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Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.
You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.
OCD often centers around certain themes — for example, an excessive fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they’re sore and chapped.
If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective.
Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by obsessions which lead to compulsive behaviors.
People often double check to make sure they’ve locked the front door or always wear their lucky socks on game days — simple rituals or habits that make them feel more secure.
OCD goes beyond double checking something or practicing a game day ritual. Someone diagnosed with OCD feels compelled to act out certain rituals repeatedly, even if they don’t want to — and even if it complicates their life unnecessarily.
What is OCD?
Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions).
Although people with OCD may know that their thoughts and behaviors don’t make logical sense, they’re often unable to stop them.
Causes
The exact cause of OCD is unknown, but researchers believe that certain areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other.
Genetics are thought to contribute to OCD, as well.
If you, your parent, or a sibling have OCD, there’s about a 25 percent chance that another immediate family member will have it.
The cause of obsessive-compulsive disorder isn’t fully understood. Main theories include:
- Biology. OCD may be a result of changes in your body’s own natural chemistry or brain functions.
- Genetics. OCD may have a genetic component, but specific genes have yet to be identified.
- Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.
Symptoms
Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it’s also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.
Obsession symptoms
OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you’re trying to think of or do other things.
Obsessions often have themes to them, such as:
- Fear of contamination or dirt
- Doubting and having difficulty tolerating uncertainty
- Needing things orderly and symmetrical
- Aggressive or horrific thoughts about losing control and harming yourself or others
- Unwanted thoughts, including aggression, or sexual or religious subjects
Examples of obsession signs and symptoms include:
- Fear of being contaminated by touching objects others have touched
- Doubts that you’ve locked the door or turned off the stove
- Intense stress when objects aren’t orderly or facing a certain way
- Images of driving your car into a crowd of people
- Thoughts about shouting obscenities or acting inappropriately in public
- Unpleasant sexual images
- Avoidance of situations that can trigger obsessions, such as shaking hands
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Compulsion symptoms
OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.
You may make up rules or rituals to follow that help control your anxiety when you’re having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they’re intended to fix.
As with obsessions, compulsions typically have themes, such as:
- Washing and cleaning
- Checking
- Counting
- Orderliness
- Following a strict routine
- Demanding reassurance
Examples of compulsion signs and symptoms include:
- Hand-washing until your skin becomes raw
- Checking doors repeatedly to make sure they’re locked
- Checking the stove repeatedly to make sure it’s off
- Counting in certain patterns
- Silently repeating a prayer, word or phrase
- Arranging your canned goods to face the same way
Severity varies
OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.
When to see a doctor
There’s a difference between being a perfectionist — someone who requires flawless results or performance, for example — and having OCD. OCD thoughts aren’t simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way.
If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health professional.
Compulsions
These are repetitive acts that temporarily relieve the stress and anxiety brought on by an obsession. Often, people who have compulsions believe these rituals will prevent something bad from happening.
Types of OCD
There are several different types of obsessions and compulsions. The most well known include:
- obsessions that involve fear of contamination (germs) with related compulsions of cleaning and washing
- obsessions related to symmetry or perfectionism with related compulsions of ordering or redoing
According to Dr. Jill Stoddard, author of “Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, and Stress Using Mindfulness and Acceptance,” other obsessions include:
- intrusive and unwanted sexual thoughts
- fear of harming oneself or someone else
- fear of acting impulsively (like blurting out a curse word during a moment of silence). These involve compulsions like checking, counting, praying, and repeating, and can also involve avoidance (different from compulsions) like avoiding sharp objects.
OCD in children
OCD usually develops in children within two age ranges: middle childhood (8–12 years) and between late adolescence and emerging adulthood (18–25 years), says Dr. Steve Mazza, a clinical postdoctoral fellow at the Columbia University Clinic for Anxiety and Related Disorders.
“Girls tend to develop OCD at an older age than boys,” says Mazza. “Although there is a higher rate of OCD in boys than girls during childhood, there are equal rates of OCD between adult men and women.”
OCPD vs OCD
While the names are similar, obsessive-compulsive personality disorder (OCPD) and OCD are very different conditions.
OCD typically involves obsessions that are followed by compulsive behaviors. OCPD describes a set of personality traits that can often interfere with a person’s relationships.
OCPD is characterized by an extreme need for orderliness, perfection, and control, including within interpersonal relationships, says Mazza. Whereas OCD is usually confined to a set of obsessive thoughts and related compulsions.
“People [who have] OCD are more likely to seek help because they are distressed or disturbed by the symptoms,” he says. “People with OCPD may not see their characterological rigidity and need for perfection as problematic, despite its destructive effects on their relationships and well-being.”
OCD diagnosis
OCD is diagnosed by a mental health professional using a semi-structured interview process, according to Mazza.
One of the most widely used instruments is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which assesses for a variety of the most common obsessions and compulsions, as well as the degree to which OCD symptoms cause a person distress and interfere with their functioning.
Risk factors
Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:
- Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.
- Stressful life events. If you’ve experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.
- Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.
Complications
Problems resulting from obsessive-compulsive disorder may include, among others:
- Excessive time spent engaging in ritualistic behaviors
- Health issues, such as contact dermatitis from frequent hand-washing
- Difficulty attending work, school or social activities
- Troubled relationships
- Overall poor quality of life
- Suicidal thoughts and behavior
Prevention
There’s no sure way to prevent obsessive-compulsive disorder. However, getting treatment as soon as possible may help prevent OCD from worsening and disrupting activities and your daily routine.
Treatment
A typical treatment plan for OCD will usually include both psychotherapy and medications. Combining both treatments is usually the most effective.
Medication
Antidepressants are prescribed to help lessen symptoms of OCD.
A selective serotonin reuptake inhibitor (SSRI) is an antidepressant that’s used to reduce obsessive behaviors and compulsions.
Therapy
Talk therapy with a mental health professional can help to provide you with tools that allow changes in thought and behavior patterns.
Cognitive behavior therapy (CBT) and exposure and response therapy are types of talk therapy that are effective for many people.
Exposure and response prevention (ERP) is aimed at allowing a person with OCD to deal with the anxiety associated with obsessive thoughts in other ways, rather than engaging in the compulsive behavior.
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