OCD

What is OCD?

Obsessive-compulsive disorder (OCD) is a health condition in which a person gets caught in a loop of unwanted, distressing thoughts, called obsessions, and repeated actions or mental acts done to relieve that distress, called compulsions.

Most people with OCD know their fears are excessive or don’t quite make sense, yet they cannot shake them off. Doing the ritual brings brief relief, which teaches the brain to repeat it, and the loop tightens. Over time, rituals can take up hours of the day.

OCD is not a character flaw, a lack of faith or something a person chooses. In India, the National Mental Health Survey 2015–16 found that about 0.8% of adults had experienced OCD at some point in their lives. It usually begins between late childhood and early adulthood, and it is treatable.

Obsessions and compulsions: what they look like

Obsessions are thoughts, images or urges that come into the mind again and again. They feel intrusive and unwanted, and they bring anxiety, disgust, guilt or a sense that something is “not right”.

Compulsions are what a person feels driven to do to reduce that distress or to prevent something bad from happening. They may be visible actions, or silent mental rituals such as counting, repeating a phrase, praying in a fixed way or going over events again and again in the mind.

Common patterns include:

• Contamination and washing: fear of germs, dirt, bodily fluids or feeling “unclean”. A person may bathe again after touching something from outside, wash hands until the skin cracks, stop guests from sitting on the bed, or re-wash clothes and utensils many times.
• Checking: repeatedly checking that the gas knob is off, the main door is locked or the geyser and iron are switched off, sometimes turning back from halfway to work to check again.
• Religious or “sinful” thoughts: unwanted disrespectful thoughts about God during prayer, or constant fear of having committed a sin. This may lead to repeating prayers, mantras or rituals until they feel “perfect”, or asking elders again and again whether something was wrong.
• Fear of harming loved ones: unwanted thoughts or images of hurting a child, spouse or parent, perhaps while holding a knife in the kitchen, or fear of having hit someone while driving. People may hide knives, avoid being alone with a baby or retrace their route.
• Symmetry and “just right” feelings: needing things arranged evenly or in an exact order, repeating an action a set number of times, or rewriting a line until it looks right.
• Other taboo thoughts: unwanted sexual thoughts, or nagging doubts about relationships, that feel deeply against a person’s values.

Reassurance-seeking is a common, often hidden, compulsion. It sounds like “Are you sure I locked it?”, “Did I touch that?” or “Am I a bad person?”, asked many times a day, or hours spent searching online for answers. The relief never lasts, and the question returns.

Mental rituals are easy to miss. A person may silently repeat a “good” thought to cancel a “bad” one, count to a lucky number, or replay a conversation to make sure they said nothing offensive. Because nothing shows on the outside, the family may not realise how much of the day OCD is taking.

OCD or just being particular?

People often say “I’m so OCD” when they mean they like things neat. Being tidy, organised, careful or religious is not OCD. The differences are:

• Distress, not satisfaction: a tidy person enjoys order; a person with OCD feels driven by anxiety or dread and gets only brief relief
• Time: obsessions and rituals often take more than an hour a day
• Control: people with OCD usually know the fear is excessive, but cannot stop
• Impact: OCD gets in the way of work, studies, sleep, family life or relationships

Someone who prays daily with devotion is practising their faith. Someone who repeats the same prayer dozens of times, terrified that one mistake will bring harm, and feels tormented rather than peaceful, may be experiencing OCD.

Having a thought is not the same as wanting it

Many people with OCD suffer in silence because their thoughts are about things they find shocking: harming a loved one, sexual content, or disrespecting God. They fear the thought means they are dangerous, immoral or sinful, and feel too ashamed to tell anyone, sometimes even their doctor.

A few facts can help:

• Almost everyone has odd or unpleasant thoughts from time to time. In OCD, the brain treats these thoughts as alarms and gets stuck on them.
• The thoughts cause distress precisely because they go against the person’s values.
• Having a thought is not the same as wanting it or agreeing with it. In OCD, it is a symptom, not a hidden wish.
• Trying hard to push a thought away usually makes it come back more strongly.

A psychiatrist has heard such thoughts many times before and will not judge you. Talking about them openly is the first step towards treatment.

Why people delay seeking help

People with OCD often live with symptoms for several years before seeing a doctor. Common reasons include:

• Shame or secrecy about the content of the thoughts
• Believing rituals are simply cleanliness, carefulness or devotion
• The family quietly adjusting around the symptoms, so problems seem manageable
• Not knowing that OCD is a recognised, treatable condition
• Fear of being labelled or judged

Meanwhile, OCD can lead to exhaustion, low mood and strain at home. Seeking help earlier makes treatment simpler.

When love gets pulled into OCD

Families want to ease their loved one’s distress, so they often get drawn into the rituals without realising it. This is called family accommodation. In Indian homes it can look like:

• A mother re-washing a child’s school uniform because it “might be dirty”
• Everyone having to bathe or change clothes as soon as they come home
• A spouse checking the locks and gas every night on the person’s behalf
• Relatives being discouraged from visiting, or certain rooms kept “clean” and out of bounds
• Meals waiting until prayers or washing rituals are finished
• Answering the same question again and again to keep the peace

Accommodation comes from kindness and brings short-term calm. But it also tells the brain that the fear was justified, and research shows that higher accommodation is linked with more severe OCD. The answer is not to withdraw support suddenly, but to reduce accommodation gradually, with guidance.

Why does it happen?

There is no single cause. Several factors combine:

• Genes and family history. OCD and anxiety can run in families.
• Brain circuits. Differences in the brain systems that handle threat, doubt and habits play a part.
• Stress and life changes. Exams, a new job, marriage, pregnancy or the months after childbirth can trigger OCD or make it worse.
• Temperament. A strong sense of responsibility, perfectionism or difficulty tolerating uncertainty may add to the risk.

Whatever starts it, certain patterns keep OCD going: performing rituals, avoiding triggers, seeking reassurance and family accommodation. Treatment works by gently breaking these patterns.

When to see a psychiatrist

Consider speaking to a psychiatrist if:

• Thoughts or rituals take up more than an hour a day, or make you late or unable to finish tasks
• You feel distressed, exhausted or ashamed because of them
• Rituals are affecting studies, work, sleep or relationships
• Family members are being drawn into washing, checking or answering the same questions
• You also feel low or hopeless
• Your child is washing, checking or seeking reassurance far more than usual

How OCD is diagnosed

A first consultation is a conversation, not a judgement. The psychiatrist will ask about your thoughts and rituals, how much time they take, what you avoid, how far you believe the fears, and how the family is affected. You will also be asked about mood, anxiety, sleep, alcohol or other substance use, medical conditions and family history. With your permission, a family member can join part of the discussion.

Some people recognise clearly that their fears are excessive; others feel quite convinced by them. Both can be helped, and knowing this guides treatment. A structured rating scale, such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), helps measure severity and track progress. The diagnosis follows international criteria (ICD-11), and the plan is built around your goals.

Treatment

OCD responds well to treatment, though it takes steady effort. Most plans combine the following.

1. CBT with exposure and response prevention (ERP)

ERP is a form of cognitive behavioural therapy with strong evidence for OCD. It works in two parts:

• Exposure: gradually facing situations that trigger obsessions, starting with easier ones
• Response prevention: resisting the urge to wash, check, repeat, pray in a fixed way or ask for reassurance

For example, a person with contamination fears might touch a doorknob and wait before washing, first for a few minutes and later for longer. Anxiety rises, then settles on its own. With repeated practice, the brain learns that the feared outcome does not happen, or that the discomfort can be tolerated, and the urges weaken.

You and your therapist plan each step together, and nothing is forced. Practice between sessions matters. When thoughts are religious, therapy respects your faith; the aim is to separate genuine devotion from fear-driven rituals, not to take faith away.

2. Medicines

Antidepressant medicines, from a specific group that acts on serotonin, are a first-line treatment for OCD. They are not habit-forming. They often take 8–12 weeks to start helping, sometimes at higher amounts than are used for depression, so it is important not to give up too early. When they work, they are usually continued for at least one to two years to prevent relapse, and some people need longer.

For more severe OCD, medicines and ERP are often combined. Medicines must only be started, changed or stopped with your doctor.

3. Family guidance on reducing accommodation

Family sessions help relatives understand OCD and agree a step-by-step plan to reduce accommodation and reassurance. Family members learn supportive things to say instead, such as “I know this is hard, and I believe you can manage the anxiety.” Changes are made kindly and in agreement with the person, so that home supports recovery rather than the OCD.

4. Treating other conditions together

Depression, anxiety, tics, sleep problems and alcohol or pill use can occur alongside OCD. Treating them together improves recovery.

Outpatient or online care?

Most people with OCD are treated as outpatients. Online consultations work well for follow-up and family guidance, and ERP can often be practised at home by video. Dr. Tarwani sees patients at Sukoon Health in Gurugram and South Delhi, and online.

Recovery and setbacks

With treatment, most people spend far less time on obsessions and rituals and regain control of their daily lives. Some symptoms may remain in the background or return during stressful times. This is not failure. Using ERP skills early, and reviewing with your psychiatrist, usually brings things back under control.

For families

Living with OCD can be tiring and frustrating for the whole family. A few things help:

• Remember that your loved one is not being stubborn; the fear feels very real
• Avoid anger, mocking or forcing them to stop rituals suddenly
• Work with the treating team to reduce accommodation and reassurance gradually
• Praise small steps, such as a shorter bath or one check instead of five
• Keep family routines as normal as possible
• For children and teenagers, involve the school when helpful. Under-18s are seen with a parent or guardian
• Look after your own health too

You are welcome to consult Dr. Tarwani first, on your own, to plan the next steps.

Common myths

• “Everyone is a little OCD.” Liking order is common. OCD is a distressing, time-consuming condition that needs treatment.
• “Scary thoughts mean the person is dangerous.” Unwanted intrusive thoughts are a symptom of OCD and go against the person’s wishes.
• “Just stop washing. It’s a matter of willpower.” Rituals are driven by intense anxiety. ERP helps people reduce them step by step.
• “Reassuring them will calm them down.” Reassurance brings short relief but keeps the doubt coming back.
• “OCD medicines don’t work.” They often need 8–12 weeks and an adequate amount before their effect is clear.