Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and fears that can cause repetitive, unwanted behaviors. These symptoms can be stressful to experience and might lead you to avoid activities you usually enjoy. Understanding the signs and symptoms of OCD, its causes, and available treatments can be the first step toward getting help.
What is OCD?
OCD involves intrusive, unwanted thoughts — also known as “obsessions” —that cause feelings of fear, disgust, or discomfort. These obsessions can lead people with OCD to engage in repetitive behaviors, known as “compulsions,” in order to relieve anxiety caused by these thoughts. Someone with an obsessive fear of contracting a disease, for example, might compulsively look up symptoms on the internet.
Some people with OCD don’t experience physical compulsions. This is often informally — and erroneously — called “pure O” OCD. Rather than physical compulsions, they may experience invisible mental compulsions. These might include overanalyzing thoughts, replaying memories, or imagining “what-if” scenarios.
Possible causes of OCD
It’s unclear what causes OCD, though it’s likely to involve both familial and environmental influences. Some studies have linked OCD to genetic factors (Pauls, 2010). Other studies have demonstrated a higher prevalence of OCD in people who have experienced trauma (Dykshoorn, 2014).
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OCD signs and symptoms
It’s normal to have some intrusive thoughts. However, intrusive thoughts that make you uncomfortable, tense, or anxious for a significant part of your day may benefit from the help of mental health clinician.
Often, obsessions are organized into themes that can include:
- Harming oneself or others, or allowing harm to happen
- Catastrophic events, like house fires or burglary
- Engaging in illegal acts, violence, or taboo behavior
- Contamination with dirt, germs, chemicals, or bodily fluids
- Developing a health problem or contracting a disease
- Romantic or relationship fears, such as infidelity or falling out of love
- Things not being symmetrical or orderly
- Not performing tasks perfectly or correctly
- Behaving immorally or blasphemously
- Becoming psychotic or losing control of one’s mind or behavior
- Uncertainty about whether an event did or did not happen
- Being wrong or uncertain about something
People with OCD typically engage in compulsions, also known as “safety behaviors,” to relieve the fears associated with OCD. Common compulsions include:
- Checking things, such as the stove or a lock
- Rearranging and ordering items
- Repeating acts until it feels “just right”
- Counting until one arrives at the “right” number
- “Neutralizing” or “undoing” bad thoughts
- Hoarding or collecting objects
- Excessive cleaning, showering, or handwashing
- Seeking reassurance from others or from resources like the internet
- Replaying one’s memories about a particular event
- Analyzing one’s thoughts, impulses, or behavior
- Excessive praying beyond what is required in one’s faith
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How is OCD diagnosed?
OCD can be diagnosed by a mental health clinician. During your appointment, the clinician will ask questions about your history, current symptoms, and overall functioning. They may also use standardized questionnaires to find out more about the type and severity of your symptoms.
Treatments for OCD
OCD often responds well to treatment. Many find that therapy alone is enough to reduce their symptoms. Others respond well to medication, while some do a combination of the two.
Exposure and response prevention (ERP) is a common type of cognitive behavioral therapy designed to gently help patients confront the situations that can cause intrusive thoughts without engaging in physical or mental compulsions. This can help patients understand that the thoughts aren’t dangerous or threatening and that the compulsions won’t necessarily prevent bad things from happening.
Antidepressants are the most widely prescribed OCD medication. Medication is considered most effective when combined with therapy.
Dykshoorn, K. L. (2014). Trauma-related obsessive–compulsive disorder: A Review. Health Psychology and Behavioral Medicine, 2(1), 517–528. https://doi.org/10.1080/21642850.2014.905207
Pauls, D. L. (2010). The genetics of obsessive-compulsive disorder: A Review. Dialogues in Clinical Neuroscience, 12(2), 149–163. https://doi.org/10.31887/dcns.2010.12.2/dpauls