{"id":140354,"date":"2026-07-22T10:00:09","date_gmt":"2026-07-22T09:00:09","guid":{"rendered":"https:\/\/www.harleytherapy.co.uk\/counselling\/?p=140354"},"modified":"2026-07-03T13:55:42","modified_gmt":"2026-07-03T12:55:42","slug":"he-spent-four-hours-checking-his-route-every-morning-what-ocd-really-looks-like","status":"publish","type":"post","link":"https:\/\/www.harleytherapy.co.uk\/counselling\/he-spent-four-hours-checking-his-route-every-morning-what-ocd-really-looks-like.htm","title":{"rendered":"&#8220;He Spent Four Hours Checking His Route Every Morning&#8221;: What OCD Really Looks Like"},"content":{"rendered":"<p><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/WPoUFnA42Pc\" width=\"600\" height=\"338\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><br \/>\n<\/iframe><\/p>\n<p><a href=\"https:\/\/www.harleytherapy.co.uk\/naresh-buttan.htm\"><em>By Dr Naresh Buttan, Consultant General Adult Psychiatrist at Harley Therapy<\/em><\/a><\/p>\n<p>I once treated a patient whose job involved hours of driving every day, who was convinced, every single day, that he might have hurt someone without realising it. Each morning before his shift, he would spend up to four hours mentally retracing his previous day&#8217;s routes, checking and re-checking that nothing had happened along the way that he hadn&#8217;t noticed.<\/p>\n<p><em>(Some details have been changed here to protect patient confidentiality.)<\/em><\/p>\n<p>Four hours. Every morning. Before he&#8217;d even started work.<\/p>\n<p>This is obsessive compulsive disorder, and it rarely looks like what people expect.<\/p>\n<h2>OCD is not about being tidy<\/h2>\n<p><a href=\"https:\/\/www.harleytherapy.co.uk\/obsessive-compulsive-disorder-counselling-london-ocd.htm\">OCD<\/a> is commonly misunderstood as a preference for order, being &#8220;a bit OCD&#8221; about a tidy desk or a colour-coded wardrobe. In clinical practice, it&#8217;s something far more distressing than that. It&#8217;s estimated that between 0.5% and 2% of the population have diagnosable OCD, and it affects both adults and children, though it presents differently from person to person.<\/p>\n<p>At its core, OCD is made up of two parts: <strong>obsessions<\/strong> and <strong>compulsions<\/strong>.<\/p>\n<p><strong>Obsessions<\/strong> are repetitive, intrusive thoughts, images, or urges that keep returning no matter how much you don&#8217;t want them to. They often start from a rational thought &#8211; <em>did I lock the door?<\/em> &#8211; but spiral into something your logical mind knows isn&#8217;t proportionate, yet can&#8217;t shake. They provoke real anxiety, precisely because they won&#8217;t leave you alone.<\/p>\n<p><strong>Compulsions<\/strong> are the actions &#8211; mental or physical &#8211; that people perform to try to neutralise that anxiety. Going back to check the door. Repeating a phrase in your head a certain number of times. Washing your hands until they&#8217;re raw. The relief compulsions bring is usually brief, which is why the cycle repeats.<\/p>\n<p>In the cases we see clinically, 50\u201375% of people experience both obsessions and compulsions together. A smaller number experience predominantly one or the other.<\/p>\n<h2>When &#8220;checking&#8221; takes over a life<\/h2>\n<div id=\"attachment_140356\" style=\"width: 160px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/11706313955_b318f10c7c.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-140356\" class=\"size-thumbnail wp-image-140356\" src=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/11706313955_b318f10c7c-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/11706313955_b318f10c7c-150x150.jpg 150w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/11706313955_b318f10c7c-200x200.jpg 200w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/11706313955_b318f10c7c-50x50.jpg 50w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><p id=\"caption-attachment-140356\" class=\"wp-caption-text\">By: <a href=\"https:\/\/www.flickr.com\/photos\/54131547@N00\/11706313955\/\" target=\"_blank\" rel=\"nofollow noreferrer\">alangraham999<\/a><\/p><\/div>\n<p>Most of us have had the moment of leaving the house and wondering, <em>did I turn off the gas?<\/em> For most people, a quick mental check, or even a second look, resolves it, and life carries on.<\/p>\n<p>For someone with OCD, that reassurance doesn&#8217;t stick. The thought returns. And returns again. It can pull someone back home from halfway to work, sometimes more than once in a single morning, and even after checking, checking again, and checking a third time, the anxiety often isn&#8217;t resolved, it can simply move to a new question five minutes later.<\/p>\n<p>This is exactly what was happening for that patient. It wasn&#8217;t carelessness or paranoia, it was OCD consuming four hours of his working day, every day, in service of an obsession that never let up no matter how thoroughly it was addressed.<\/p>\n<div id=\"attachment_140361\" style=\"width: 160px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-140361\" class=\"size-thumbnail wp-image-140361\" src=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581-150x150.jpg 150w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581-400x400.jpg 400w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581-200x200.jpg 200w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581-50x50.jpg 50w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/49729976507_116bb29581.jpg 499w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><p id=\"caption-attachment-140361\" class=\"wp-caption-text\">By: <a href=\"https:\/\/www.flickr.com\/photos\/edenpictures\/49729976507\/\" target=\"_blank\" rel=\"nofollow noreferrer\">Eden, Janine and Jim<\/a><\/p><\/div>\n<p>Contamination fears work the same way. Many people became more careful about hygiene during the pandemic out of genuine necessity. For someone with contamination-based OCD, that same instinct can persist long after the need has passed, hours spent cleaning a surface that&#8217;s already clean, because the anxiety, not the actual risk, is driving the behaviour.<\/p>\n<p>Other common patterns include intrusive fears of having harmed someone without realising it, obsessive list-making that never feels sufficient no matter how thorough, counting rituals, or repeating certain phrases or numbers to &#8220;neutralise&#8221; a feared outcome.<\/p>\n<h2>The cost most people don&#8217;t see<\/h2>\n<p>What&#8217;s easy to miss from the outside is how much OCD takes from someone&#8217;s life. Missed meetings. Skipped social plans. Hours lost that could have gone to work, family or simply rest. Left unaddressed for long enough, it commonly brings depression and anxiety alongside it, and some people turn to alcohol or other substances to manage the distress, which can create a second problem on top of the first.<\/p>\n<p>OCD can also occur alongside other conditions &#8211; it&#8217;s sometimes seen with tics and Tourette&#8217;s, particularly in children and young people, and can accompany certain neurological or psychiatric conditions. It isn&#8217;t always a standalone diagnosis, which is part of why a full clinical history matters so much at the assessment stage.<\/p>\n<h2>What actually helps OCD<\/h2>\n<div id=\"attachment_140357\" style=\"width: 160px\" class=\"wp-caption alignright\"><a href=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/4383262220_98db286f2d.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-140357\" class=\"size-thumbnail wp-image-140357\" src=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/4383262220_98db286f2d-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/4383262220_98db286f2d-150x150.jpg 150w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/4383262220_98db286f2d-200x200.jpg 200w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/4383262220_98db286f2d-50x50.jpg 50w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><p id=\"caption-attachment-140357\" class=\"wp-caption-text\">By: <a href=\"https:\/\/www.flickr.com\/photos\/southpaw2305\/4383262220\/\" target=\"_blank\" rel=\"nofollow noreferrer\">Clare Black<\/a><\/p><\/div>\n<p>When someone comes to us for assessment, we take a full history &#8211; what else is going on, any past treatment and how it went, any side effects experienced &#8211; and we&#8217;ll often run basic blood tests to rule out contributing factors like vitamin D or thyroid deficiencies.<\/p>\n<p>From there, treatment depends on severity:<\/p>\n<ul>\n<li><strong>Milder OCD<\/strong>, where someone isn&#8217;t severely distressed, often responds well to therapy alone &#8211; particularly cognitive behavioural therapy aimed at the obsessive thought patterns, alongside anxiety management, relaxation techniques and mindfulness.<\/li>\n<li><strong>Moderate to severe OCD<\/strong> usually calls for a combination of therapy and medication, most commonly SSRIs such as sertraline, fluoxetine or citalopram. If a first medication doesn&#8217;t help sufficiently, we may move to a different one &#8211; always weighing effectiveness against side-effect profile and what&#8217;s tolerable for that person.<\/li>\n<\/ul>\n<p>One thing worth knowing if you or someone you love is starting treatment: <strong>OCD medication takes longer to show results than many people expect.<\/strong> Where depression medication might show effect in four to six weeks, OCD can take six to twelve weeks for a full, fair trial. That&#8217;s a long time to keep faith in something that doesn&#8217;t yet feel like it&#8217;s working &#8211; which is exactly why support, whether from family or ongoing therapy, matters so much during this period.<\/p>\n<h2>The outlook<\/h2>\n<div id=\"attachment_140363\" style=\"width: 160px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/29217310635_3ce7c1bbd3.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-140363\" class=\"size-thumbnail wp-image-140363\" src=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/29217310635_3ce7c1bbd3-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/29217310635_3ce7c1bbd3-150x150.jpg 150w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/29217310635_3ce7c1bbd3-200x200.jpg 200w, https:\/\/www.harleytherapy.co.uk\/counselling\/wp-content\/uploads\/29217310635_3ce7c1bbd3-50x50.jpg 50w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><p id=\"caption-attachment-140363\" class=\"wp-caption-text\">By: <a href=\"https:\/\/www.flickr.com\/photos\/gromin\/29217310635\/\" target=\"_blank\" rel=\"nofollow noreferrer\">Nikolay Gromin<\/a><\/p><\/div>\n<p>OCD tends to follow a fluctuating course. <strong>Around 40\u201350% of people recover fully.<\/strong> Others may see the condition return after some years of remission, and for some, it becomes a longer-term, chronic condition to manage. Even in that last group, treatment isn&#8217;t wasted &#8211; reducing the intensity and distress of symptoms, even without eliminating them entirely, allows people to get their lives back in a meaningful way.<\/p>\n<p>My patient recovered, with a combination of medication and therapy giving him his mornings back. That&#8217;s the outcome we&#8217;re aiming for with every person who comes through our doors.<\/p>\n<p>If any of this sounds familiar &#8211; whether it&#8217;s the checking, the counting, the intrusive thoughts you know are irrational but can&#8217;t dismiss &#8211; <strong>please don&#8217;t wait to get it looked at.<\/strong> The earlier OCD is properly assessed and treated, the better the outcome tends to be.<\/p>\n<hr \/>\n<div style=\"width: 183px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/www.harleytherapy.co.uk\/naresh-buttan.htm\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.harleytherapy.co.uk\/assets\/Media\/images\/therapist-photos\/NareshButtanConsultantPsychiatristLondon.webp\" alt=\"Dr Naresh Buttan - General Adult Psychiatrist on Harley Street, appointments available via Harley Therapy clinics, central London.\" width=\"173\" height=\"185\" \/><\/a><p class=\"wp-caption-text\">Dr Naresh Buttan &#8211; General Adult Psychiatrist<\/p><\/div>\n<p><em><a href=\"https:\/\/www.harleytherapy.co.uk\/naresh-buttan.htm\">Dr Naresh Buttan<\/a> is a Consultant General Adult Psychiatrist with over 20 years&#8217; experience, including 17 years in the NHS and 7 years in private practice at Harley Therapy. <\/em><\/p>\n<p><em>If you&#8217;d like to speak with him about OCD or another concern, you can book a session at <a href=\"https:\/\/www.harleytherapy.co.uk\/\">Harley Therapy<\/a>&#8216;s Harley Street or City of London clinic, or explore UK-wide options through the <a href=\"https:\/\/www.harleytherapy.com\">Harley Therapy Platform<\/a>.<\/em><\/p>\n<p><em>Watch Dr Naresh discuss <a href=\"https:\/\/youtu.be\/WPoUFnA42Pc\">OCD in more depth in the accompanying video<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff\ufeff\ufeff\ufeff\ufeff\ufeff\ufeff\ufeff By Dr Naresh Buttan, Consultant General Adult Psychiatrist at Harley Therapy I once treated a patient whose job involved hours of driving every day, who was convinced, every single day, that he might have hurt someone without realising it. Each morning before his shift, he would spend up to four hours mentally retracing his [&hellip;]<\/p>\n","protected":false},"author":88,"featured_media":140356,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","_lmt_disableupdate":"no","_lmt_disable":"no","footnotes":""},"categories":[21,5329],"tags":[103,102],"class_list":["post-140354","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anxiety-and-stress","category-ocd","tag-obsessive-compulsive-disorder","tag-ocd","has_thumb"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.0 (Yoast SEO v28.0) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>&quot;He Spent Four Hours Checking His Route Every Morning&quot;: What OCD Really Looks Like - Harley Therapy\u2122 Blog<\/title>\n<meta name=\"description\" content=\"I once treated a patient whose job involved hours of driving every day, who was convinced, every single day, that he might have hurt someone without realising it. 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