GPAtlas🧭 When to suspect
Obsessive-compulsive disorder (OCD) is defined by obsessions – recurrent, intrusive, unwanted thoughts, images or urges that provoke anxiety or distress – and/or compulsions – repetitive behaviours or mental acts performed to neutralise that distress. Most people have both. The hallmark is a self-perpetuating cycle: an intrusion triggers anxiety, a compulsion brings brief relief, and that relief reinforces the behaviour, with avoidance layered on top.
Suspect OCD when symptoms are time-consuming – often more than an hour a day – and cause significant distress or interfere with work, study, relationships or self-care. Affecting roughly 1–2% of people, OCD is frequently concealed through shame and may be missed for years, so ask directly. Actively case-find in higher-risk groups – those with depression, anxiety, substance misuse, body dysmorphic disorder (BDD), an eating disorder, or attending dermatology – with simple questions such as whether they wash or check excessively, whether an unwanted thought keeps intruding, or whether everyday tasks take a long time to finish.
The two core primary-care skills are to recognise it (because patients hide it) and to match treatment intensity to functional impairment, escalating risk promptly.
| Functional impairment | Typical picture | First-line management |
|---|---|---|
| Mild | Limited interference; symptoms occupy relatively little of the day, or the patient prefers a low-intensity approach | Low-intensity CBT with ERP – guided self-help, by telephone, or group |
| Moderate | Clear interference with daily functioning | Choice of more intensive CBT with ERP or an SSRI (comparably effective) |
| Severe | Marked distress and impairment; may be unable to function or housebound | Combined SSRI plus intensive CBT with ERP |
|
🧠 Clinical pearl Intrusive thoughts of a violent, sexual or blasphemous nature – harming a loved one, a fear of being a paedophile, distressing religious images – are common, ego-dystonic features of OCD and are not a sign the person will act on them. They are routinely misread as risk; the very distress the thought causes is itself a clue that this is OCD. Recognise and reassure rather than over-pathologise – while still taking a genuine risk history. |
Source: NICE CG31
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.