What are signs of obsessive behavior?

CBT looks at the link between how you think, feel and behave. CBT focuses on problems and difficulties in the present rather than your past or childhood.

CBT can help you to understand how you think about yourself, the things around you, and how that affects your reaction to situations.

Exposure and response prevention (ERP)

NICE guidelines say that you should only be offered ERP alongside CBT. You can read more about the NICE guidelines below.

ERP helps people deal with situations or things that make them anxious or frightened. With the support of your therapist, you are ‘exposed’ to whatever makes you frightened or anxious. For example, dirt or germs.

You learn other ways of coping with your fear or anxiety instead of avoiding the situation or repeating a compulsion. You repeat this until your anxiety or fear is more managable.

Medication

Your doctor may offer you a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) to help with your OCD. The main types of SSRIs doctors use for OCD are fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram.

If your doctor prescribes any medication, they should tell you how it might help and what side effects to expect.

NICE guidelines

The National Institute for Health and Care Excellence (NICE) produces guidance on recommended treatments for OCD. You can find this guidance at: www.nice.org.uk/guidance/cg31.

If you have OCD and your symptoms are mild, your doctor should offer you low intensity psychological treatments of up to 10 hours. Low intensity treatments include:

• brief CBT, including ERP, using self-help materials,
• brief individual CBT, including ERP, by telephone, and
• group CBT, including ERP.

If you have moderate OCD, your doctor should offer you the choice of either:

• a course of SSRIs, or
• arrange more intensive CBT, including ERP. The therapy should be one-to-one with a therapist.

You might have severe symptoms. Your doctor should offer you CBT including ERP, together with an SSRI.

What if these treatments don’t work?

If these have not helped, your doctor or therapist may suggest further assessment and treatment. This might be given further psychological therapy or medication. For example, your doctor may offer you a different type of SSRI or an antidepressant called clomipramine.

If these treatments still don’t work, then you will be referred to a specialist OCD team. They should give you additional treatments, which might include:

• having additional CBT with ERP or cognitive therapy,
• taking an antipsychotic drug in addition to an SSRI or clomipramine,
• taking clomipramine and a drug called citalopram at the same time.

National specialist OCD services

If you have severe, long-term OCD you may be referred to a specialist national OCD service. Especially if you have not responded well to the treatments available from local or regional services.

The following webpage from the NHS Choices website gives details of some specialist OCD services: www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/treatment/.

Cultural or religious guidance

OCD symptoms may sometimes involve religion. Such as obsessions with religious or cultural practices.

The boundary between religious or cultural practice and OCD symptoms might sometimes be unclear to healthcare professionals. The NICE guidelines say professionals can seek the advice and support of an appropriate religious or community leader if appropriate. But they should only do this with your consent.

You can find more information about:

• Talking therapies by clicking here.
• Antidepressants by clicking here.
• Antipsychotics by clicking here.
• Spirituality, religion and mental illness by clicking here.

How can I get help and treatment?

You should make an appointment to talk with your GP if you are worried about your symptoms. Or they are causing problems in your day-to-day life.

Your GP may:

• Offer you medication,
• refer you to a service for talking treatment or
• refer you to a specialist mental health service.

Your GP will look at different areas when considering treatment options for you. Such as the following.

• Your goals and preferences.
• Your diagnosis and symptoms.
• What options you have tried already.
• Any other conditions you have.
• Guidance from the National Institute for Health and Care Excellence (NICE).

How do I get talking treatment?

Talking treatment is often provided by a service called an IAPT service. This stands for Improving Access to Psychological Therapies. They deal with mild to moderate mental health symptoms.

You can self-refer to IAPT services in most areas. But you can ask your GP to refer you if you prefer. Professionals in an IAPT service are not medically trained. But they are trained to give therapy and identify OCD symptoms. They will assess if they think you will benefit from having treatment with them.

You can also get talking treatment through a specialist mental health service if you have more severe OCD.

How do I get referred to a specialist mental health service?

Usually, a GP will refer you to a specialist mental health service if they think your symptoms are more severe.

A specialist doctor, called a psychiatrist, may then see you for an assessment.

Healthcare professionals may ask questions to find out how you are affected by your symptoms.

• Do you wash or clean a lot?
• Do you check things a lot?
• Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
• Do your activities take a long time to finish?
• Are you concerned about putting things in a special order or are you very upset by mess?
• Do these problems trouble you?

You can find more information about:

• GPs – what to expect from your doctor by clicking here.
• NHS Mental Health Teams (MHTs) by clicking here.
• Talking therapies by clicking here.
• Recovery by clicking here.

What if I am not happy with my treatment?

If you are not happy with your treatment you can:

• talk to your doctor about your treatment options,
• ask for a second opinion,
• get an advocate to help you speak to your doctor,
• contact Patient Advice and Liaison Service (PALS) and see whether they can help, or
• make a complaint.

There is more information about these options below.

Treatment options

You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment, ask your doctor to explain why it is not suitable for you.

Second opinion

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

Advocacy

An advocate is independent from the NHS. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available.

Community advocates may be able to support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like.

You can get an NHS Complaints advocate to help you make a complaint about an NHS service.

You can search online to search for a local advocacy service.

The Patient Advice and Liaison Service (PALS)

PALS is part of the NHS. They give information and support to patients.

You can find your local PALS’ details through this website link: www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

Making a complaint

It is often quicker to try to solve your issue informally by first talking to the service or professional directly. Explain:

What are the characteristics of an obsessive person?

What does obsessive behavior look like?

What triggers obsessive Behaviour?