Obsessive compulsive disorder

What is it?

Obsessive compulsive disorder (OCD) is a chronic mental health condition that is usually associated with both obsessive thoughts (unwanted thoughts, images or urges that repeatedly enter a person’s mind) and compulsive behaviour (a repetitive behaviour or mental act that a person feels compelled to perform).

How does it affect people?

While obsessive compulsive disorder (OCD) is a condition that can affect people differently, it usually causes a particular pattern of thought and behaviour. Most people with OCD generally fall into a set cycle of thought and behaviour. This cycle has four main steps:

Obsession – their thoughts are overwhelmed by a constant obsessive fear or concern
Anxiety – this obsession provokes a feeling of intense anxiety and distress
Compulsion – a pattern of compulsive behaviour is then adopted to reduce the anxiety and distress, such as checking that all windows and doors are locked at least three times before leaving the house
Temporary relief – the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the cycle to begin again

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on their compulsion. Some common types of compulsive behaviour that affect people with OCD include:

Cleaning
Hand washing
Checking – such as checking that doors are locked, or that the gas or a tap is off
Counting
Ordering and arranging
Hoarding
Asking for reassurance
Needing to confess
Repeating words silently
Prolonged thoughts about the same subject
‘Neutralising’ thoughts (to counter the obsessional thoughts or images)

How is it treated?

Treatment will depend on how badly OCD is affecting a person’s ability to function. OCD which causes mild functional impairment is usually treated using a short course of cognitive behavioural therapy (CBT)
OCD which causes moderate functional impairment can be treated with a more intensive course of CBT and medication. Such cases may also require referral to a specialist mental health service
OCD which causes severe functional impairment will require referral to a specialist mental health service for a combination of intensive CBT and a course of medication

How might it affect work?

The symptoms and severity of OCD vary considerably from one person to another. An employee with mild symptoms may be able to function effectively with no significant impact on their performance or attendance at work, whereas an employee with moderate or severe symptoms may have behaviours that significantly impact on their ability to perform at work. For example, if an employee is continually checking that they have completed a piece of work properly it may have an impact on them being able to complete their required workload in the allocated time frame.

What do I need to do as the manager?

Firstly and most importantly, if you notice behaviour as outlined above then raise this with the employee and encourage them to take advice from their GP. Treatment is available and about 80% of people will respond to initial treatment.

Discuss how their condition is affecting their work; identify what tasks they can perform and what tasks they have difficulties with. It may help to make some modifications to their work.

Where symptoms associated with OCD have had an adverse impact at work or are the cause of absence from work you may want to make a referral to Occupational Health.

OCD can be treated and individuals do get better and remain better
Focus on supporting the employee. If they are well enough, help them to remain at work or to return to work as soon as possible
Encourage the employee to seek help. Left untreated, the symptoms of OCD may not improve and in some cases they will get worse. Without treatment, nearly half of people with OCD still have symptoms 30 years later

Points to remember

Fit notes

If an employee produces a fit note indicating that they require modified duties, discuss this with them and consider if the modification recommended can be reasonably accommodated.

Job tasks and risk assessments

Review the risk assessment for the employee’s job role and work tasks including the ability to drive safely where required. Take into consideration any temporary modification that may be required to accommodate their reduced ability to undertake certain tasks.

General guidance

If you require further information, refer to the general advice on managing attendance.