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- Obsessive Comulsive Disorder (OCD) is a mental health diagnosis for someone who experiences anxiety with repetitive compulsions.
- OCD compulsions are often triggered by intrusive or overwhelming thoughts, which are sometimes taboo.
- Signs someone may have undisclosed or undiagnosed OCD in the workplace include anxiety, irritability, compulsive behaviour or attempts to cover up compulsive behaviour.
- Employees with an OCD diagnosis may find that workplace adjustments including flexible hours, working from home, dedicated desk space and longer deadlines help them do their best at work.
- If an employee tells you they have OCD, listen to their concerns and offer support through HR, workplace benefits and reasonable adjustments.
People with Obsessive Compulsive Disorder (OCD) in the workplace face an unusual kind of stigma. Unlike other mental health conditions, the tendency is to underestimate how hard OCD is to live with. Though hand washing and light switches have become a shorthand for OCD ‘quirks’ in soap operas, OCD is a scary, and sometimes debilitating, mental health condition.
The first step towards managing, supporting or working with someone with OCD is to understand a bit more about their personal experience.
What is OCD?
OCD is an anxiety disorder that affects 1-2% of the UK population, according to specialist charity OCD UK.
Around 750,000 people in the UK live with OCD, according to the British Psychological Society.
It affects both adults and young people, and although onset is most common in early adulthood it can also begin in adulthood.
It can also take a long time not only to get diagnosed but to get help. The International OCD Foundation estimates it can take as much as a year and half to go from diagnosis to treatment. But with the right support and treatment, people can often see positive changes to symptoms.
Maz Connolly is a therapist who has worked here at Spill for six years. She also has lived experience of OCD. “Some people have literally had the same compulsions for pretty much their entire life, thinking that this is just how their life is going to be,” she says. “It's only when they start really impacting on their day to day life, whether that be at work, whether it be their personal life, that they seek help".
Therapist Phil Brain has worked with Spill for four years. “When OCD clients get ‘stuck’, it's a bit like being a race car on a circuit, but there's no slip lane, so they just keep going round and round in a circle, and there's no way out. They're stuck in that circular thought pattern. But it’s good to see that therapy helps clients manage their symptoms better and make progress, for example they are able to start socialising more.”
How does OCD affect someone's life?
People with OCD symptoms often find that the anxiety they feel around a particular topic seems to be soothed by doing a particular action – for example, hand-washing.
Unfortunately, the soothing effect of the compulsion doesn’t actually prevent the anxiety re-occurring.
People with OCD often report the cycle between obsessive thinking and compulsions, and also talk about the massive lack of time and self-control they experience while performing compulsions. This cycle of trigger and response can make simple tasks feel impossible.
“Clients often initially present to me saying they feel that they're not good enough at things, and that they then have to keep trying and trying to be perfect,” Phil says. “I've worked with clients who say they're struggling with not feeling good enough, particularly at work. Perhaps they spend longer than they want to, trying to get things absolutely perfect, going back through work and correcting it again and again.
“As we explore that, a pattern becomes a bit clearer: it's not just in work, but that can be the first place they notice it. They can't let something go unless it's perfect, but they struggle to get to that point of perfection. Then they start struggling with workload because they're spending too long overcorrecting the same piece and fall behind. Alternatively, clients will initially present with stress, anxiety or depression but when you start to dig into it, you recognise patterns.”
“OCD isn't a choice. Nobody is choosing to do this. A compulsion is something that someone with OCD has to do. There is a belief system that tells them if they don't do these checks or if they don't carry out these rituals, something bad is going to happen.” - Maz Connolly, Spill therapist
Are there different types of OCD?
Some people find it useful to talk about common themes in OCD such as fear of germs. However, people with an OCD diagnosis report that after treating one ‘type’ of OCD, their anxiety might ‘jump’ to another ‘type’. There is no clinical basis or different diagnosis for ‘types’ of OCD – there is only one diagnosis.
“Working with clients with an OCD diagnosis or suspected OCD, I’m always surprised by how diverse it can be,” Phil says. “It's not always obvious and it can be disguised by other things that are happening for the client. It's only as I work through what's presented to me in therapy that I can then start to identify there might be more than the presenting issues.”
Although it’s fine to understand OCD in terms of types, it’s a good idea to let employees with OCD at work lead the conversation on what they feel about the idea.
Can you have OCD without compulsions?
No, but it might appear that way!
“Another surprising thing is that OCD is not always visible,” Phil says. “Before I started being a therapist, I always thought of OCD as things like washing your hands or making sure everything's in the right order. Quite often there's not a physical thing, it's more of a mental reviewing or need for excessive reassurance, or having to go through things in your head repeatedly to make sure everything's right. A lot of it is happening behind the scenes.”
In some cases, people with OCD have a compulsion that is ‘invisible’ or not easy to spot. The reassurance-seeking may also take forms that are hard to recognise such as repeatedly seeking reassurance online by searching for answers, mentally checking something about how you feel or reciting a particular phrase or prayer.
This has sometimes been referred to as ‘Pure O’, meaning a ‘purely obsessive’ type of OCD, but the term is not widely used. With a little exploration it’s possible to start identifying these ‘invisible’ compulsions.
What is high-functioning OCD?
“For me, probably the biggest surprise about working with employees with OCD is how high-functioning some people with OCD are and the effort that they go through to appear ’normal’ or to mask what they've done,” Maz says.
“I've worked with clients who are CEOs or managed huge teams of people, and no one would know that they have OCD, but these people go to a lot of effort to keep that hidden. The pressure to mask gets higher, the higher up you go." - Maz Connolly, Spill therapist
For people with OCD, it’s particularly lonely at the top, she adds: “Some people don't have the ability to hide it, but those who do create a feeling of isolation. It often leads to people experiencing really high levels of anxiety, because what you're doing is just pushing everything down.”
It’s worth noting that ‘high-functioning’ OCD is a controversial phrase that plays down the severity of OCD. People might use this phrase to mean that while a person is privately struggling, they appear well. Using this term to describe someone in that position can be damaging as it suggests that as long as someone contains their struggle, they are ‘functioning’.
People might also use this phrase to mean that OCD symptoms at work are well-managed and that the person with an OCD diagnosis appears well. Again, this phrase can be difficult for people who have well-managed OCD because it undermines the time and effort that anyone with OCD spends while getting to a position in which they can live with their symptoms.
What does OCD in the workplace look like?
Recognising the symptoms of OCD at work
OCD is a stigmatised and poorly-understood mental health diagnosis so employees may choose not to disclose OCD in the workplace, even if they are struggling with symptoms.
People may also choose not to disclose OCD at work because obsessive thoughts can often be taboo, hence why they are so distress and anxiety-inducing. Someone with obsessive thoughts may worry that when they disclose, they will also be asked to share what they are worried about or even that people may guess what they are thinking about.
“Before I was a therapist, I was a retail manager for years,” Maz says. “A lot of people with OCD need a lot of reassurance that what they're doing is right, and not all managers have the time to be able to give that reassurance. Then often if somebody is thinking, ‘I need to check this email 10 times before I send it’, and then they get no feedback, the automatic assumption will be that there was something wrong with it.
“It might be that colleagues are seeing compulsions and not actually being very sympathetic,” she adds “That is challenging for managers as well because if they're having to make concessions, and the other people in their team don't realise that this person has a has a mental health condition, then they may well ask, ‘Why am I not getting that too?’”
“For managers, they’re treading a very thin line between wanting to support an employee with OCD, but respecting that an employee might not want to talk about it with you,” Phil says.
“In my experience of working with people with an OCD diagnosis, the longer it's left the more intense and intrusive it can become. By starting therapy earlier then there's more potential for being able to stop it and prevent it from becoming really disruptive.” - Phil Brain, Spill therapist
However, there may be signs of OCD at work that can be addressed without an employee disclosing (or being asked to disclose) their diagnosis.
Signs of OCD in the workplace might include:
- Arriving to work consistently late or upset.
- Being irritable.
- Appearing to procrastinate or lose time.
- Taking long or frequent bathroom breaks.
- Having touch or speech habits e.g. repeating words.
- Consistently going quiet or withdrawing.
- Repeatedly seeking reassurance.
- Spending a lot of time scrolling, i.e. researching.
- Avoiding ‘trigger’ situations or environments e.g. driving, using the staff kitchen.
Source: Mind
Remember, as a manager or colleague, it’s not up to you to diagnose anybody with OCD, or any other mental health disorder. But you might be able to point them towards professional help if your workplace offers mental health support or therapy, like Spill.
Supporting a colleague with OCD
If somebody you work with tells you that they have OCD, the best thing you can do is listen to how it affects them. Your professional relationship with them also makes a difference to how you might react.
Working with someone with OCD: tips for coworkers
- Be patient – most people with OCD are well aware that they may take longer than others to complete tasks.
- Be kind – for example if they share something about their OCD that is scary or gross, try not to overreact.
- Be boundaried – no need to be judgemental, but try to avoid getting involved in rituals or reassurance-seeking.
- Be supportive – ask your colleague with an OCD diagnosis to work with management to get more help with symptoms. Be frank with your colleague if you are worried about their safety.
Managing someone with OCD: tips for team leaders
- Be open – make room for employees to disclose an OCD diagnosis or symptoms and be available to listen.
- Be supportive – ask them about how OCD affects their work and inform your colleague about mental health support available to them at work.
- Be boundaried – stick to talking about how OCD affects their work. Avoid asking medical or personal questions about their diagnosis or treatment.
OCD discrimination in the workplace
OCD is often misunderstood and stigmatised and so people with an OCD diagnosis may experience discrimination at work.
‘Long-term’ OCD is classed as a disability in the Equality Act 2010; this means OCD longer than 12 months, which is likely to cover most cases. The Equality Act is a legal framework which compels your workplace to make ‘reasonable adjustments’ to ensure people with an OCD diagnosis can work as easily as a colleague without.
Is it a legal requirement to disclose OCD to your employer?
No, employees are no more required to disclose an OCD diagnosis at work than any other condition, although most experts advise employees to disclose to access support such as reasonable adjustments.
However, employers are obliged by the Equality Act to do all they reasonably can to create an environment that feels safe for employees to disclose any disability. Occupational health service Acas has clear advice on this.
What to do if an employee discloses an OCD diagnosis
If an employee does disclose OCD at work, it’s recommended that they disclose in a specific meeting to their manager, or to HR. Employees may approach HR rather than a manager if they prefer not to tell their manager, or have concerns about confidentiality. They may also bring a doctor’s note about the diagnosis or treatment if the doctor can advise on how OCD affects their work, or what reasonable adjustments to make.
If an employee discloses OCD, the only thing that needs to be discussed is how OCD symptoms and treatment might affect the employee’s work – so no need to discuss anything personal or clinical.
Making reasonable adjustments for people with OCD at work
You’ll need to talk to your colleague about any changes they’d like to make to their working day or environment. OCD workplace adjustments might include:
- Flexible hours.
- Giving some tasks to another person.
- Working from home.
- Longer deadlines.
- Making time for doctor’s appointments and therapy.
- A dedicated desk space.
Working with someone with OCD: tips for HR or People leaders
There are some things you can do at a business level to support people with OCD at work.
- Consider whether performance-related pay arrangements are still fair and achievable for everyone on the team.
- Make social events optional.
- Challenge mental health stigma at work.
- Offer mental health training for managers.
- Make sure your Mental Health Policy is up to date and accessible.
- Prepare a return-to-work plan if an employee with OCD takes health leave.
Treatment for OCD
OCD symptoms can be reduced and managed with medication and therapy.
One of the more effective modalities for OCD is a type of CBT called Exposure Response Prevention (ERP) which is about increasing a person’s window of tolerance for anxiety.
NHS England estimates that just 10 hours of therapist treatment is enough to resolve mild OCD.
Despite being given one of the most misunderstood mental health diagnoses, with the right help a person with an OCD diagnosis can be your team’s star player.
