Obsessive-compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don’t make sense, they are often unable to stop them.

Symptoms typically begin during childhood, the teenage years or young adulthood, although males often develop them at a younger age than females. 1.2% of U.S. adults experience OCD each year.

Symptoms

Most people have occasional obsessive thoughts or compulsive behaviors. In an obsessive-compulsive disorder, however, these symptoms generally last more than an hour each day and interfere with daily life.

Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them.

Examples of obsessions include:

• Thoughts about harming or having harmed someone
• Doubts about having done something right, like turning off the stove or locking a door
• Unpleasant sexual images
• Fears of saying or shouting inappropriate things in public

Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don’t make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety.

Examples of compulsions include:

• Hand washing due to a fear of germs
• Counting and recounting money because a person is can’t be sure they added correctly
• Checking to see if a door is locked or the stove is off
• “Mental checking” that goes with intrusive thoughts is also a form of compulsion

Causes

The exact cause of obsessive-compulsive disorder is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these 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 be very important. If you, your parent or a sibling, have obsessive-compulsive disorder, there’s around a 25% chance that another immediate family member will have it.

Diagnosis

A doctor or mental health care professional will make a diagnosis of OCD. A general physical with blood tests is recommended to make sure the symptoms are not caused by illicit drugs, medications, another mental illness, or by a general medical condition. The sudden appearance of symptoms in children or older people merits a thorough medical evaluation to ensure that another illness is not causing of these symptoms.

To be diagnosed with OCD, a person must have must have:

• Obsessions, compulsions or both
• Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day

Treatment

A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.

• Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.
• Psychotherapy is also helpful in relieving obsessions and compulsions. In particular, cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.

Though OCD cannot be cured, it can be treated effectively. Read more on our treatment page.

Related Conditions

There are related conditions that share some characteristics with OCD but are considered separate conditions.

• Body Dysmorphic Disorder. This disorder is characterized by an obsession with physical appearance. Unlike simple vanity, BDD is characterized by obsessing over one’s appearance and body image, often for many hours a day. Any perceived flaws cause significant distress and ultimately impede on the person’s ability to function. In some extreme cases, BDD can lead to bodily injury either due to infection because of skin picking, excessive exercise, or from having unnecessary surgical procedures to change one’s appearance.
• Hoarding Disorder. This disorder is defined by the drive to collect a large amount of useless or valueless items, coupled with extreme distress at the idea of throwing anything away. Over time, this situation can render a space unhealthy or dangerous to be in. Hoarding disorder can negatively impact someone emotionally, physically, socially and financially, and often leads to distress and disability. In addition, many hoarders cannot see that their actions are potentially harmful, and so may resist diagnosis or treatment.
• Trichotillomania. Many people develop unhealthy habits such as nail biting or teeth grinding, especially during periods of high stress. Trichotillomania, however, is the compulsive urge to pull out (and possibly eat) your own hair, including eyelashes and eyebrows. Some people may consciously pull out their hair, while others may not even be aware that they are doing it. Trichotillomania can create serious injuries, such as repetitive motion injury in the arm or hand, or, if the hair is repeatedly swallowed, the formation of hairballs in the stomach, which can be life threatening if left untreated. A similar illness is excoriation disorder, which is the compulsive urge to scratch or pick at the skin.

For many, a combination of medicine and therapy is superior to either approach alone. While medicine may work directly on the brain, the therapies are believed help to retrain the brain to recognize “false threats.”

Psychotherapy

There are two types of psychotherapies that are helpful for treating OCD:

• Exposure and response therapy exposes a person to the cause of their anxiety. For example, a person with a fear of germs may be asked by a doctor or therapist to put their hand on something considered dirty, such as a doorknob. Afterwards, they will refrain from washing their hands. The length of time between touching the doorknob and washing hands becomes longer and longer. Ultimately, when the person realizes that not washing right away does not cause a deadly reaction, the compulsion to wash fades.
• Cognitive behavioral therapy focuses on the thoughts that are causing distress, and changing the negative thinking and behavior associated them. For obsessive-compulsive disorder, the goal of this therapy is to recognize negative thoughts and, with practice, gradually lessen their intensity to the point of harmlessness.

Medication

The most common type of medication used to treat OCD are antidepressants. Treating OCD with antidepressants often takes longer to take effect than treating depression. Also, these medicines must sometimes be given in larger doses and for a longer period of time than for depression.

Complementary Health Approaches

Aerobic exercise is a key complimentary intervention that can work to improve the quality of life for people with OCD. Exercise can work to naturally reduce the baseline level of anxiety a person experiences.

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