Obsessive-compulsive disorder (OCD): what is it, symptoms, treatment

Most people have heard of obsessive-compulsive disorder or OCD. The term may trigger thoughts of quirky television characters that have peculiar cleaning or organizational habits. But OCD is not about having a type A personality or being a perfectionist. And it’s certainly not a condition that should be joked about or mocked.

If you have OCD, the symptoms may be debilitating and affect many aspects of your daily life. Work, social, and family relationships can all become strained. You may avoid people and places that provoke your symptoms, significantly decreasing your quality of life. Fortunately, treatment is available. Here’s what you should know about this condition and how treatment may benefit you. 

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Obsessive-compulsive disorder (OCD) is a mental health condition involving uncontrollable, recurrent thoughts (obsessions) and repetitive behaviors or rituals (compulsions). People with OCD often experience significant distress in response to their obsessions and engage in compulsive behaviors in an attempt to ease their anxiety. OCD affects 2.3% of the population; however, the actual number is likely greater since only people with moderate to severe symptoms usually seek treatment (Stein, 2019). 

Young adults are commonly affected, with the average age of diagnosis being 19.5 years (Fenske, 2015). Men are typically diagnosed earlier in childhood, but the condition is more commonly diagnosed in women (Brock, 2020). 

It is important to differentiate OCD from obsessive-compulsive personality disorder (OCPD). OCPD is a separate condition, and unlike OCD, it is not defined by unwelcome thoughts and repetitive behaviors. Instead, people with OCPD excessively focus on perfectionism, organization, and a sense of control (Fenske, 2015). 

People with OCD can experience either obsessions or compulsions, but studies show most people experience both (Shavitt, 2014). The obsessions or compulsions are time-consuming and interfere with social and work functioning and daily life (Brock, 2020).

Obsessions

Obsessions are recurrent, unwanted thoughts, images, or urges. People with OCD actively try to minimize these obsessions since they can cause anxiety and distress. Examples of obsessions include (Fenske, 2015): 

• A strong desire for objects to be in a particular order or balance 

• Concerns about harming others or violent images 

• Doubting things were done correctly or completely (such as worrying you forgot to lock the doors or turn off the oven)

• Fear of contamination with germs or dirt 

• Superstitious thoughts such as believing specific numbers or colors are “bad”

• Worries about acting inappropriately in public or behaving in a sexually inappropriate manner 

While we all experience intrusive thoughts from time to time, people with OCD cannot dismiss these thoughts. Instead, they feel a strong urge to perform a behavior (compulsion) that offers a temporary feeling of relief from the anxiety caused by the obsession. These behaviors may become automatic over time (Fenske, 2015). 

Compulsions

Compulsions can be repetitive behaviors or mental rituals. Common compulsions include (Fenske, 2015):

• Avoiding situations, people, or objects that trigger obsessive thoughts 

• Excessive hand washing

• Mental rituals such as praying, counting, or repeating words silently

• Placing items in a particular order

• Repetitive checking, such as checking to make sure the doors are locked or that the oven is turned off 

Compulsive behaviors may be related to the obsession but are excessive, such as the fear of germs and constant hand washing. Other times, the compulsion may have no logical connection to the obsession. For example, someone experiencing an obsessive thought about their family being harmed may feel the urge to flip the light switch a certain number of times before leaving the house (Dykshoorn, 2014). 

Most people with OCD recognize their obsessions and compulsions are unfounded, yet are unable to control them. However, a small percentage of people believe their obsessions or compulsions are valid and may have difficulty seeking out or sticking with treatment programs or medications (Dykshoorn, 2014).  

While there are no official subtypes of OCD, there are common sets of obsessions and compulsions. You may notice your symptoms fall into one of these groups, sometimes referred to as “symptom dimensions” (Stein, 2019):

• Contamination: Fears about germs or dirt; excessive washing, showering, or cleaning 

• Harm-related: Concerns about yourself or others becoming harmed; “checking” compulsions, such as frequently checking that doors are locked 

• Symmetry: The need for symmetry and balance; repeated ordering or counting 

• Taboo thoughts: Aggressive, sexual, or religious thoughts (such as harming someone, molesting children, or committing sins); mental rituals or frequent praying

Many people with OCD experience some of these obsessions or compulsions, but others do not. OCD is a highly individualized condition that can present in many different ways, so don’t be concerned if what you are experiencing doesn’t fit into one of these categories (Fenske, 2015). 

Researchers don’t know for sure what causes OCD, but changes in the brain structure and the way the brain communicates may play a role. Alterations in certain chemical messengers, including serotonin, glutamate, and dopamine, may also be involved (Stein, 2019). 

Researchers have identified several risk factors that increase a person’s chance of developing OCD. These include:

• Family history: Having a family member with OCD increases your chance of developing the condition. This is particularly true for childhood-onset OCD with tics (uncontrollable twitches, movements, or sounds) (Stein, 2019). 

• Infections in children: Streptococcal infections in children, such as strep throat, may cause a sudden onset of OCD symptoms. This condition is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, or PANDAS (Brock, 2020). 

• Pregnancy: Those who are pregnant or in the postpartum period are up to two times more likely to develop OCD than the general female population. OCD symptoms may also worsen during this period for women with a prior diagnosis of OCD (Fenske, 2015). 

• Stressful or traumatic experiences: Studies have shown people who have experienced a traumatic event are 30–82% more likely to develop OCD (Dykshorrn, 2014). 

The diagnosis of OCD is based on your symptoms. Your healthcare provider will ask you a series of questions to determine if you are experiencing OCD or a different condition. 

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)—published by the American Psychiatric Association—states that all of the following criteria must be met for a diagnosis of OCD (Fenske, 2015):

• Symptoms include obsessions, compulsions, or both. 

• The obsessions or compulsions are time-consuming (take up at least one hour per day), cause significant distress, or interfere with functioning. 

• The symptoms are not caused by something else, such as substance abuse, medication side effects, or another mental health or medical condition. 

The DSM-5 groups OCD with other conditions that share similar symptoms. These “obsessive-compulsive-related disorders” include (Fenske, 2015):

• Body dysmorphic disorder (obsession with perceived flaws in physical appearance)

• Excoriation (skin-picking) disorder

• Hoarding disorder (difficulty discarding or parting with possessions) 

• Trichotillomania (hair-pulling disorder)

Differentiating OCD from these disorders and other mental health conditions helps ensure you receive the appropriate treatment. However, it should be noted that the majority of people with OCD also have other mental illnesses, such as anxiety disorders or depression, and recognizing all conditions you may have can help you get the care you need (Fenske, 2015). 

Early and aggressive treatment can help significantly improve the symptoms of OCD. Unfortunately, the average time from symptom onset until a diagnosis is 11 years. People are often too embarrassed to seek help, especially if their symptoms involve sexual or violent thoughts (Brock, 2020). It’s important to remember that your healthcare provider recognizes these symptoms are part of a disease and are not your fault. You should not hesitate to seek help, especially since effective treatment options are available. 

The treatment of OCD mainly involves psychotherapy, medications, or both. Deciding which treatment is right for you will depend on your preference, your other medical conditions, and the severity of your symptoms. 

Psychotherapy 

Cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP), is the main psychotherapy used for OCD. ERP involves slowly exposing people to situations that cause anxiety or distress and helping them learn techniques to avoid performing the compulsive behavior. ERP sessions are led by a mental health professional and can be provided individually or in a group setting. Typically, healthcare providers recommend attending 10–20 sessions (Stein, 2019).  

Medications 

A group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are the most commonly used medications to treat OCD. Examples of SSRIs include fluoxetine (brand name Prozac), fluvoxamine (brand name Luvox), paroxetine (brand name Paxil), and sertraline (brand name Zoloft) (Fenske, 2015).

It is important to take your medication each day, even if you don’t see any benefit initially.

Some people will notice an improvement in their symptoms within two weeks, but for others, it can take up to 8–10 weeks, or even longer—so don’t get discouraged. If treatment is successful, most people will continue taking medication for 1–2 years, sometimes indefinitely, to prevent a relapse (Fenske, 2015). 

Some people don’t respond to the first medication that’s tried, and that’s okay. Your healthcare provider may recommend switching to a different SSRI, adding an antipsychotic medication to your regimen, or switching to or adding clomipramine (a different type of antidepressant) (Fenske, 2015).  

Other treatments

If you’ve tried multiple medication regimens and your symptoms still persist, your healthcare provider may recommend neuromodulation. Neuromodulation methods attempt to reset faulty nerve activity in the brain that may contribute to OCD symptoms. These methods include repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (Stein, 2019):

• rTMS is performed by placing magnetic coils against your scalp and sending a painless electrical impulse to activate nerve cells.

• Deep brain stimulation is a more invasive procedure that involves surgically implanting tiny electrodes into areas of the brain . 

If you’re struggling with the symptoms of OCD, just getting through the day can be a challenge. Luckily, it doesn’t have to be this way. Speak with your healthcare professional about your treatment options. Together you can develop a plan that gets you started on the path to recovery. 

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Current version

June 21, 2021

Written by

Christina Varvatsis, PharmD

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.