OCD

Everything you need to know about OCD - symptoms, causes, treatment options available in Australia and how Doccy can help you.

Dr. Louis J Sisk

BSc(Hons) MBChB MRCS(Glasg) MTrauma

Published: August 23, 2025

Overview

OCD isn't about being "a bit tidy". It's a medical condition with well-described patterns. Obsessions create intense distress or disgust, and compulsions bring short-term relief but keep the cycle going. Over time, rituals can expand and begin to dominate daily life at home, school, work, and in relationships.¹

In Australia, OCD is common. The most recent national survey estimates that around 3.6% of Australians aged 16–85 experienced OCD in the past year, making it a significant public health issue.² Research suggests differences in cortico-striato-thalamo-cortical (CSTC) circuits (habit learning, threat appraisal and cognitive control) and serotonin signalling play a role. While biology sets the stage, learning loops (avoidance and rituals) strengthen OCD over time. The good news: specific psychological therapies target these loops and are highly effective.³

Symptoms and Clinical Presentation

Obsessions (examples):

• Contamination: fear of germs/chemicals/illness; disgust reactions.
• Harm: intrusive images of causing accidents, making mistakes that hurt others, or "what if I didn't lock the door?".
• Symmetry/"just-right": intense discomfort if things feel uneven, misaligned or incomplete.
• Forbidden/taboo themes: unwanted sexual, violent or blasphemous thoughts that clash with one's values.

Compulsions (examples):

• Cleaning/washing; checking doors, appliances, messages, posts.
• Repeating/ordering/counting until it feels safe or "right".
• Mental rituals: reviewing events, silently repeating phrases, neutralising "bad" thoughts.
• Reassurance seeking from family/friends/colleagues.

People with OCD usually recognise the thoughts/rituals are excessive or irrational, but feel driven to perform them. Symptoms often worsen under stress and may be hidden due to shame. Early recognition and treatment make a big difference.^{1 3}

Causes and Risk Factors

There's no single cause. Instead, OCD reflects a mix of factors:

• Genetic vulnerability (tends to run in families).
• Brain-circuit differences in habit/threat systems and serotonin modulation.
• Perinatal/early-life contributors (e.g., prematurity) and significant stressors can act as triggers.
• Learning mechanisms: compulsions reduce distress in the moment (negative reinforcement), locking in the cycle.

Having risk factors doesn't mean you'll develop OCD; they simply increase the likelihood.³

Diagnosis (what to expect in Australia)

OCD is a clinical diagnosis. Your GP may start the process, with referral to a clinician experienced in OCD (psychologist, psychiatrist or paediatrician for young people).

A good assessment will:

1. Map obsessions and compulsions (including hidden mental rituals) and their impact.
2. Use validated questionnaires and, for children, parent/teacher input.
3. Screen for co-existing conditions (anxiety, depression, tics, autism, eating disorders, substance use, sleep disorders).
4. Check for mimics (e.g., thyroid issues, neurological conditions) when indicated.
5. Produce a clear plan: therapy options, medication (if suitable), school/work adjustments, and safety-net advice.¹

Tip: People often under-report OCD symptoms because they're embarrassing or feel "odd". Clinicians have heard it all before—being open helps you get the right care.¹

Treatment Options in Australia

1) Psychological therapy (first-line)

Cognitive Behavioural Therapy with Exposure and Response Prevention (CBT-ERP) is the gold standard. With a trained therapist, you gradually face triggers (exposure) without performing rituals (response prevention), allowing anxiety to habituate. Over time, your brain relearns that feared outcomes don't occur (or can be tolerated), and the urge to ritualise fades. Many people experience major, durable improvements with ERP.³

Access & costs: Medicare's Better Access programme provides rebated psychology sessions when your GP creates a Mental Health Treatment Plan (caps and out-of-pocket costs vary by provider). Telehealth options can improve access if local ERP providers are limited.⁴

2) Medication (often alongside therapy)

If symptoms are moderate–severe, if ERP access is limited, or if therapy alone hasn't helped enough, medication can be very useful:

• SSRIs (e.g., fluoxetine, sertraline, fluvoxamine) are first-line. Doses and trial duration are often higher/longer than for depression (allow 8–12 weeks for meaningful effects).
• Clomipramine (a TCA) may help if SSRIs are not effective/tolerated.
• Augmentation strategies are specialist-led for complex cases.

Many OCD medicines are PBS-subsidised, reducing costs for most Australians; eligibility and co-payments vary.^{3 5 6}

Note: Stopping and starting medication can worsen symptoms—always make changes with your prescriber.³

3) Step-up options

For complex or severe OCD, options include intensive ERP programmes, combined therapy + medication, and in highly selected, treatment-refractory cases, neuromodulation under specialist teams. Your clinician will advise what's appropriate.³

4) What about self-help?

ERP-based digital programmes and evidence-informed self-help workbooks can help as an adjunct—especially while waiting for therapy—but they're not a full substitute for clinician-guided ERP when symptoms are significant.¹

Living with OCD

Skills that make daily life easier:

• Name the loop: "This is an OCD thought/urge" (not a fact). Delay responding; let the wave pass without ritual.
• Graded exposures: build a ladder from easier to harder triggers with your therapist; practise consistently.
• Cut reassurance: agree house rules that reduce family accommodation (e.g., answer once, then redirect to ERP strategies).
• Structure the day: set routines for sleep/meals/activity; schedule ERP practice in your diary.
• Digital hygiene: limit compulsive searching/scrolling; use website blockers during ERP tasks.

Family & partners: Loved ones often (with the best intentions) accommodate rituals—doing checks, offering repeated reassurance—which can entrench OCD. Learn how to support recovery instead: encourage ERP practice, celebrate small wins, and step back from rituals in a planned way.¹

School & work adjustments:

• Written instructions and predictable routines.
• Extra time for tasks without enabling rituals.
• Quiet spaces for exposures or short breaks.
• A supportive point-person (teacher, manager, HR/uni disability support).

Relapse prevention: OCD can wax and wane. Create a plan listing early warning signs, your exposure ladder, and who to contact if symptoms climb. Resume ERP strategies early; small slips are easier to turn around.¹

Access and Affordability in Australia

• GP & specialist care: Medicare rebates apply (gap fees vary).⁴
• Psychology (Better Access): rebates for a set number of sessions per year when referred by a GP with a Mental Health Treatment Plan; availability and fees differ by provider/location; telehealth may help.⁴
• Medicines: Many OCD medicines are PBS-subsidised, lowering out-of-pocket costs.^{5 6}
• If ERP providers are scarce, ask about telehealth, group programmes, or interim guided self-help while you're on a waitlist.¹

Prevention (and early action)

There's no guaranteed way to prevent OCD, but you can reduce impact by:

• Seeking help early if intrusive thoughts and rituals are taking up time or disrupting life.
• Learning the basics of ERP and avoiding excessive reassurance/avoidance.
• Looking after sleep, exercise and stress—not cures, but helpful foundations.

Public education and routine mental-health screening can improve detection so people access evidence-based care sooner.²

When to Seek Help Now

• Rituals consume more than an hour a day, or you're late/avoiding life due to OCD.
• You feel compelled to act on distressing thoughts or are not safe.
• Marked drop in school/work performance or relationships due to OCD.
• You've started/stopped medicine and symptoms have spiked.

Start with your Doccy for assessment and referral options. If you're in crisis, call 000.

Key Takeaways

• OCD is common and treatable. About 3.6% of Australians experience it each year.²
• CBT with ERP is first-line and often life-changing; SSRIs can help, especially for moderate–severe symptoms.³
• Australia's Medicare (Better Access) and the PBS support access to therapy and medicines—ask Doccy about referrals and about the best local pathway.^{4 5 6}

References & Useful Links