Obsessive-Compulsive Disorder

What Is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a mental health condition in which people experience recurring, persistent, and unwanted thoughts, drives, or mental images. The unwanted thoughts experienced by people with OCD are referred to as obsessions, and these obsessions lead a person to perform repetitive behaviors, which are called compulsions.

People with OCD feel compelled to perform compulsive behaviors in an attempt to ease their worries. Attempts to dismiss or erase the disruptive thoughts and urges often take place without success, leading to compulsive behaviors. This is the cycle of OCD that causes notable distress to people suffering from it.OCD obsessions may involve worries of being contaminated by germs or performing socially unacceptable acts.

The DSM-5 characterizes OCD under the category titled “obsessive-compulsive and related disorders.” This category also includes conditions, including:

• Hoarding disorder
• Trichotillomania (compulsive pulling out the hair)
• Body dysmorphic disorder (BDD)
• Excoriating (compulsive skin-picking) disorder
• Medication- or substance-induced obsessive-compulsive disorder
• Other specified obsessive-compulsive disorder
• Unspecified obsessive-compulsive disorder

Stigma Surrounding OCD

Many people experience OCD, and it is not something to be ashamed or embarrassed of. In popular culture, people often use the phrase OCD (such as, “I’m so OCD”) in ways that are highly inaccurate and can be hurtful to those suffering from the condition. They might use these phrases to describe someone who likes things very clean or organized or is worried about germs.

In reality, OCD is a serious condition that causes significant impairment and distress. Understanding the realities of OCD may help discourage people from using the phrase “OCD” in flippant and harmful ways.

Who Does OCD Affect?

OCD usually starts in childhood, adolescence, or the early adult years. During adulthood, females experience OCD at slightly greater rates than others do. Conversely, males experience OCD more often during childhood.

According to the DSM-5, OCD is often experienced by people with other comorbid mental health disorders such as depression, anxiety disorders, PTSD, bipolar disorder, and eating disorders. As many as 30% of people living with OCD also have a diagnosable tic disorder. According to the National Library of Medicine, 90% of people with OCD have another diagnosable mental health condition. These can also include impulse control disorders and substance abuse disorders.

People with OCD can fall on a spectrum regarding their level of insight into their mental health condition. A person with poor insight might see their obsessive thoughts as being true or possibly true^, while someone with good insight will often understand that their OCD-related obsessions are untrue and that their compulsions are not helping them.

OCD symptoms can vary as time passes, while the disorder itself can go on for years, decades, or a lifetime, especially if treatment is not received.

How Common Is Obsessive-Compulsive Disorder (OCD)?

According to the DSM-5, the prevalence of OCD in the U.S. is 1.2% in any given 12-month period. Other estimates show that between 2% and 3% of U.S. residents suffer from OCD during their lifetimes.

The DSM-5 indicates an international prevalence of 1.1% – 1.8%, while a 2024 study published by the National Library of Medicine states that between 1% and 3% of people have the condition.

What Are The Symptoms Of OCD?

Obsessive-compulsive disorder symptoms involve both obsessions and compulsions. The unwanted thoughts that characterize OCD obsessions are recurring and intrusive and can involve drives or mental images that produce worry and distress in a person with the condition. The obsessions often continue to occur despite a person trying to dismiss them by ignoring them or replacing them with other thoughts.

Obsessions can include many themes, including:

• Fear of dirt or germs and resulting contamination
• Aggressive, violent, or scary thoughts about harming oneself or other people
• Insisting that things be kept clean, organized, or symmetrical
• Having persistent doubts or fear about uncertainties

OCD symptoms of obsession delineated in the DSM-5 include:

• Doubts that important or seemingly important acts have been conducted, such as locking doors or shutting off things such as lights, the oven, or the stove
• Worries about being contaminated or becoming sick from having contact with things others have touched
• Feeling unbearable anxiety when things are not cleaned, organized, symmetrical, or facing a specific direction
• Fear of causing injury to others by hurting them (such as driving your car into a person or a crowd)
• Worries about behaving inappropriately in front of other people
• Distressing mental images of a religious or sexual nature
• Avoiding situations or acts that could cause the above obsessions, such as hugging or shaking hands

Compulsions seen in OCD are repetitive and distressing behaviors that a person with the condition feels compelled to perform. These behaviors can be mental or physical and are conducted in response to the obsessions and in an attempt to stop something perceived as negative or dangerous from occurring. Acting out the compulsive behaviors is not enjoyable and provides little or limited relief from OCD-related worry.

Similar to obsessions, OCD-related compulsions can consist of numerous themes. These can include themes such as:

• Counting
• Checking
• Washing, cleaning, and sterilizing items
• Organizing and ordering things
• Following very strict routines
• Needing repeated assurance from oneself or other people

OCD compulsions listed in the DSM-5 include the following:

• Washing hands or other body parts until the skin is red, raw, or irritated
• Counting in specific patterns
• Checking things repeatedly
• Repeating words, phrases, or prayers (silently or aloud)
• Trying to replace thoughts perceived as negative with others seen as positive
• Arranging items, such as clothing or food, alphabetically or in the same direction

OCD-related mental obsessions and behavioral compulsions can vary. They usually worsen over time and can increase during times of change or significant distress. Without mental health treatment, OCD can be debilitating. Symptoms can vary from mild to severe to the point that they take up a large percentage of a person’s day and cause extreme distress and impairment.

What Is The Difference Between OCD And OCPD?

OCD is not the same thing as obsessive-compulsive personality disorder (OCPD), the latter of which is one of the ten personality disorders listed in the DSM-5. Unlike OCD, OCPD (and all other personality disorders) can only be diagnosed in people aged 18 and up, as personalities are not developed before this point. Diagnosis of personality disorders requires professionals to look at long-term symptoms and levels of functioning in a person. Also, in contrast to OCD, a person with OCPD may not be aware that they have a mental health problem.

OCPD is characterized by a personality-wide pattern of preoccupation with things such as perfection, control, and organization or orderliness. Someone with OCPD may spend excessive time at work, be highly focused on details, exhibit moral intractability, and not give themselves time to socialize or have fun. In contrast to OCD, these qualities are pervasive over time and throughout their entire personalities. OCPD is characterized by long-term behavior and interpersonal experiences that vary greatly from what is typically expected in a person’s culture.

Also, in contrast to OCD, OCPD and other personality disorders are long-lasting, as personalities generally do not change over time.There are no specific pharmaceutical remedies for OCPD.

What Causes OCD?

There is not a single known cause for OCD, but several factors are thought to play a role in its development.

Genetics

Genetics can be a major factor, as OCD is known to run in families. Having a parent or sibling with it increases a person’s risk of developing OCD. Genetics also plays a larger role when symptoms start during childhood. However, a single gene or set of genes has not been implicated in the development of OCD, and research in this area is ongoing.

Your Brain Structure

Brain structure is another related factor. People with OCD have differences in the function and structure of their brains. This is especially true in areas of the brain that regulate impulse control, decision-making, and the experiencing of emotions. These areas include the frontal cortex and the brain’s subcortical structures.

Your Temperament

The temperament of a person can also be a causal factor. According to the National Institute of Mental Health, OCD is more likely to develop in those who exhibit excessively reserved behaviors, experience more negative emotions than most people, and go through depression and anxiety during childhood.

Life Experiences

Life events of a stressful and traumatic nature are thought to trigger and exacerbate OCD in many people. It is thought that these factors may be more significant in females with the condition. Trauma experienced during childhood may be especially relevant when it comes to experiencing symptoms of OCD.

How Is OCD Diagnosed?

OCD is diagnosed based on a person’s history of experiencing obsessions and compulsions as described in the DSM’s characterization of obsessive-compulsive disorder. Obsessions or compulsions must be present for OCD to be diagnosed. The thoughts and behaviors must be time-consuming and notably interfere with daily life and functioning.

Receiving a diagnosis begins by seeing a qualified healthcare provider who will check for existing medical and psychiatric conditions. This can include therapists, psychologists, psychiatrists, and other mental healthcare providers.

Other psychiatric conditions must also be ruled out before OCD can be accurately diagnosed. There is not a single test used to diagnose OCD, so clients or patients are examined by having their current symptoms and history of symptoms examined by using criteria in the DSM-5.

Healthcare professionals will conduct a structured clinical intake assessment to assess for related symptoms. Different standardized tests may utilized to evaluate family history, medical and psychiatric issues, as well as the presence of any problems concerning  the use of substances such as alcohol or drugs.

How Is OCD Treated?

Treatment for OCD focuses on teaching a person healthy ways of thinking and how to reduce related symptoms that are interfering with daily life. Effective treatments include psychotherapy, brain stimulation therapies, and medication.

Over 50% of people who receive treatment for OCD achieve a significant decrease in symptoms or even a life experiencing no OCD symptoms.

Psychotherapy

Obsessive-compulsive disorder treatment typically involves a combination of psychotherapy and medication. The type of therapy proven to be most successful in treating OCD is cognitive-behavioral therapy (CBT).

CBT is a form of mental and behavioral health therapy that helps people recognize their harmful or maladaptive patterns of thinking so they can more clearly see and react to OCD-triggering situations. It helps teach patients to see and question these thoughts, see how they influence their feelings and subsequent actions, and change upsetting or destructive patterns of behavior. CBT is best used in treating OCD when it is customized to the specific individual.

Exposure and response prevention (ERP), which is a specific type of CBT, has been shown to successfully treat OCD. ERP therapy involves gradually exposing a person over time to objects or elements of their obsessions. After this, they are assisted in learning how to replace compulsive behaviors with healthy ones that lower their levels of anxiety.

Meditation and related techniques involving mindfulness can help a patient to see and understand their obsessions more clearly and help to adjust or alleviate them.

Brain Stimulation Therapy

Neurosurgery is less common but is also an option for people experiencing symptoms that are not adequately treated by other means. It is reserved for OCD patients with highly treatment-resistant symptoms.Neurosurgery conducted for OCD is called deep brain stimulation (DBS). This procedure involves using electricity to stimulate specific areas of the brain. Research regarding using DBS to treat severe OCD continues to be conducted.

One other FDA-approved therapy involves repetitive transcranial magnetic stimulation (also known as rTMS) alongside medication and therapy for people whose severe OCD has not responded to other methods of formal treatment. This noninvasive form of therapy is most often used in the treatment of depression. It involves the use of a magnet to administer recurrent low-intensity impulses to specific parts of the brain to help stimulate them.

Getting diagnosed at an early age and receiving treatment sooner than later can help a person both alleviate their symptoms and keep them from getting worse as time passes. By getting help and following an assigned treatment plan from a professional, symptoms can be decreased and the possibility of reaching remission from OCD improved significantly.Children and adolescents with OCD may be notably helped by receiving support from loved ones such as family members in addition to help from healthcare providers.

Medication For OCD

The psychotropic medication shown to best treat OCD is an selective serotonin reuptake inhibitor (SSRI). SSRIs are antidepressants that help to treat OCD by increasing serotonin levels in a person. An increase in serotonin helps by improving mood, sleep patterns, and other functions.

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Treatment with SSRIs may take eight to twelve weeks before amelioration of symptoms is seen. Additionally, OCD treatment often requires higher medication doses than those used for treating clinical depression. Side effects may be experienced, although some only last for a short period and can be managed or stopped by adjusting the medication dosage. Healthcare providers should be used to monitor patients’ health while they are being treated and should always be consulted before any medication is discontinued.

When Should I See My Healthcare Provider?

When obsessions and compulsions are experienced to the point that they are affecting someone’s quality of life and taking up a significant part of their day, it is time to see a healthcare provider to see if you are experiencing OCD. Symptoms can take a toll mentally, physically, and even financially.

Contact your healthcare provider today to learn more about your options for treating OCD.