Obsessive-compulsive disorder

Obsessive-compulsive disorder is a mental health condition where unwanted, intrusive thoughts drive people to perform repetitive behaviors over and over again, often consuming hours each day and interfering with normal life activities.

Table of contents

• What is obsessive-compulsive disorder
• Understanding obsessions and compulsions
• Who is affected by OCD
• What causes OCD
• How OCD is diagnosed
• Treatment options
• Living with OCD

What is obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a mental health condition in which you have frequent unwanted thoughts and sensations, called obsessions, that cause you to perform repetitive behaviors, called compulsions.^[1] These obsessions and compulsions get in the way of daily activities and cause significant distress.^[1]

OCD is more than just a personality quirk or preference. While many people use phrases like “I’m a little OCD” casually in everyday conversation, true OCD is a serious and often debilitating mental health disorder that can consume hours of a person’s day.^[3] In order for a diagnosis of OCD to be made, this cycle of obsessions and compulsions must be so extreme that it consumes a lot of time (more than an hour every day), causes intense distress, or gets in the way of important activities that the person values.^[3]

OCD is usually a lifelong condition, but symptoms can come and go over time.^[4] The good news is that treatment can be very effective in bringing symptoms under control.

Understanding obsessions and compulsions

The main symptoms of OCD are obsessions and compulsions that interfere with normal activities. You may know that these symptoms are beyond reason, but you can’t stop them.^[1]

What are obsessions

Obsessions are unwanted, intrusive thoughts, images, or urges that occur over and over again and cause intense anxiety or distress.^[3] These thoughts feel outside of a person’s control. People with OCD do not want to have these thoughts and find them disturbing.^[3] In most cases, people with OCD realize that these thoughts are illogical or irrational.^[4]

Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, uncertainty, doubt, or a feeling that things have to be done in a way that is “just right.”^[3] These obsessions usually intrude when you’re trying to think of or do other things.^[1]

Common examples of obsessions include:^[4]

• Fear of coming into contact with perceived contaminated substances, such as germs or dirt
• Fear of causing harm to yourself or someone else because you’re not careful enough or you’re going to act on a violent impulse
• Unwanted thoughts or mental images related to sex
• Fear of making a mistake
• Excessive concern with morality or what is “right or wrong”
• Feelings of doubt or disgust
• Need for order, neatness, symmetry or perfection
• Need for constant reassurance
• Doubting and having a hard time dealing with uncertainty
• Needing things to be orderly

What are compulsions

Compulsions are repetitive behaviors or mental acts that you feel you need to do over and over to try to reduce your anxiety or stop the obsessive thoughts.^[6] People with OCD don’t want to perform these compulsive behaviors and don’t get pleasure from them. But they feel driven to do them to ease their stress.^[4] Performing compulsive behaviors may briefly give relief from the anxiety, but the obsessions keep coming back.^[6]

Common examples of compulsions include:^[6]

• Excessive cleaning and/or handwashing
• Repeatedly checking on things, such as whether the door is locked or the oven is off
• Compulsive counting
• Ordering and arranging things in a particular, precise way

Some people with OCD also perform mental compulsions, such as silently repeating words, phrases or prayers, or counting over and over.^[7]

Who is affected by OCD

OCD can affect anyone regardless of age or gender.^[4] It affects people of all walks of life.^[3] Obsessive-compulsive disorder is relatively common, affecting 1.6% to 2.3% of the general U.S. population.^[4] An estimated 3.5 million Americans are affected by OCD, which is considered one of the top 10 leading causes of disability.^[7]

OCD usually begins when you are a teen or young adult.^[6] The average age of onset is 19 years.^[4] About 50% of people with OCD begin to have symptoms in childhood and adolescence.^[4] Boys often develop OCD at a younger age than girls.^[6] People can start having symptoms from as early as 6 years old, but it often begins around puberty and early adulthood.^[5] It’s rare for someone to develop OCD after the age of 40.^[4]

What causes OCD

It’s not clear what causes OCD. The exact cause is unknown, but factors such as genetics, brain biology and chemistry, and your environment may play a role.^[6]

A number of different factors may contribute to the development of OCD:^[5]

Family history: You’re more likely to develop OCD if a family member has it. People with a first-degree relative (such as a parent, sibling, or child) who has OCD are at higher risk, especially if the relative developed OCD as a child or teen.^[6] This may be learned behavior, or possibly because of your genes.

Differences in the brain: Imaging studies have shown that people with OCD have differences in certain parts of the brain.^[6] Some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin.^[5] Researchers need to do more studies to understand the connection between the brain differences and OCD.

Life events: OCD may be more common in people who have been bullied, abused or neglected, and it sometimes starts after an important life event, such as childbirth or a bereavement.^[5] Some studies have found a link between trauma in childhood and OCD, though more research is needed to understand this relationship better.^[6]

Personality: People who are neat, meticulous, and methodical with high personal standards may be more likely to develop OCD, as well as people who are generally quite anxious or have a very strong sense of responsibility for themselves and others.^[5]

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection. This is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).^[6]

How OCD is diagnosed

The first step is to talk with your health care provider about your symptoms.^[6] Steps to help diagnose obsessive-compulsive disorder may include:^[8]

Psychological evaluation: This includes talking about your thoughts, feelings, symptoms and behavior patterns to find out if you have obsessions or compulsive behaviors that get in the way of your quality of life. With your permission, this may include talking to your family or friends.^[8]

Physical exam: This may be done to rule out other issues that could cause your symptoms and check for any related complications.^[8] It’s important to check whether a physical problem is causing your symptoms. So your provider will do a physical exam and will ask you about your medical history.^[6]

If your symptoms do not seem to be caused by a physical problem, your provider may do an OCD test or may refer you to a mental health specialist for further evaluation or treatment.^[6]

Obsessive-compulsive disorder can sometimes be hard to diagnose. Its symptoms are like those of other mental disorders, such as anxiety disorders, depression, schizophrenia or other mental health disorders.^[8] It is also possible to have both OCD and another mental disorder.^[6]

Not everyone who has obsessions or compulsions has OCD. Your symptoms would usually be considered OCD when you:^[6]

• Can’t control your thoughts or behaviors, even when you know that they are excessive
• Spend at least 1 hour a day on these thoughts or behaviors
• Don’t get pleasure when performing the behaviors, although doing them may briefly give you relief from the anxiety
• Have significant problems in your daily life because of these thoughts and behaviors

Treatment options

There are effective treatments for OCD that can help reduce the impact it has on your life. Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don’t rule your daily life.^[8] The sooner OCD is diagnosed and treated, the better the outlook.^[4] Depending on how serious your OCD is, you may need long-term, ongoing or more-intensive treatment.^[8]

The two main treatments for OCD are talking therapy and medicine. Often, a mix of both treatments is most effective.^[8]

Talking therapy

The main type of therapy recommended for OCD is cognitive behavioral therapy (CBT), specifically a type called exposure and response prevention (ERP).^[9] ERP is the proven, most effective, first-line therapy for OCD in adults, children, and adolescents.^[11]

This therapy involves:^[9]

• Working with your therapist to break down your problems into their separate parts, such as your thoughts, physical feelings and actions
• Encouraging you to face your fears and have obsessive thoughts without neutralizing them with compulsive behaviors
• Starting with situations that cause the least anxiety first, before moving on to more difficult thoughts

The treatment may be hard work, but many people find that when they confront their obsessions, the anxiety eventually improves or goes away.^[9] People with fairly mild OCD usually need about 8 to 20 sessions of therapist treatment, with exercises done at home between sessions. If you have more severe OCD, you may need a longer course of treatment.^[9]

CBT will usually have an effect quite quickly. Most people will eventually benefit from this treatment.^[5]

Medicine

You may need medicine if talking therapy does not help treat your OCD, or if your OCD is fairly severe.^[9] The main medicines prescribed are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs).^[9] These are the first-line, evidence-based medications for treating OCD, because they are effective for most people with OCD and generally well tolerated.^[11]

An SSRI can help improve OCD symptoms by increasing the levels of a chemical called serotonin in your brain.^[9] You may need to take an SSRI for up to 12 weeks before you notice any benefit.^[9] It can take up to 12 weeks before you notice the effects of treatment with SSRIs, but most people will eventually benefit.^[5]

Most people need treatment for at least a year. You may be able to stop if you have few or no troublesome symptoms after this time, although some people need to take an SSRI for many years.^[9]

Do not stop taking an SSRI without speaking to your doctor first because suddenly stopping can cause unpleasant side effects.^[9] Your dose may need to be increased again if your symptoms return.

Possible side effects of SSRIs include feeling agitated, shaky or anxious; feeling or being sick; diarrhea or constipation; dizziness; sleeping problems; headaches; and changes to your sex life.^[9] There’s also a very small chance that SSRIs could cause you to have suicidal thoughts or want to self-harm. If this happens, contact a doctor or go to your nearest emergency department.^[9]

Most side effects improve after a few weeks as your body gets used to the medicine, although some can persist.^[9] Make sure you report side effects or concerns about your medication to your doctor right away so that your doctor can change your dosage or prescribe a different medication.

Other treatment options

If talking therapy and medicine are not effective, further treatment by a specialist team may sometimes be necessary.^[9] If these treatments do not help, you may be offered an alternative SSRI, a combination of an SSRI and CBT, or an antidepressant called clomipramine.^[5]

Some people with severe, long-term and difficult-to-treat OCD may be referred to a national specialist OCD service.^[9]

Living with OCD

People with OCD are sometimes reluctant to seek help because they feel ashamed or embarrassed.^[5] OCD is a health condition like any other, so there’s nothing to feel ashamed or embarrassed about. Having OCD does not mean you’re “mad” and it’s not your fault you have it.^[5]

It’s unlikely OCD will get better without proper treatment and support.^[5] If you or your child have symptoms of OCD that interfere with daily life, you should talk to a healthcare provider.^[4]

In addition to getting medical help, you might find it helps to contact a support group or other people with OCD for information and advice.^[5] Many people with OCD find support groups helpful, as they can provide reassurance and coping advice, reduce feelings of isolation, offer a chance to socialize with others, and provide information and advice for family members and friends.^[9]