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If you have obsessive-compulsive disorder (OCD), you feel you have no control over certain thoughts, idea or urges, which seem to force themselves into your mind, like a stuck record. These thoughts - obsessions - are often frightening or distressing, or seem so unacceptable that you can't share them with others. Contained within the obsession is an underlying belief that you, or other people, may come to harm. However absurd or unrealistic this belief, you can't dismiss it or reason it away. It creates unbearable anxiety, and makes you feel helpless to do anything except perform the particular ritual which can neutralise the devastating thought.

The irresistible urge to carry out such rituals is known as a 'compulsion'. This could be something like repeatedly opening and closing a door, washing hands, repeating a litany, or counting. In other words, exaggerated elements of everyday actions and routines. You may feel compelled to do these actions over and over again, because of an unquenchable fear that you didn't do it properly last time, or because the unwanted thoughts intrude again. The relief from the anxiety is only temporary.

OCD is similar to a phobia, which is another anxiety disorder. In both cases, fear brings on symptoms of anxiety and panic, including a racing heart, churning stomach, dizziness, shortness of breath, sweating and trembling. A phobia also involves an exaggerated fear of something that doesn't represent a realistic danger, but other people can usually relate to it, or even share it. But with OCD the fear is of your own thoughts, and other people may not be able to relate to this or understand them at all. What's more, someone who has a phobia can avoid the thing that triggers their phobia, such as cats or spiders, but with OCD, these devastating thoughts are unavoidable, and are constantly ready to emerge.

OCD isn't a psychotic disorder, such as schizophrenia, whereby people feel that certain thoughts and ideas come from somewhere outside themselves (hallucinations). If you have OCD, you know that it s your own thoughts tormenting you. Some people only experience obsessive thoughts, without having any compulsions. Others have compulsions without knowing why they feel the need to do them.

The anxiety caused by experiencing obsessions and compulsions feeds back into the problem, creating a vicious circle and making the OCD worse. Often, people with OCD are also depressed, and this may also be partly or wholly due to the experiene of OCD.

Causes: OCD sometimes occurs for no reason, but it may be triggered by stressful life events. It can be caused by a lack of serotonin in the brain. It also tends to run in families, suggesting that some people have a genetic predisposition to OCD. 

Effect: People with OCD are tormented by unwanted thoughts and feel compelled to carry out rituals to free themselves of these thoughts. For example, you may be very worried that there are germs on your hands, and to make yourself feel better you wash them. Washing relieves your anxiety for a while, so it becomes a ritual. This creates a vicious cycle and you might wash your hands twenty or more times an hour, even when your skin is raw from scrubbing. Other OCD behaviours include counting objects, checking switches are turned off and doors are locked, or rearranging furniture so it is symmetrical. If a person cannot carry out their rituals, they feel panicky and fear that a disaster will happen. 

Solutions: The first step is breaking the cycle. Remind yourself that your desire to carry out a ritual is a symptom of OCD, and will not protect you from harm. When you have resisted a compulsion a few times, it will get easier.

Cognitive Behavioural Therapy may help.

Anti-Depressants.