Obsessive-compulsive disorder (OCD) is a long-lasting disorder defined by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). ¹

OCD is a type of anxiety disorder because of the severe anxiety you’ll experience through obsessive thoughts. In fact, the only reason you participate in compulsive behaviors is to reduce this anxiety.

Throughout this article, we’ll look deeper at OCD, its risk factors, and what treatment options are available.

OCD Defined

Obsessive-compulsive disorder (OCD) is a mental health condition marked by obsessions and compulsions interfering with daily life. More specifically:

• Obsessions are intrusive thoughts, images, or ideas. They don’t go away, are unwanted, and can be extremely distressing or worrying (i.e. “What if I become infected with a deadly virus?” ²

• Compulsions are ritualistic behaviors you do over and over again to relieve anxiety. These are directly related to your obsessions. For example, you may be obsessed with contamination and feel compelled to constantly wash your hands. ³

OCD is a fairly common condition, with 2-3% of the U.S. population struggling with it. This percentage may be due to recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) changes. OCD is now classified as its own class of “Obsessive-Compulsive and Related Disorders.” These related conditions include body dysmorphic disorder and hoarding disorder.

Signs and Symptoms of OCD

OCD is marked by two classifications of symptoms; obsessions and compulsions. In other words, to relieve obsessive thoughts, you’ll participate in compulsive behaviors.

Obsessive Symptoms

Obsessions are repeated thoughts, impulses, or mental pictures that cause anxiety. These include:

• Aggressive thoughts (either towards self or others)
• A need for everything to be symmetrical or perfectly ordered
• Paranoia of germs or contaminations
• Undesired prohibited or taboo thoughts (i.e. sexual obsession)

Compulsive Symptoms

Compulsive behaviors are an attempt to relieve obsessive thoughts. These include:

• Compulsive counting
• Imprudent cleaning and/or handwashing
• Keeping everything ordered in a particular and precise manner
• Redundantly checking on things, such as to see if the door is locked

Other Signs and Symptoms

The signs of OCD aren’t always obvious. For example, it’s normal for people to double-check on things they may worry about (i.e. locking the door at night). However, OCD can take these behaviors a step further and may result in:

• Lack of control over thoughts and conduct, even when you can identify the excessiveness of these thoughts and behaviors. ⁴
• You don’t receive satisfaction when acting out these behaviors but continue to continue to anyway as you feel brief alleviation from anxiety.
• Experiences complications in your daily life due to these thoughts and conduct. ⁵
• Spends an hour or more a day on these thoughts and behaviors.

People with OCD may also suffer from something known as a tic disorder (also referred to as motor tics). These are sudden and short monotonous movements such as: ⁶

• Eye blinking and/or other eye movements
• Facial wincing
• Grunting sounds
• Head jerking
• Shoulder jerking/shrugging
• Sniffing
• Throat-clearing

When Do Symptoms Appear?

Symptoms for OCD will come and go at random. For some people, they ease over time. For others, they worsen. People who struggle with OCD may try to take care of themselves by keeping away from situations or objects that bring on these symptoms. ⁷ Some may also use alcohol or drugs to self-medicate. ⁸

On average, most people experience OCD for the first time at 18 years old, with symptoms lasting about 12 years. ⁹ However, OCD symptoms can appear earlier (including in childhood) or later in life.

What are the Types of OCD?

OCD can appear in a few different ways. Some may only experience obsessions. However, it’s more common for people to experience obsessions and compulsions (even if compulsions are all mental).

There are no official subtypes of OCD. However, research confirms the most common themes include: ¹⁰

• Anxiety about causing harm to oneself or others
• Desire for order, symmetry, or lawlessness
• Obsession with cleanliness or fear of germs
• Unacceptable or prohibited thoughts

It’s worth noting that OCD can be triggered in children through some infections, including strep throat. These health conditions result in the child’s immune system attacking the brain, causing obsessive and compulsive behaviors. ¹¹

What Causes OCD?

The precise causes of OCD are unknown, but several factors are thought to contribute. These include:

Genetics

While an “OCD gene” has never been identified, the condition has been found to run in families. In fact, research confirms that if a first-degree family member (i.e. a parent or sibling) has OCD, there’s a 25% chance you also have it. ¹²

Brain Formation and Functioning

Image studies reveal people with OCD showcase a difference in their frontal cortex and subcortical formations. It’s not entirely understood how these irregularities in the brain work. However, we do know these abnormalities can lead to OCD symptoms. ¹³

Environment

Some types of trauma (i.e. physical or sexual abuse) can lead to OCD and other anxiety disorders. ¹⁴ As mentioned, some types of infections can also cause OCD symptoms to develop.

On top of that, various types of stress can lead to symptoms of OCD. ¹⁵ These include:

• Childbirth
• Physical illness
• Problems at school
• Relationship difficulties
• Unemployment

How to Prevent OCD

There’s no guaranteed way to prevent obsessive-compulsive disorder. However, early treatment may help prevent OCD from worsening and interfering with your daily activities and routine.

It can also help to incorporate self-care measures, including: ¹⁶

• Compulsion management
• Connecting with others
• Intrusive thought management
• Mindfulness
• Using distraction and visualization

OCD Treatment

Treatment of OCD involves medication, psychotherapy, or a combination of the two.

Medication

People with OCD may benefit from serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs). These medications ease symptoms in both children and adults. ¹⁷ The most common medication given to people with OCD is clomipramine. ¹⁸ However, you may also receive: ¹⁹

• Fluoxetine
• Fluvoxamine
• Sertraline

When you begin taking an SRI, it may take 8 to 12 weeks before it starts to work. Still, there are some cases where the medication works immediately.

On the other hand, sometimes medication doesn’t work at all. Some people with OCD respond better to antipsychotic medication (such as risperidone). ²⁰

Whenever you’re taking a prescription medication, you’ll want to:

• Discuss your prescription with your healthcare provider to better understand the hazards and benefits.
• Never stop taking medication without letting your doctor know. When you instantly take medication out of your system, there’s a chance you’ll worsen OCD symptoms. ²¹ Not to mention, some people experience withdrawal. ²²
• Talk to your doctor immediately if you experience any side effects.

Psychotherapy

People with OCD also benefit from psychotherapies. The purpose of the treatment is to focus on the root cause of OCD and then teach you how to alleviate symptoms. ²³

The most common psychotherapy for OCD is cognitive behavioral therapy (CBT). CBT calls for Exposure and Response Prevention (EX/RP) which can reduce impulsive conduct. It’s even been proven beneficial for those who don’t react to SRIs. ²⁴

Other Therapies

When both medication and psychotherapy are ineffective, you may be offered a deep brain stimulation (DBS). There are a variety of DBS out there, but the most common is electroconvulsive therapy (ECT). ²⁵

Get Involved in a Study

Would you like to participate in the progress of OCD treatment?

Then it may be in your best interest to sign up for a clinical trial. These studies seek new alternatives to preventing, detecting, and treating mental health conditions.

To learn more about these trials, visit NIMH Clinical Trials – Participants or Join a Study.

References

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³ Starcevic V, Berle D, Brakoulias V, Sammut P, Moses K, Milicevic D, Hannan A. Functions of compulsions in obsessive-compulsive disorder. Aust N Z J Psychiatry. 2011 Jun;45(6):449-57. doi: 10.3109/00048674.2011.567243. Epub 2011 Apr 21. PMID: 21510720.

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