Obsessive-Compulsive Disorder (OCD)

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition in which a person experiences obsessions, compulsions, or both. Obsessions are repeated, unwanted thoughts, images or urges that cause anxiety or distress. Compulsions are repetitive behaviors or mental acts that a person feels driven to perform to reduce that distress or prevent a feared outcome.

Symptoms

Common obsession themes include fear of contamination, fear of causing harm, a need for order or symmetry, and unwanted taboo thoughts. Common compulsions include excessive cleaning or handwashing, checking, counting, repeating actions, arranging, and seeking reassurance.

These symptoms can occur with OCD, but only a qualified healthcare professional can provide a diagnosis.

Causes and risk factors

The causes of OCD aren’t fully understood. Genetics, differences in brain circuits, and stressful or traumatic life events may all play a role. OCD often begins in childhood, adolescence or early adulthood, and it can run in families.

Diagnosis

A clinician diagnoses OCD through a clinical interview, often using structured questionnaires, and by ruling out other explanations. OCD commonly occurs alongside anxiety disorders, depression and tic disorders.

Treatment

• Exposure and response prevention (ERP): a type of CBT in which you gradually face feared thoughts or situations while resisting compulsions. ERP has strong research support. Learn more about exposure therapy.
• Medication: selective serotonin reuptake inhibitors (SSRIs) are commonly used, sometimes at different doses than for depression, as determined by a prescriber.
• Combination: many people benefit from therapy and medication together.

ERP can be done by video. If you use an online service such as BetterHelp or Sesame, look for a therapist who lists ERP or OCD specifically.

Common themes in OCD

OCD can take many forms, and the content of obsessions often targets what matters most to a person, which is part of why it is so distressing. Common themes include:

• Contamination: fear of germs, dirt or illness, with washing or cleaning compulsions.
• Harm: unwanted thoughts of accidentally or deliberately harming oneself or others, with checking or reassurance-seeking.
• Symmetry and order: a need for things to be “just right,” with arranging or repeating.
• Unwanted taboo thoughts, including sexual, religious or violent thoughts that go against a person’s values.
• Relationship or identity doubts, with constant questioning and seeking certainty.

Compulsions can be visible, such as washing or checking, or mental, such as counting, praying, reviewing events or silently repeating phrases. Some people mainly experience mental compulsions, sometimes called “pure O,” although compulsions are present even if not visible.

Intrusive thoughts versus OCD

Almost everyone has odd or unwelcome thoughts at times. What distinguishes OCD is how much distress they cause, how much time they take, and the cycle of compulsions or avoidance that people use to relieve distress. Trying to push thoughts away, check or seek reassurance gives short-term relief but strengthens the cycle in the long run. Having a violent or taboo thought doesn’t mean you want to act on it, and people with OCD are typically very concerned about acting against their values. A clinician can help you tell the difference. Only a qualified healthcare professional can provide a diagnosis.

How OCD is treated

OCD is treatable. The most effective psychological treatment is a form of CBT called exposure and response prevention (ERP). In ERP, you gradually face feared situations or thoughts, with guidance, and resist the urge to perform compulsions, so you learn that anxiety fades and that feared outcomes either do not happen or can be tolerated. See exposure therapy for how this works. Medication, particularly SSRIs, can also help, sometimes with a longer trial than for depression, and is chosen and monitored with a prescriber; see antidepressants. Many people benefit from both. For severe, treatment-resistant OCD, specialist options exist.

Living with OCD

• Seek a therapist trained in ERP; not every therapist is, and general talk therapy that offers reassurance can unintentionally worsen OCD.
• Try to reduce reassurance-seeking, and ask loved ones to respond with supportive but non-reassuring statements, as agreed with your therapist.
• Expect that treatment is hard work, and that progress may be uneven.
• Take care of sleep, stress and alcohol or drug use, which can worsen symptoms.
• Connect with others through support organizations.

Supporting someone with OCD

Learn about the condition, avoid criticism or telling them to “just stop,” and talk with them about how you can help without taking part in compulsions, such as providing endless reassurance. Encourage professional help, and be patient: recovery takes time.

When to seek help

Consider seeking help if obsessions and compulsions take up an hour or more a day, cause distress or interfere with work, relationships or daily life. Seek urgent help if you have thoughts of harming yourself; see Get Help Now. OCD often occurs with anxiety and depression, and these can be treated at the same time.

Self-care

Learning about OCD can reduce shame. Try to notice reassurance-seeking and avoidance, since these can keep the cycle going. Support groups and involving trusted family members in treatment can also help.