Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is listed in the category of “obsessive-compulsive and related disorders” in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This is a change from the DSM-IV, which included obsessive-compulsive disorder in the category of “anxiety disorders”. OCD is still widely considered an anxiety disorder due to the worry and nervousness that accompany obsessions and compulsions.

Because obsessive-compulsive disorder is a mental health condition that involves a cycle of thoughts, obsessions, and compulsions, it may be helpful to break the symptoms of the condition down into these specific categories. 

Obsessions

People with obsessive-compulsive disorder often experience repetitive thoughts, impulses, or mental images that cause distress, worry, and fear. According to the Diagnostic and Statistical Manual of Mental Disorders, obsessions are “intrusive” and “unwanted”. These obsessive thoughts can be distracting and time-consuming, preventing individuals from partaking in activities they need or want to do. Examples of common obsessions in OCD include the following:

• Contamination obsessions: These obsessions may include fear of germs, dirt, body fluids, household cleaners, and environmental contaminants like mold or radiation. Contamination may also be related to a situation or element that other people don’t normally consider a form of contamination, such as taking baths or eating certain foods. 
• Sexual obsessions: Sexual obsessions can include intrusive or unwanted thoughts related to the fear of acting on a sexual impulse, harming children or relatives sexually, or engaging in sexually aggressive behaviors.
• Violent obsessions: These obsessions may lead people to have repetitive fearful thoughts about harming themselves or others. 
• Religious or moral obsessions: These obsessions often involve fear of damnation, upsetting God, going against one’s religion, or not being a moral person.
• Identity obsessions: Identity obsessions can involve unwanted thoughts about gender identity or sexuality.
• Perfectionism obsessions: Perfectionism can involve concerns about evenness and symmetry or the fear of making mistakes, forgetting, or performing inadequately. 
• Responsibility obsessions: Responsibility obsessions may involve a fear of hurting someone else due to carelessness or fear of being responsible for a catastrophic event (such as a car accident or fire). 

While the above obsessions are among the most common in people with OCD, there are other obsessions that people experience.

Compulsions

For people with obsessive-compulsive disorder, compulsions are actions or behaviors that follow obsessive thoughts and are extremely difficult to ignore. Obsessional compulsions are often repetitive and can be ritualistic, and individuals with OCD may believe engaging in their compulsive action will get rid of obsessive thoughts or offer emotional or physical reassurance. However, engaging in compulsions following obsessive thoughts often makes the fear worse over time. 

Compulsions must be either unrelated or disproportionate to the feared harm, according to the Diagnostic and Statistical Manual of Mental Disorders. For some people, compulsive actions may be body-focused, such as picking the skin. For others, their compulsions may be centered around neatness, organization, or actions that seem unrelated to the obsession. Common compulsions may include the following:

• Cleanness-centered compulsions: These compulsions may involve washing hands excessively, bathing or grooming excessively, avoiding contact with others (who may be viewed as “dirty” or contaminated), avoiding public places for fear of germs, or constantly disinfecting surfaces, among others. 
• Mental compulsions: Mental compulsions can include counting in a specific pattern, praying repeatedly in an attempt to prevent harm from oneself or others, trying to “cancel” thoughts deemed “bad” and replace them with “good” thoughts, or excessively replaying events in the mind to prevent harm.
• “Checking” compulsions: Checking compulsions may involve leaving the house but repeatedly returning to ensure the stove is off, the door is locked, and items are unplugged from electrical outlets. They may also involve checking that your physical and mental health is “normal” or checking that you did not harm others or make a mistake. Reassurance seeking is a checking compulsion. 
• Repetitive compulsions: Repetitive compulsions may include specific body movements (tapping, touching, etc.) or multiple activities, such as locking the door four times because four is a “safe” number. 

These are a few common examples of OCD compulsions, but obsessions and compulsions can vary from person to person. According to the Diagnostic and Statistical Manual of Mental Disorders, obsessions or compulsions must take up a substantial amount of time, cause significant concern, or markedly impair functioning.

The exact cause of obsessive-compulsive disorder (OCD) is unclear, but it appears that a combination of factors can make a person more likely to develop the condition. Obsessive-compulsive disorder may be caused by one or more of the following:

• Genetic factors. Although the particular genes responsible for OCD have yet to be identified, it is possible that OCD, like other mental health conditions, has a genetic component.
• Biology. OCD may occur due to an individual’s natural hormonal changes or changes in brain chemistry. 
• Environmental factors. It is possible for individuals to “learn” OCD from a parent, caregiver, or other close family member. Observing a person with OCD over time may lead to a person developing their own obsessions and compulsions. 

Risk factors of obsessive-compulsive disorder

Risk factors⁴ for OCD may include:

• Having someone in your family who has OCD
• Having experienced trauma or many stressful life events, which can cause OCD
• Having other mental health disorders like depression, anxiety, substance use disorders, and tic disorder

Obsessive-compulsive disorder can be quite a disturbance in a person’s life. While there is no cure for obsessive-compulsive disorder (OCD), there are several treatment options that can significantly decrease the severity and occurrence of OCD symptoms. The most common treatments for OCD include therapy and medication. 

Medication

Several medications are FDA-approved to treat OCD, including clomipramine, sertraline, fluoxetine, fluvoxamine, and paroxetine. These medications, which are antidepressants, are often used first to treat OCD. If these medications don’t improve symptoms, some doctors may prescribe other specific medications off-label, which may improve OCD.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis. 

Other treatment options

For individuals who have severe OCD that impacts their ability to function on a day-to-day basis, inpatient treatment or intensive outpatient treatment can provide one-on-one care and may be valuable tools in healing.

Others may wish to try interventions like deep brain stimulation (DBS), which is an FDA-approved OCD treatment that involves implanting electrodes in the brain to correct abnormal thought patterns or urges. A noninvasive option is transcranial magnetic stimulation, which is an FDA-approved OCD treatment that stimulates nerve cells in the brain to improve OCD.

Self-care

While self-care may not be sufficient on its own to treat mental health conditions, prioritizing self-care can be a way to set yourself up for success and improve symptoms of OCD, according to the American Psychiatric Association. Some people find that getting proper sleep, eating a nutritious diet, and exercising regularly can enhance mood and outlook. Spiritual practices like prayer or meditation may be calming habits to implement into one’s self-care routine. Additionally, spending time with loved ones and partaking in activities you enjoy can be ways to practice self-care.

Resources for obsessive-compulsive disorder include therapy, support groups, and other educational and social support services. Some people with OCD may be so affected by the disorder that they struggle to leave their house. In these cases, online therapy through a platform like BetterHelp can be an option that offers similar modalities you might find in person. Experts have found that online therapy can be as effective as in-person therapy for a range of mental health conditions.

Individuals looking to learn more about OCD may be interested in checking out online resources such as the International OCD Foundation and NAMI, which provide educational content, personal stories about living with OCD, online support groups, and other support resources. The American Psychiatric Association also has informational content, including a video, on OCD and related conditions. Individuals with OCD who are interested in joining an in-person OCD support group may be able to locate local support groups by searching “OCD support group near me” or searching for local groups through the International OCD Foundation’s directory.

OCD research is ongoing, with researchers focusing on discovering information about causes, risk factors, and potential treatments for OCD. Recent studies at the University of Michigan have centered on the causes and mechanisms of OCD. Their discoveries suggest that people with OCD may have a faulty “linkage between the brain system that links their ability to recognize errors and system that governs their ability to do something about those errors.” In other words, individuals with OCD know that their actions are harmful to themselves or illogical but may be unable to easily break free of OCD patterns due to differences in their brains. This information can be crucial since understanding the way OCD works is a fundamental part of treating the condition.

There are various advancements in treatment methods for OCD. One particularly promising treatment is deep brain stimulation. The DBS method works by using implanted electrodes to zap areas of the brain with electrical pulses, affecting emotions and decision-making and potentially improving OCD symptoms. Research indicates that nearly two-thirds of individuals with severe-to-extreme OCD experienced a significant improvement in their symptoms following DBS. 

DBS may also improve other mental health conditions, such as depression, according to the same study. While some people see improvement with their OCD by utilizing therapy or medication, others may find their symptoms are treatment-resistant. DBS and ongoing research into its efficacy for OCD provide hope and an alternative treatment option for those struggling with the disorder.

Below are several statistics on OCD:

• An estimated 1.2% of adults living in the US had OCD in the past year.
• OCD varies in its severity. For adults in the US with OCD, 50% experience serious impairment from OCD, 34.8% experience moderate impairment, and 14.6% have mild impairment.
• 90% of people with OCD have a co-occurring mental health condition, such as depression or anxiety. 
• Therapy, particularly exposure and response prevention therapy (ERP), is proven to be an effective treatment for OCD.