OCD | BOMH

OCD

Overview

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

OCD often centers around certain themes — for example, an excessive fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped.

If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective.

Symptoms

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

Fear of contamination or dirt
Doubting and having difficulty tolerating uncertainty
Needing things orderly and symmetrical
Aggressive or horrific thoughts about losing control and harming yourself or others
Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:

Fear of being contaminated by touching objects others have touched
Doubts that you've locked the door or turned off the stove
Intense stress when objects aren't orderly or facing a certain way
Images of driving your car into a crowd of people
Thoughts about shouting obscenities or acting inappropriately in public
Unpleasant sexual images
Avoidance of situations that can trigger obsessions, such as shaking hands

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.

As with obsessions, compulsions typically have themes, such as:

Washing and cleaning
Checking
Counting
Orderliness
Following a strict routine
Demanding reassurance

Examples of compulsion signs and symptoms include:

Hand-washing until your skin becomes raw
Checking doors repeatedly to make sure they're locked
Checking the stove repeatedly to make sure it's off
Counting in certain patterns
Silently repeating a prayer, word or phrase
Arranging your canned goods to face the same way

Obsessions

Obsessions are recurrent and persistent thoughts, impulses, or images that cause distressing emotions such as anxiety, fear or disgust. Many people with OCD recognize that these are a product of their mind and that they are excessive or unreasonable. However, the distress caused by these intrusive thoughts cannot be resolved by logic or reasoning. Most people with OCD try to ease the distress of the obsessional thinking, or to undo the perceived threats, by using compulsions. They may also try to ignore or suppress the obsessions or distract themselves with other activities.

Examples of common content of obsessional thoughts:

Fear of contamination by people or the environment
Disturbing sexual thoughts or images
Religious, often blasphemous, thoughts or fears
Fear of perpetrating aggression or being harmed (self or loved ones)
Extreme worry something is not complete
Extreme concern with order, symmetry, or precision
Fear of losing or discarding something important
Can also be seemingly meaningless thoughts, images, sounds, words or music

Compulsions

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors typically prevent or reduce a person's distress related to an obsession temporarily, and they are then more likely to do the same in the future. Compulsions may be excessive responses that are directly related to an obsession (such as excessive hand washing due to the fear of contamination) or actions that are completely unrelated to the obsession. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

Examples of compulsions:

Excessive or ritualized hand washing, showering, brushing teeth, or toileting
Repeated cleaning of household objects
Ordering or arranging things in a particular way
Repeatedly checking locks, switches, appliances, doors, etc.
Constantly seeking approval or reassurance
Rituals related to numbers, such as counting, repeating, excessively preferencing or avoiding certain numbers
People with OCD may also avoid certain people, places, or situations that cause them distress and trigger obsessions and/or compulsions. Avoiding these things may further impair their ability to function in life and may be detrimental to other areas of mental or physical health.

Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions.
Genetics. OCD may have a genetic component, but specific genes have yet to be identified.
Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.

Risk factors

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.
Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.
Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Problems resulting from obsessive-compulsive disorder may include, among others:

Excessive time spent engaging in ritualistic behaviors
Health issues, such as contact dermatitis from frequent hand-washing
Difficulty attending work, school or social activities
Troubled relationships
Overall poor quality of life
Suicidal thoughts and behavior

Diagnosis

Steps to help diagnose obsessive-compulsive disorder may include:

Psychological evaluation. This includes discussing your thoughts, feelings, symptoms and behavior patterns to determine if you have obsessions or compulsive behaviors that interfere with your quality of life. With your permission, this may include talking to your family or friends.
Diagnostic criteria for OCD. Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.

Diagnostic challenges

It's sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it's possible to have both OCD and another mental health disorder. Work with your doctor so that you can get the appropriate diagnosis and treatment.

Treatment

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. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.