Obsessive-Compulsive Disorder (OCD)

What Is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder is a mental health condition in which the person experiences intrusive, repetitive, and unwanted thoughts (obsessions) and actions (compulsions).

Many who have OCD are fully aware of their thoughts and actions; however, they cannot control or stop them.

While everyone might have certain habits or quirks that they deal with daily, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for someone to be dealing with OCD, their thoughts or actions:

• Take up at least 1 hour of the day
• Are beyond their control
• Directly interfere with daily life
• Are not enjoyable

OCD symptoms commonly begin to show up in teens and young adults, and most diagnoses occur between the ages of 18 and 25.

Symptoms of OCD

Obsessive-compulsive disorder breaks down into two main categories: thoughts (obsessions) and actions (compulsions). These obsessive thoughts and repetitive behaviors can often cause the person significant distress.

While OCD can vary from person to person, most symptoms of OCD manifest in one of four ways:

• Checking: constantly checking things such as the time, locks, and appliances
• Contamination: Having a fear of things that are not clean, including yourself
• Symmetry and order: Needing things arranged in a particular, specific way
• Ruminations and intrusive thoughts: Obsessing over specific thoughts

OCD Obsessions

Obsessions are intrusive and often irrational thoughts that regularly occur. These obsessions can often come with feelings of anxiety, shame, or disgust. They also tend to occur at inopportune times and can affect a person’s overall quality of life.

Examples of common obsessions that can appear with OCD include:

• Unpleasant or disturbing thoughts and mental images
• Fear of losing or misplacing things
• Thoughts of harming yourself or others
• Fear of contamination, germs, dirt, etc.
• Constantly questioning if you did something
• Perfectionism
• An irrational fear of saying or doing the wrong thing
• Needing things placed in a particular location or in a certain way
• Convincing yourself something is happening even with no proof or reason to believe it is

OCD Compulsions

Compulsions are acts or rituals performed for the sole purpose of attempting to relieve the symptoms that are associated with an obsession.

In many cases, these compulsive behaviors aren’t needed and are often time-consuming. People with OCD still act out the compulsion because they feel they MUST perform the behavior.

Below are some common compulsions that appear with OCD:

• Repeated hand washing, showering, brushing your teeth, etc.
• Repetitive mental acts (i.e., counting, repeating words silently)
• Constantly checking locks or appliances
• Repeated cleaning
• Ordering things in a specific order or in a particular way
• Following a strict routine even when it’s not convenient or is detrimental
• Constantly seeking approval

What Are the Risk Factors of OCD?

While there is no known cause of obsessive-compulsive disorder, medical professionals have theorized that certain factors can trigger symptoms or make them worse.

Genetics

Studies have shown that people who have a direct family member with OCD are at a much higher risk of having OCD as well. If that relative developed OCD as an adolescent or teenager, the risk becomes even more significant.

Environment

Studies have also shown a strong connection between the environment a person grows up in and developing obsessive-compulsive disorder. It is believed that children exposed to trauma and abuse, either directly or indirectly, are more likely to develop OCD.

Chemical Makeup of the Brain

Obsessive-compulsive disorder involves communication problems between the frontal cortex of the brain and the deeper subcortical area. Research has shown that people with OCD have abnormalities in these specific brain sections.

Pediatric Strep Throat or Scarlet Fever

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) can occur when tic disease or OCD appears suddenly in a child who was recently sick with strep throat or scarlet fever. Alternatively, PANDAS may also be diagnosed if OCD and/or tic syndrome symptoms worsen noticeably after a strep infection.

PANDAS typically comes on very suddenly. Notably, PANDAS is a pediatric disorder affecting children between the ages of 3 and about 12 (the onset of puberty). PANDAS does not occur in adults.

Disorders Related to OCD

There are many disorders that, while different from obsessive-compulsive disorder, share many of the same characteristics as OCD. Sometimes, these disorders might even get misdiagnosed as OCD.

Eating Disorders

Eating disorders all involve a disturbance in eating behaviors. Someone with an eating disorder will often obsess over food, whether it be the amount they are eating (anorexia) or what they are eating is doing to their body (bulimia and binge eating).

Personality Disorders

Personality disorders feature rigid and unhealthy thinking, functioning, and behavioral patterns.

There are many personality disorders, but one in particular shares many traits with OCD; it is called obsessive-compulsive personality disorder (OCPD).

Like OCD, someone with OCPD can become obsessed with orderliness, perfection, and control.

Trichotillomania

Trichotillomania is a hair-pulling disorder where the person regularly pulls their hair out to the point where they begin experiencing hair loss. They continue pulling their hair out despite repeated attempts to stop.

Similar to OCD, after pulling their hair out, they might feel a sense of relief or even gratification despite the negative impact the hair pulling has on their appearance.

Hoarding Disorder

Someone with a hoarding disorder has difficulty parting ways with possessions, even if there is no legitimate use for the item. They will often feel distressed at just the mere thought of getting rid of something they have.

If not appropriately addressed, hoarding disorder can lead to an unsafe living environment for the hoarder and anyone in the house.

Tic Disorder (Tourette’s Syndrome)

Also known as Tourette’s syndrome, tic disorder is highlighted by rapid, sudden, recurrent, and nonrhythmic movements such as blinking, sniffing, or throat-clearing. Like OCD, these actions are hard or impossible to control independently.

Post-Traumatic Stress Disorder (PTSD)

Someone with PTSD may also experience intrusive thoughts and then act in a way specifically meant to reduce their feelings of anxiety or stress as it relates to those thoughts.

Schizophrenia

OCD and schizophrenia share many similarities. Both are mental illnesses, and they are linked to abnormalities in the brain’s structure and normal functioning. Additionally, both schizophrenia and OCD can cause disruptions to a person’s everyday life.

However, the most notable difference between schizophrenia and OCD is that someone with OCD will deal with obsessions, whereas someone with schizophrenia will experience delusions (i.e., things that aren’t real or true).

OCD and Addiction

Addiction (i.e., substance use disorder) can sometimes form as a result of someone struggling to manage their OCD symptoms. They may think substance abuse will relieve some of their symptoms and make them feel more “normal,” even if it’s just for a short time.

An estimated 25% of individuals with OCD also have a co-occurring substance use disorder.

Unfortunately, long-term substance abuse can not only make their symptoms worse, but it can also lead to the development of a substance dependency or addiction.

OCD Treatment Options

Not everyone responds the same way to the same types of treatment, and there are various effective treatment methods available for those with OCD.

Psychotherapy

Psychotherapy, or talk therapy, is one of the more popular treatment methods for OCD among therapists and other healthcare professionals.

Cognitive-behavioral therapy (CBT) is a type of psychotherapy commonly used to help individuals deal with their OCD symptoms and triggers.

A form of CBT called Exposure and Response Prevention (ERP)—also known as exposure therapy—can also be particularly effective in treating OCD by exposing patients to triggers in a safe environment and then helping them work through any compulsions or obsessive thoughts and behaviors.

Medication

In addition to psychotherapy, some treatment professionals may prescribe certain medications to help treat OCD.

These medications affect the brain’s serotonin levels, which in turn can alleviate some of the symptoms associated with OCD and improve overall communication within the brain.

Medications that can be effective in treating obsessive-compulsive disorder include:

• Selective Serotonin Reuptake Inhibitors (SSRIs), which includes:
  • Escitalopram (Lexapro®)
  • Fluoxetine (Prozac®)
  • Paroxetine (Paxil®)
  • Sertraline (Zoloft®)
  • Citalopram (Celexa®)
  • Fluvoxamine (Luvox®)
• Clomiprane (Anafranil®), a special type of antidepressant that reduces compulsions and obsessions

Transcranial Magnetic Stimulation (TMS)

In 2018, the Federal Drug Administration (FDA) approved Transcranial Magnetic Stimulation as a form of OCD treatment for adults.

The TMS unit is a non-invasive device held above the head to induce a magnetic field, and it targets specific parts of the brain that control and regulate OCD symptoms through deep brain stimulation.

Support Groups

It might feel difficult to talk to someone about your OCD who doesn’t either have OCD themselves or know what you are going through. Support groups provide a safe and supportive environment to share what you are going through with others who also have OCD.

The International OCD Foundation (IOCDF) offers a directory with over 400 support groups for OCD and related disorders worldwide.

Find Help for Obsessive-Compulsive Disorder

Having OCD can be challenging, but it doesn’t have to be something you face on your own.

If you are unsure which treatment option is best for you or a loved one, you can talk to your healthcare provider or a mental health professional for guidance.

The Substance Abuse and Mental Health Services Administration (SAMHSA) also offers a free helpline at 1-800-662-4357 as well as a free online treatment locator to help people find resources for managing and treating OCD and other mental health conditions.