Obsessive compulsive disorder is a mental health condition characterized by persistent, recurring thoughts or images (obsessions) that are distressing, causing someone to carry out behaviors (compulsions) in an attempt to neutralize or suppress the intrusive thoughts. The obsessions and compulsions are so prevalent that they interfere with day-to-day life.
For people with obsessive compulsive disorder, their obsessions are relentless. They can’t just be shrugged off. Typically, if someone tries to make their obsessions stop, the obsessions will grow to be even stronger and more distressing. The troubling thoughts drive people with OCD to engage in their compulsions to try to reduce the anxiety and distress that they are feeling. However, even carrying out the compulsions does not make the obsessions go away. This creates an ongoing cycle of obsessions and compulsions. Usually, someone’s OCD will pertain to a specific theme, and the obsessions will mainly relate to that category.
In some cases, people with obsessive compulsive disorder are aware that their obsessions are irrational. However, that doesn’t stop the intrusive thoughts from invading their minds, and doesn’t stop them from engaging in their compulsions. In other cases, people don’t believe their obsessions are irrational. Regardless of the situation, obsessive compulsive disorder can be difficult to deal with and have a negative effect on quality of life.
It is estimated that about 1.2% of adults age 18 or over in the United States had obsessive-compulsive disorder in the past year. Females are more likely to have OCD than males are, with the prevalence being 1.8% for females and 0.5% for males. The impact that OCD has on someone’s life can vary. Looking at the sample of people who had OCD in the past year, 50.6% of them said that they experienced serious impairment due to their condition, whereas 34.8% said they had a moderate impairment, and 14.6% only had mild impairment.
Someone can develop obsessive compulsive disorder at any point in their life. However, it is most commonly diagnosed either between the ages of eight and 12, or throughout the late teens and early adult years. Additionally, some people may live with OCD for many years before seeking treatment and receiving a diagnosis.
Obsessive Compulsive Disorder (OCD) Symptoms & Behaviors
While obsessive compulsive disorder is typically characterized by the presence of both obsessions and compulsions, in some cases OCD may present with only obsessions or only compulsions. OCD symptoms usually take up a lot of time, getting in the way of daily activities.
Obsessions are unwanted intrusive thoughts, mental images, or urges that cause great discomfort and anxiety.
Some examples of common themes of obsessions include:
- Harming (having obsessive fears about harming yourself or others)
- Contamination (having obsessive fears about germs or sickness)
- Unacceptable thoughts (having taboo sexual, religious, or aggressive intrusive thoughts)
- Symmetry (having the need to keep things in order and symmetrical)
Some ways that these obsessions might present themselves are:
- Intrusive thoughts about losing control and violently hurting somebody
- Being unsure to a troubling extent of whether you’ve turned off the oven off
- Fearing getting sick from shaking hands with someone or touching surfaces
- Experiencing unwanted taboo sexual images that don’t align with one’s own morals
- Feeling extremely uneasy when things are not symmetrical
This is by no means an exhaustive list of how obsessions may present themselves. There’s a long list of obsessive thoughts that people might have, and thoughts can vary from person to person.
Compulsions are the behaviors or rituals that people with obsessive-compulsive disorder carry out in an attempt to reduce anxiety and distress. Sometimes, people feel like they must engage in their compulsive behaviors in order to stop something bad from happening. Compulsions aren’t always physical actions. They can be mental, too. Compulsions may be a very temporary fix for coping with the worry and fears attached to obsessions, but the obsessions come back, and the cycle repeats.
Some types of compulsions include:
- Putting things in order
- Seeking reassurance
Some examples of these types of compulsive behaviors are:
- Checking the oven multiple times to ensure that it’s off
- Excessive hand washing
- Repeating a certain behavior a specific number of times
- Rearranging things to be in order and symmetrical
- Asking friends or family for reassurance that you won’t lose control and carry out a violent action
Again, this is not an exhaustive list of all of the compulsive behaviors out there. There is a huge range of compulsions, and they vary depending on the individual.
Obsessive Compulsive Disorder (OCD) Causes & Risk Factors
There isn’t one singular cause of OCD, and researchers are still not sure exactly what causes it. However, there are some theories and risk factors that have been shown to contribute to obsessive compulsive disorder. These include:
- Family history of obsessive compulsive disorder: Genetics does play a role in OCD. Someone with a family history of OCD is more likely to also have OCD, such as if someone’s parent has OCD. Research has shown that in OCD cases, 20%-40% of first degree relatives (meaning parents or siblings) have obsessional traits.
- Co-occurring mental health conditions: Having co-occuring mental health conditions such as depression and anxiety may contribute to developing OCD.
- History of trauma: Trauma or high stress situations may trigger obsessive compulsive disorder.
- History of abuse: A history of abuse (physical abuse or sexual abuse) particularly during childhood can make someone more likely to have obsessive compulsive disorder.
- Differences in parts of the brain: Through imaging studies, research has found evidence of abnormalities in certain parts of the brain (including the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus in people who have obsessive compulsive disorder.
In some cases, people may meet the criteria for multiple risk factors, which puts them at an even higher risk for developing OCD.
Obsessive-compulsive Related Disorders
The DSM-5 notes the presence of disorders that are related to obsessive compulsive disorder. Similarly to obsessive compulsive disorder, obsessive-compulsive related disorders are characterized by someone having obsessions and compulsions that cause distress and impact their life. However the difference is that these disorders each have unique distinguishing factors that set them apart and create enough criteria for them to be their own subtypes.
These obsessive-compulsive related disorders include:
- Excoriation (skin picking) disorder: With skin picking disorders, the patient has strong urges to pick their skin they can’t ignore. They end up obsessively picking at their skin, sometimes for hours throughout the day. People with skin picking disorder might feel anxious or on edge before they pick, and then the picking provides feelings of pleasure and relief from anxiety. Sometimes, the picking is severe enough that it can cause scarring or tissue damage, which may even require medical attention and antibiotics. In many cases, skin picking disorder starts along with a dermatological condition like acne. It commonly co-occurs with anxiety and mood disorders.
- Trichotillomania (hair-pulling disorder): The behavior associated with trichotillomania is pulling hair out, whether it be from their head, eyebrows, eyelashes, or elsewhere. Within this disorder, there are two types of hair-pulling that have been identified: focused and automatic. Focused hair pulling is closer to an OCD compulsion, and the person is very aware that they’re doing it. On the other hand, automatic hair pulling is done more automatically or subconsciously without the person being fully aware that they’re doing it. Trichotillomania can result in hair loss, and the onset is usually in childhood or adolescence.
- Body dysmorphic disorder (BDD): When someone has body dysmorphic disorder, they obsess over what they perceive to be physical flaws, whether they be about their body, facial features, or skin. The flaws that they see are distorted, and they may not even be perceived by other people. This obsession with flaws is accompanied by related repetitive behaviors. For example, they may constantly examine themselves in the mirror or practice excessive grooming. The onset of BDD is typically in adolescence. Body dysmorphic disorder commonly occurs with major depressive disorder or social anxiety disorder.
- Hoarding disorder: People with hoarding disorder accumulate and keep an abnormal amount of items in their home. They have an intense need to keep all of their belongings, and they have an extremely difficult time parting with any of their belongings, which is why they have so much. This results in very cluttered living situations. Many people with hoarding disorder will continue to buy more and more items even though they know there is no space for them at their home. Typically, there are feelings of embarrassment and shame around hoarding, especially if other people see their home. The condition is chronic, usually starting in adolescence and continuing into adulthood.
- OCD-induced by a medication or due to another medical condition: In some cases, obsessive compulsive disorder may be caused by medications or substances. For example, some studies have reported that certain antipsychotics may induce obsessive compulsive disorder in some patients. Medical conditions can also cause obsessive compulsive disorder. One example of this is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
Another diagnosis to consider here is obsessive compulsive personality disorder. While it sounds very similar to obsessive compulsive disorder, there are clinical differences that set them apart from one another. It falls under the umbrella of personality disorders. People with obsessive compulsive personality disorder are extreme perfectionists and are fixated on doing everything their way, which is what they believe to be the only correct way. They may be preoccupied with lists, rules, and organization. Typically, they do not question themselves or feel ashamed of this obsession to do everything perfectly. Obsessive compulsive personality disorder can get in the way of relationships, especially in living situations.
Many people with obsessive compulsive disorder commonly also experience major depressive disorder (MDD). People living with either OCD or depression both experience anxious symptoms such as agitation, apprehension, and worry. Both of these conditions are also commonly treated by the same SSRI medications.
Treatment for Obsessive Compulsive Disorder (OCD)
Obsessive compulsive disorder is treatable. Treatment may not make OCD disappear completely, but it can certainly make it more manageable. Treatment options for OCD include both therapy and medication. Oftentimes, the two treatment types are used in conjunction with each other for the best results. The type and duration of treatment will depend on the severity of the obsessions and compulsions, as well as the effect that they have on the person’s quality of life.
In many cases, people who have obsessive compulsive disorder also have other co-occurring mental health conditions such as depression and anxiety. The overall treatment plan for obsessive compulsive disorder will take these other conditions into account when a mental health professional decides on the best course of action.
Types of therapy for obsessive compulsive disorder
Therapy can be very helpful for people with OCD. It can help them work through their problems, learn new coping strategies, and tackle their obsessions and compulsive behaviors head on.
- Cognitive behavior therapy (CBT): CBT is a type of psychotherapy that helps people learn to change their thought and behavioral patterns, as well as healthy ways to cope with their conditions. CBT will help someone identify what their unhelpful ways of thinking are and how they impact their behavior, and then create more helpful, healthy thoughts and in turn, healthy behaviors. Oftentimes CBT also includes learning about relaxation techniques. On top of the work done during therapy sessions, patients need to also put in work outside of the session for the best results. CBT can be very effective for various mental health conditions, such as anxiety and depression, not just OCD.
- Exposure and Response Prevention (ERP): ERP is an offshoot of CBT that’s often used to help treat OCD. It involves the patient being exposed to things that are anxiety-inducing or trigger their obsessions (exposure). Then, the patient is prevented from carrying out the compulsion that usually goes along with the obsession (response prevention). For example, with the guidance of the trained professional, a patient with contamination obsessions will be exposed to a trigger such as shaking hands with someone or touching a doorknob that many other people have touched. Then, they would have to stop themselves from completing their excessive hand washing compulsion. Over time, this can help people become desensitized to their triggers.
Types of medications for obsessive compulsive disorder
Patients with more severe OCD often require psychiatric medication as well as therapy. There are a variety of medications available for treating obsessive compulsive disorder, and the patient’s prescriber will determine which is the best fit for the individual based on their situation. The medications that treat OCD fall into the following four categories:
- Selective serotonin reuptake inhibitors (SSRIs): This is a class of antidepressant medications that can be used for treating OCD. These include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). These are the most commonly prescribed medications for OCD.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): This is a class of antidepressants similar to SSRIs. One SNRI in particular, venlafaxine (Effexor), has been shown in studies to help treat OCD.
- Tricyclic antidepressants (TCAs): TCAs are an older class of antidepressants. One TCA, clomipramine (Anafranil), has been shown to be effective in treating OCD. In fact, it was the first medication that proved to benefit patients with OCD. However, the side effects and risks of clomipramine are greater than those of SSRIs and SNRIs, so it typically is not prescribed as a first line of treatment.
- Antipsychotics: In cases where one antidepressant on its own isn’t effectively providing relief, an antipsychotic may be added on to augment the effects. Risperidone (Risperdal) is the antipsychotic that’s been studied the most for treatment of OCD, for example.
It should be noted that any of these types of medications take time to work. Patients may need to take an SSRI, for example, for 10-12 weeks before the medication takes full effect and really makes a difference in someone’s symptoms. Additionally, people with OCD typically require a higher dose of these medications than people who are taking the meds for another condition such as depression.
If you think that you might have obsessive-compulsive disorder, do not hesitate to seek professional help. The sooner you get a diagnosis, the sooner you can be on track to feeling better and living life with OCD.