience of treating OCD in children.

The level of treatment for OCD can be increased in steps until it is effective. For example, if a short course of CBT does not help, you may move on to trying SSRIs.

It's important to remember it can take several months before a treatment has a noticeable effect.

Cognitive behavioural therapy with exposure and response prevention

Cognitive behavioural therapy (CBT) that involves exposure and response prevention (ERP) can be used to help people with OCD of all severities.

People with mild to moderate OCD usually need about 10 hours of therapist treatment, combined with exercises done at home between sessions.

Those with moderate to severe OCD may need a more intensive course of CBT that lasts longer than 10 hours.

During the sessions, you will work with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions.

Your therapist will also need to ask you to use a technique called graded ERP. This therapy encourages you to face your fear and let the obsessive thoughts occur without "putting them right" or neutralising them with compulsions.

It requires motivation and is difficult, but should start with situations that cause you the least anxiety first.

These exposure exercises need to take place several times a day, and need to be done for one to two hours without engaging in compulsions to undo them.

Although this sounds frightening, people with OCD find that when they confront their anxiety without carrying out their compulsion, the anxiety does eventually improve or go away. Each time, the anxiety is likely to be less and last for a shorter period of time.

Once you have conquered one exposure task, you can move on to a more difficult task, until you have overcome all of the situations that make you anxious.

Medication

You may need medication if CBT fails to treat mild OCD or if you have moderate or severe OCD. The main type of medication you may be prescribed is discussed below.

If these medications prove ineffective, you will be referred to a specialist mental health service.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medication that increase the levels of a chemical called serotonin in your brain. Serotonin is a neurotransmitter the brain uses to transmit information from one brain cell to another.

Although SSRIs are a type of antidepressant, they have been shown to work in people with OCD regardless of their level of depression. The doses that have been shown to be effective in OCD are also higher than those generally used for depression.

Possible SSRIs you may be prescribed include:

You will usually need to take an SSRI for 12 weeks before you notice any benefit. Most people with moderate to severe OCD need to take one for at least 12 months.

After this time, your condition will be reviewed. If it causes few or no troublesome symptoms, you may be able to stop taking the medication.

People with more severe OCD, however, may need to take the medication for many years to prevent the condition recurring.

Possible side effects of SSRIs can include headaches, feeling agitated or shaky, and feeling sick. However, these will often pass within a few weeks.

In the case of clomipramine, common side effects can include:

a dry mouth
constipation
diarrhoea
blurred vision
dizziness
fatigue (extreme tiredness)

SSRIs can also affect your heart, so it is advisable to have an electrocardiogram (ECG) after being on the medication for a few weeks.

This may be done before treatment starts if you are advised to take clomipramine. An ECG is a simple test to measure the electrical activity of your heart.

There is also an extremely small chance that SSRIs will increase your anxiety, which can very occasionally cause you to have suicidal thoughts or a desire to self-harm.

Contact your GP immediately or go to your nearest accident and emergency (A&E) department if you are taking an SSRI and have suicidal thoughts or want to self-harm.

You may also have side effects when you stop taking SSRIs, so you shouldn't stop taking your medicine suddenly. If you no longer need the medicine, your GP will gradually reduce your dose.

To find out more about the possible side effects, check the patient information leaflet that comes with your medicine or search for your medication in the Medicines A-Z.

Further treatment

Further specialist treatment may sometimes be necessary if you have tried all the treatments above and your OCD is still not under control.

Some people with severe, long-term, difficult-to-treat (refractory) OCD may be referred to the National Service for Refractory OCD centre.

The service offers assessment and treatment to people with OCD who have not responded to treatments available from their local and regional OCD specialist services.

To be eligible for this service, you must have been diagnosed as having severe OCD and have received:

at least two full trials of different SSRIs at recommended doses
two trials of unsuccessful CBT treatments both in a clinic and at home
additional treatment with a dopamine-blocking agent medication or an SSRI at a dose higher than normally recommended

Most people improve after receiving treatment from the national service.