OCD
Obsessive-compulsive disorder (OCD) affects an estimated 1 in 50 Australians at some point in their life. It has two connected parts: obsessions (intrusive, unwanted thoughts that cause distress) and compulsions (repetitive behaviours done to reduce that distress or prevent a feared outcome).
Popular culture tends to reduce OCD to a preference for tidiness. In reality it covers a wide range of themes, and the compulsions come from real anxiety, not a lifestyle choice. OCD responds well to specific, evidence-based treatment.
What are the symptoms of OCD?
Obsessions — intrusive thoughts, images, or urges that are unwanted and cause significant distress. Common themes include:
- Fear of contamination or germs
- Fear of causing harm to yourself or others, even accidentally
- A need for symmetry or order, or for things to feel just right
- Intrusive taboo or distressing thoughts (violent, sexual or blasphemous) that conflict with your actual values
- Persistent doubt (did I lock the door, did I say the wrong thing) that’s hard to resolve
- Intrusive doubts about relationships, or about your own feelings
Compulsions — repetitive behaviours or mental acts performed to reduce the anxiety caused by obsessions, or to prevent a feared outcome. Common examples include:
- Excessive washing or cleaning
- Checking locks, appliances, or that no harm was caused
- Ordering or arranging items until they feel right
- Mental rituals: counting, silent prayer, repeating phrases, or reviewing events
- Seeking reassurance repeatedly from others
- Avoiding situations, people or objects that trigger obsessions
Compulsions usually bring only short-term relief and, over time, tend to reinforce the underlying anxiety rather than resolve it. That’s part of why OCD needs a specific treatment approach rather than general reassurance or willpower.
What causes OCD?
Biological factors
Genetics and differences in the brain circuits involved in threat detection and habit formation appear to play a role.
Learning & reinforcement
Compulsions bring short-term relief from anxiety, which reinforces the cycle over time even though it doesn’t address the obsession.
Life stress or transitions
OCD symptoms often first emerge or intensify during stressful periods, though stress alone doesn’t cause OCD.
Temperament
A tendency toward anxiety, high responsibility, or intolerance of uncertainty is common among people who develop OCD.
As with most mental health conditions, OCD usually develops from a combination of these factors rather than one cause.
How is OCD treated?
OCD has a specific, well-researched first-line treatment, which is different from general talk therapy.
Exposure and response prevention (ERP)
A specialised form of CBT: gradually and safely facing obsession-triggering situations while resisting the urge to perform the compulsion. This is the gold-standard treatment, with strong evidence.
Cognitive behavioural therapy (CBT)
Often used alongside ERP to address the thinking patterns that maintain OCD, such as inflated responsibility or intolerance of uncertainty.
Acceptance & commitment therapy (ACT)
Sometimes used to build tolerance for uncertainty and distress without acting on compulsions.
Because ERP is a specific, structured approach, it matters that the psychologist you see has real experience delivering it for OCD. Not all general therapy training includes it.
When should I see a psychologist about OCD?
It’s worth reaching out if you’ve noticed:
- Intrusive thoughts that are distressing, repetitive and hard to dismiss
- Repetitive behaviours or mental rituals that take up significant time (an hour or more a day is a common reference point, though distress and interference matter more than time alone)
- Avoiding situations, people or places because of obsessive fears
- OCD symptoms starting to affect work, relationships or daily functioning
- Shame or secrecy around thoughts or behaviours that are affecting your wellbeing
A GP can set you up with a Mental Health Care Plan under Medicare’s Better Access scheme, which covers a rebate for a set number of psychology sessions each year.
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Get matched with a psychologistFrequently asked questions
Is OCD just about being clean or organised?
No. Some people with OCD have contamination or symmetry obsessions, but OCD can centre on many themes, including harm, relationships and intrusive taboo thoughts. The defining feature is the cycle of distressing obsessions and the compulsions used to manage them.
Are intrusive thoughts a sign of who I really am?
No. Obsessions in OCD are typically ego-dystonic: they go against the person’s actual values and cause distress precisely because the person doesn’t want to have them. Having an intrusive thought is not the same as wanting to act on it.
What’s the difference between OCD and general anxiety?
Anxiety involves excessive worry. OCD specifically involves the cycle of obsessions and compulsions. Many people with OCD also have broader anxiety, but the compulsion cycle is what distinguishes OCD.
Can OCD go away without treatment?
OCD tends to be persistent and doesn’t usually resolve without treatment. It can worsen over time as compulsions reinforce the underlying anxiety. Structured treatment, particularly ERP, has strong evidence for reducing symptoms.
How long does treatment for OCD take?
It varies with the person and the severity. Many ERP programs run over a structured course of weekly sessions, often several months, depending on the symptoms and how someone responds.
Do I need a GP referral to see a psychologist for OCD?
No. A GP referral is only needed for a Medicare rebate through a Mental Health Care Plan.
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