Obsessive Compulsive Disorder

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) that you feel compelled to repeat over and over, according to the National Institute of Mental Health (NIMH). (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 psychology at the University of North Carolina in Chapel Hill and the editor in chief 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." 

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Signs and Symptoms of OCD

People who have obsessive-compulsive disorder may have obsessions, compulsions, or both, according to the NIMH. 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
Aggressive thoughts about yourself or others
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
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 or compulsive thoughts or 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.

Causes and Risk Factors of OCD

Scientists still don't know the exact causes of OCD. But the following risk factors might contribute to the condition, per the NIMH.

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 abnormalities in certain areas of the brain. Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in people who have OCD.
Early Childhood Trauma Some studies have found a link between childhood trauma and OCD symptoms.
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.

How Is Obsessive-Compulsive Disorder Diagnosed?

Your healthcare provider may use a variety of methods to determine whether you have OCD, according to the Mayo Clinic. 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, according to the Mayo Clinic. Your obsessions and compulsions can also change over time.

Most people who have OCD respond to treatment, but some continue to experience symptoms.

Duration of OCD
OCD is typically considered a lifelong disorder, according to the Mayo Clinic. Symptoms may come and go, improve over time, or worsen.

Treatment and Medication Options for Obsessive Compulsive Disorder

OCD is typically treated with medication, psychotherapy, or both, according to the NIMH.

Psychotherapy
Research shows that a type of cognitive behavior therapy (CBT) called Exposure and Response Prevention (EX-RP), 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. Other related therapies, like habit reversal training, can also be effective.

When patients 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. 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. Per the NIMH, 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. TMS is a noninvasive procedure in which an electromagnetic coil is placed against your scalp near your forehead. 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 also help the 10 percent of people who have treatment-resistant OCD, according to a July 2017 study published in the journal Medicine. DBS is approved by the FDA to treat OCD in adults who don't respond to traditional treatment methods. With DBS, electrodes are implanted within certain areas of the brain. These electrodes produce electrical impulses that may help regulate abnormal impulses.

Prevention of OCD

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

Complications of OCD

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

Other complications include:

Anxiety
Depression
Career difficulties
Relationship difficulties
Additional complications include:

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

Research and Statistics: Who Has OCD?

OCD equally affects men, women, and children of all races, ethnicities, and socioeconomic backgrounds, according to Beyond OCD. 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. Most people are diagnosed by about age 19, and boys usually have an earlier age of onset than girls.

BIPOC Communities and OCD

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 February 2020 in the journal Clinical and Experimental Psychology. 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, published in 2017 in the American Journal of Orthopsychiatry, 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.

Related Conditions and Causes of OCD

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

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