What Is Obsessive-Compulsive Disorder (OCD)? Symptoms, Causes, Diagnosis, and Treatment

Obsessive-compulsive disorder is a condition in which you have recurrent obsessions (thoughts, urges, or mental images) that you can’t control, or compulsions (behaviors or thoughts) that you feel compelled to repeat over and over. (1) These obsessions and compulsions can have a disruptive effect on your daily life, including work, school, and personal relationships.

However, having OCD doesn’t mean that your brain is beyond help, says Jonathan Abramowitz, PhD, a professor of clinical psychology at the University of North Carolina in Chapel Hill and founding editor of the Journal of Obsessive-Compulsive and Related Disorders.

“Actually, everyone has unwanted thoughts, and everyone has anxiety sometimes,” he explains. “The whole idea of really overcoming OCD is learning that you can tolerate these experiences, and they don’t have to stop you from doing what’s important in your life. When you stop fighting anxiety and obsessions, that’s ironically when the anxiety and obsessions stop bullying you.”

People who have obsessive-compulsive disorder may have obsessions, compulsions, or both. (1) Symptoms can be mild, moderate, or severe, and usually get worse during times of stress.

Common obsessions include:

• Excessive fear of germs or contamination
• Unwanted, forbidden, or taboo thoughts about sex, religion, or harm
• Thoughts about harming yourself or others, even though you have no real desire to do so
• A need to have things in perfect order or symmetry

Common compulsions include:

• Excessively cleaning or washing your hands
• Ordering or arranging items in a specific way
• Repeatedly checking on certain things, such as making sure the oven is turned off
• Trying to think only “acceptable” thoughts
• Compulsively counting

Additionally, a person who has OCD typically:

• Can’t control their thoughts or behaviors
• Spends at least one hour each day on these uncontrollable thoughts or behaviors
• Doesn’t get pleasure from the behaviors or rituals, but may feel a fleeting sense of relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to their obsessive thoughts or compulsive behaviors

Some people who have OCD also have a tic disorder featuring motor tics or vocal tics. Motor tics are sudden, brief, repetitive movements, such as blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common examples of vocal tics include repetitive throat-clearing, sniffing, or grunting.

Scientists still don’t know the exact causes of OCD. But the following risk factors might contribute to the condition. (1)

• Genetics OCD sometimes runs in families. You have a higher risk of developing OCD if you have a parent, sibling, or child with the disorder. Your risk is higher if your relative developed OCD as a child or teenager.
• Brain Structure Researchers are still trying to understand the connection between OCD symptoms and differences in certain areas of the brain. Imaging studies have shown average differences in the frontal cortex and subcortical structures of the brain among people who have OCD compared to people who don’t have OCD.
• Early Childhood Trauma Some studies have found a link between childhood trauma and OCD symptoms, although many people with OCD never experienced significant childhood trauma.
• Childhood Streptococcal Infections Streptococcal infections can sometimes cause children to develop OCD or OCD symptoms known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.

Your healthcare provider may use a variety of methods to determine whether you have OCD. (2) These include:

• Psychological Evaluation Your doctor will want you to share your thoughts, feelings, symptoms, and behavior patterns so they can determine whether your obsessions or compulsive behaviors are interfering with your quality of life.
• Physical Exam Your doctor may examine you to make sure that you don’t have another health problem that could be causing your symptoms.
• Diagnostic Criteria for OCD Your doctor may see if you meet the criteria for OCD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Prognosis of OCD

OCD symptoms typically come on gradually and fluctuate in severity over the course of a lifetime. (3) Your obsessions and compulsions can also change over time.

Most people who have OCD respond to treatment, but many continue to experience symptoms. (1)

OCD is typically considered a lifelong disorder. (3) Symptoms may come and go, improve over time, or worsen. (1)

OCD is typically treated with medication, psychotherapy, or both. (1)

Psychotherapy

Research shows that a type of cognitive behavior therapy (CBT) called Exposure and Response Prevention (ERP), or spending time in the situation that triggers your compulsions (such as touching dirty objects) but then not performing the usual resulting compulsion (such as hand-washing), effectively reduces compulsive behaviors in OCD.

Noah Clyman, a licensed clinical social worker and the director of NYC Cognitive Therapy, a private psychotherapy practice in New York City, says that exposure therapy can help people who have OCD find a way to understand and then relinquish the habits that disrupt their daily lives.

“I tell patients that when they confront situations that cause them distress, and they stay in the situation for long enough without escaping or doing rituals, they’ll learn several things,” he says. “They’ll learn that the anxiety does not last forever. In fact, it decreases even without escaping, avoiding, or ritualizing. Also, they’ll find out that as their anxiety decreases, their urge to ritualize and to escape from the situation also decreases.”

Medication Options

Although therapy is the treatment of choice for OCD, some people who have a severe form, or do not respond to therapy, may use medications to help with the disorder. Medications used to treat OCD include:

• Serotonin Reuptake Inhibitors (SRIs) Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms.
• Antipsychotic Medication If your symptoms don’t improve with SRIs, research shows that some people who have OCD may find some relief with an antipsychotic medication.

However, research suggests that medications for OCD are only partially effective. “Cognitive behavioral therapy, using the techniques of Exposure and Response Prevention, have the best and most consistent research support for OCD,” says Dr. Abramowitz.

Alternative and Complementary Therapies

The FDA approved transcranial magnetic stimulation (TMS) in 2018 as a supplementary treatment for OCD in adults. (1) TMS is a noninvasive procedure in which an electromagnetic coil is placed against your scalp near your forehead. (2) The electromagnet uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of OCD. The FDA approved a device, BrainsWay Deep Transcranial Magnetic Stimulation, to treat OCD in adults when traditional treatments have not been effective.

Deep brain stimulation (DBS) may help the 10 percent of people who have treatment-resistant OCD. (4) DBS is approved by the FDA to treat OCD in adults who don’t respond to traditional treatment methods. (2) With DBS, electrodes are implanted within certain areas of the brain. These electrodes produce electrical impulses that may help regulate abnormal impulses.

There’s no way to prevent obsessive-compulsive disorder. (3) However, getting treatment as soon as you can may help prevent your symptoms from getting worse.

People with OCD may use alcohol or drugs to calm themselves. (2)

Other complications include: (1)

• Anxiety
• Depression
• Career difficulties
• Relationship difficulties

Additional complications include: (3)

• Spending an abundance of time on compulsive behaviors
• Health issues, such as contact dermatitis from too much hand-washing
• Difficulty going to work, school, or social activities
• Poor quality of life
• Suicidal thoughts and behavior

OCD equally affects men, women, and children of all races, ethnicities, and socioeconomic backgrounds. (5) In the United States, about 1 in 40 adults (about 2.3 percent of the population) and 1 in 100 children have the condition.

OCD usually manifests in the teen or young adult years, but it can begin as early as childhood. (3) Most people are diagnosed by about age 19, and boys usually have an earlier age of onset than girls. (1)

Members of certain Black, Indigenous, and People of Color (BIPOC) populations are more likely to be undertreated for OCD, according to a study published in 2020. (6) The study found that nonminorities were more likely to receive counseling (2.09 times), Exposure and Response Prevention (1.86 times), and to be taking medications (1.51 times) than ethnic minorities, who were twice as likely to have never taken medication.

The study also underscores the need for more education and psychological and psychiatric services that are easily accessible to BIPOC who have OCD.

OCD and Black Americans

Another study looked at symptoms of OCD in Black Americans, and found that racial discrimination seems to exacerbate all types of obsessions and compulsions, even among individuals who may not meet the criteria for a formal OCD diagnosis. (7)

OCD may occur along with other mental health disorders, such as anxiety disorders, depression, substance abuse, or tic disorders. (3)

Body dysmorphic disorder, in which you mistakenly believe that a part of your body is abnormal, also sometimes occurs with OCD. (1)

RELATED: What Is Anxiety? Symptoms, Causes, Diagnosis, Treatment, and Prevention

National Institute of Mental Health (NIMH)

The NIMH is the lead federal agency for research on mental disorders and part of the National Institutes of Health (NIH), the largest biomedical research agency in the world. Their website offers information about the signs and symptoms of obsessive-compulsive disorder, along with risk factors, treatment, and more information.

The Mayo Clinic

The Mayo Clinic is a nonprofit organization that specializes in clinical practice, education, and research. Its website offers information about symptoms, causes, risk factors, diagnosis, and treatment of obsessive-compulsive disorder.

Beyond OCD

Beyond OCD is a new organization that aims to raise awareness of obsessive-compulsive disorder, and to pursue further education and support for people affected by the condition. Their website offers information about causes, diagnosis, and treatment of OCD.

Additional reporting by Carlene Bauer.