Many people with obsessive compulsive disorder (OCD) know their behavior is unreasonable, but they’re still unable to resist recurrent unwanted thoughts or stop engaging in repetitive actions.
Obsessive-compulsive disorder is a disorder in which a person has recurring obsessions (unwanted thoughts, ideas, images, or sensations) that lead to compulsions (repetitive behaviors or rituals). It is not officially classified as an anxiety disorder by the American Psychiatric Association, but it has similarities to anxiety disorders.
Although many people have thoughts that linger, or have a tendency to repeat certain routines or habits, these behaviors don’t necessarily interfere with daily function and may even provide structure.
But in people with OCD, frequent, upsetting thoughts are persistent enough to cause severe anxiety, and not engaging in their routines or habits can cause them great distress.
Jonathan Abramowitz, PhD, a professor of psychology at the University of North Carolina at Chapel Hill and the editor in chief of the Journal of Obsessive-Compulsive and Related Disorders, says having OCD does not mean your brain is damaged or beyond help.
“You need to have a brain to have OCD, but there is no evidence that people with OCD have diseased brains, bad genes, or broken neurotransmitter systems,” he says. “Actually, everyone has unwanted thoughts, and everyone has anxiety sometimes. The whole idea of really overcoming OCD is learning that you can tolerate these experiences, and they don’t have to stop you from doing what’s important in your life. When you stop fighting anxiety and obsessions, that’s ironically when the anxiety and obsessions stop bullying you.”
How Common Is OCD?
According to the National Institutes of Mental Health, 1.2 percent of the U.S. adult population experiences OCD within a given year. Almost 51 percent of these people experience severe OCD symptoms.
On average, OCD begins around age 19, with boys generally having an earlier age of onset than girls.
What Causes OCD?
Scientists still don’t know the exact causes of OCD. But researchers believe the following might contribute to the condition:
- Genetics OCD sometimes runs in families. You have a higher risk of developing OCD if you have a parent, sibling, or child with the disorder.
- Brain structure OCD symptoms may be connected to differences in certain areas of the brain, but research is still ongoing.
- Early childhood trauma Experiencing physical or sexual abuse at a young age increases your risk of developing OCD or an anxiety disorder.
- Childhood streptococcal infections This can sometimes cause OCD symptoms known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.
What Are the Symptoms of OCD?
Most people with OCD experience both obsessions and compulsions, although some people may only develop one or the other. Others may also have vocal or motor (movement) tics.
Common obsessions include:
- Excessive fear of germs, dirt, or contamination
- Forbidden sexual or religious thoughts
- Concern with order, symmetry, or exactness
- Aggressive thoughts about doing harm to yourself or others
- Repeatedly thinking about certain words, sounds, or numbers
Common compulsions include:
- Excessively washing yourself or cleaning your surroundings
- Repeatedly uttering the same phrase or counting to the same number
- Repeating actions, such as going in and out of a doorway or sitting down and getting up from a chair
- Ordering or arranging items in a specific way (keeping things in perfect order or symmetry)
- Repeatedly checking on certain things, such as whether a door is locked or the oven is off
- Saving things that are no longer needed (hoarding)
- Constantly praying silently or engaging in other religious rituals.
How Is OCD Diagnosed?
Diagnosis of OCD typically involves a physical exam and lab tests to rule out other causes of the symptoms, as well as a psychological examination. Because the symptoms can be so diverse, and it can be hard to admit to them, it can sometimes take a long time — an estimated 11 years, on average — for a person to receive a diagnosis.
In order to be diagnosed with the disorder, you have to meet several specific criteria set forth by the American Psychiatric Association. (3) One criterion is that you spend at least an hour a day engaging in obsessions and compulsions, and experience significant problems in social, professional, or other contexts because of them.
What Is the Treatment for OCD?
Treatment for OCD may involve therapy and medication, but, says Dr. Abramowitz, research suggests that medications for OCD are only partially effective. “Cognitive behavioral therapy, using the techniques of exposure and response prevention, have the best and most consistent research support for OCD,” he says.
Cognitive behavioral therapy (CBT) aims to teach people with OCD skills to better manage and reduce obsessive thoughts, compulsive behaviors, and anxiety.
Exposure and response prevention, or ERP, is a form of CBT used to treat certain phobias. It involves gradual and repeated exposure to a feared situation or object, and encourages you to refrain from engaging in the compulsions brought on by the situation or object, causing you to become less fearful over time.
For example, if you can’t leave the house without checking that you’ve locked the front door, your therapist would work with you to try leaving the house without double-checking, until the distress at not checking decreases significantly.
Noah Clyman, a licensed clinical social worker and the director of NYC Cognitive Therapy, a private psychotherapy practice in Manhattan, says that exposure therapy can help those with OCD find a way to understand and then relinquish the habits that disrupt their daily lives.
“I tell patients that when they confront situations that cause them distress, and they stay in the situation for long enough without escaping or doing rituals, they’ll learn several things,” he says. “They’ll learn that the anxiety does not last forever. In fact, it decreases even without escaping, avoiding, or ritualizing. Also, they’ll find out that as their anxiety decreases, their urge to ritualize and to escape from the situation also decreases.”
These are the antidepressants that are frequently prescribed to those with OCD:
- Luvox (fluvoxamine)
- Prozac (fluoxetine)
- Zoloft (sertraline)
- Anafranil (clomipramine)
In addition, meditation, yoga, and massage therapy may help ease the stress and anxiety caused by OCD.
Deep brain stimulation may also help the 10 percent of people with treatment-resistant OCD. (4)
What Is the Difference Between OCD and Obsessive-Compulsive Personality Disorder?
There are two main differences between OCD and obsessive-compulsive personality disorder (OCPD).
The first difference has to do with insight. People with obsessive-compulsive personality disorder often think that their thoughts are correct. They may even feel entitled to their responses or reactions, and may not think they should get treatment.
In addition, OCPD affects someone’s way of relating to others, whereas OCD causes certain thoughts and behaviors, such as hand-washing or counting.
In order to be diagnosed with OCPD, a person must have at least four of the following symptoms:
- Overly devoted to work at the expense of personal relationships
- Unable to throw things away, even when the objects have no value
- Rigid moral or ethical beliefs
- Lack of financial generosity
- Not wanting to allow other people to do things
- Fixation on lists, details, and regulations
- Perfectionism that interferes with an ability to complete tasks
It’s of course possible to possess these qualities without having the disorder. To be diagnosed with OCPD, these qualities have to seriously disrupt your personal and professional relationships. And, as mentioned above, those with OCPD may not think they need to be treated.
Similar to OCD, the best treatment for obsessive-compulsive personality disorder is talk therapy, and medications may also help reduce the anxiety and depression that can be associated with OCPD.