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Obsessive-compulsive disorder (OCD)

Intrusive thoughts and repetitive actions that are hard to get rid of are a disorder in their own right. With the right treatment there is a marked improvement.

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Obsessive-compulsive disorder (OCD)

How does OCD present?

Intrusive thoughts and actions that a person carries out to reduce anxiety

  1. Contamination and cleanliness

    The most frequent form: the person washes their hands again and again or disinfects everything.

  2. Doubting and checking

    You check the lock, the stove and the electrical appliances again and again.

  3. Symmetry, precision, “just right”

    Everything has to stand “exactly in place” and look “just right.” This is linked to tidiness and a drive for order.

  4. Aggressive, sexual, religious obsessions

    Such thoughts are unpleasant for you and cause anxiety.

  5. The thoughts are your own, but alien to you

    You understand that these thoughts are your own, but they are unwanted and seem irrational or unacceptable. How far a person understands that this is an illness differs from person to person.

What are obsessions and compulsions?

Obsessions are intrusive thoughts, images or impulses (sudden urges to act). They repeat, do not go away and are not wanted. They cause distress, and you try to suppress them or drown them out with another thought or action.

Compulsions are repetitive actions (washing hands, checking, putting things in order) or actions “in the mind” (counting, praying). You carry them out in response to an intrusive thought or by a strict inner rule.

Usually there are both obsessions and compulsions. A compulsion is carried out to reduce anxiety or to prevent a feared outcome, but it is either unrealistic or excessive.

In the American classification DSM-5 (2013), OCD was moved out of the anxiety disorders into a separate group, “Obsessive-Compulsive and Related Disorders.” The International Classification of Diseases, ICD-11, took the same step.

When should you see a doctor?

The signs a doctor uses to make a diagnosis

  • You have repeated unwanted thoughts, images or impulses, they cause anxiety, and you try to suppress them or drown them out with another thought or action.
  • You carry out repetitive actions or “actions in the mind” in response to an intrusive thought or by a strict rule.
  • All this takes more than an hour a day or distresses you badly and disrupts your life.
  • The doctor rules out the effect of a substance or an illness, and another mental disorder that explains the symptoms better.

How is OCD treated?

The basis of treatment is exposure and response prevention

Exposure and response prevention (ERP)

A first-line method, that is, it is chosen first. Together with your doctor you meet the frightening object or situation and do not carry out the compulsion. Anxiety gradually fades.

  • the usual course is 12–20 sessions, 1–2 times a week; a more intensive schedule (every day) also works well
  • the effect is large — this has been shown in studies where participants are randomly divided into groups and the results compared (randomised studies)
  • the cognitive part of CBT (cognitive behavioural therapy) supplements ERP: you review your thoughts about the obsessions, including the belief that a thought equals an action, and an excessive sense of responsibility

Medication

The first choice is SSRIs at high doses. SSRIs are a group of antidepressants (selective serotonin reuptake inhibitors).

  • a higher dose is needed than for depression
  • the effect appears after 8–12 weeks — slower than in depression
  • if SSRIs do not help, the doctor chooses a second-choice drug; such drugs can have side effects, including effects on the heart
  • in persistent cases, when the usual treatment does not help, a small dose of an atypical antipsychotic is added

ERP combined with medication

It gives no advantage over ERP alone.

  • in a comparative study, ERP alone and ERP together with medication gave the same result, and both were better than the drug alone
  • the main strength lies in ERP itself
  • medication is added when ERP is not available or there are other conditions alongside

The role of the family

When relatives adapt to the rituals (this is called accommodation), OCD gets stronger.

  • reducing this adapting by the family is an important part of treatment

Severe OCD that does not respond to usual treatment

Special methods.

  • deep brain stimulation — a surgical method that acts on the brain areas linked to OCD (the ventral capsule and the ventral striatum)
  • in individual cases — neurosurgical procedures (capsulotomy, cingulotomy)
  • electroconvulsive therapy (ECT) has no effect in OCD; the rapid action of ketamine and esketamine is now being studied

How long treatment lasts

The course is chronic, but with the right treatment there is a significant improvement.

  • treatment is long-term; after remission (when the symptoms have gone) it continues for at least 1–2 years
  • if relapses keep coming back many times, treatment continues for life

Consultations by

Kenan RagimovKenan RagimovPsychotherapist

Consultation fees

A single session or a monthly package — we choose the format together

Session with one specialist, online1 hour100 AZN
Session with one specialist, in person1 hour150 AZN
Session with both specialists, online1 hour150 AZN
Session with both specialists, in person1 hour200 AZN
Monthly package, online4 sessions + WhatsApp support (100 min limit)400 AZN
Monthly package, in person4 sessions + WhatsApp support (100 min limit)600 AZN

After you register, you will be taken to the payment page. Once you have paid, send the receipt via WhatsApp to +994 70 220 03 76 and we will confirm the time.

Frequently asked questions

Is OCD just a love of cleanliness and order?

No. In OCD a person is tormented by anxiety, it disrupts life, and the thoughts are felt as unwanted and irrational (doctors call this “ego-dystonic”). Obsessive-compulsive personality disorder is a separate disorder in which a person feels their traits to be their own (“ego-syntonic”).

Can obsessions be stopped by willpower?

No. In OCD the regulation of a circuit linking parts of the brain (the cortico-striato-thalamo-cortical circuit, CSTC) is disturbed, and willpower cannot stop it. ERP and SSRIs act at this level, that is, at the level of how the brain works.

Will an ordinary antidepressant dose do?

In OCD, high doses of SSRIs are needed. The dose used to treat depression often brings no result. The effect appears after 8–12 weeks.

Doesn’t ERP cause trauma, since a person is kept in a frightening situation?

No. ERP is carried out in a structured way, step by step and with your consent. The method has shown proven long-term effectiveness.

If relatives adapt to the rituals, will it calm things?

No. When relatives adapt to the rituals (accommodation), OCD gets stronger. That is why reducing this adapting by the family is an important part of treatment.

Sources

WHO. ICD-11. 6B20 Obsessive-compulsive disorder. 2024.

APA. DSM-5-TR. 2022.

NICE CG31. Obsessive-compulsive disorder and body dysmorphic disorder. 2005, 2019 surveillance.

APA. Practice Guideline for the Treatment of Patients with Obsessive-Compulsive Disorder. 2007.

Bandelow B. et al. WFSBP guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders. World J Biol Psychiatry 2008;9(4):248–312.

Foa E.B., Liebowitz M.R., Kozak M.J. et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry 2005;162(1):151–161.

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