Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a mental health condition that causes a pattern of unwanted thoughts and fears (obsessions). These lead to repetitive behaviors (compulsions) that can interfere with your daily life and responsibilities.

If you have this condition, you may focus on different worries or behaviors. You might fear germs or contamination, need things to feel symmetrical or “just right,” have unwanted intrusive thoughts or feel the urge to collect or save items.

It affects about 2 out of every 100 people in the U.S.

While many people “obsess” over things now and then, OCD isn’t short term. These thoughts and behaviors are strong and overwhelming. A healthcare provider can help you manage this condition.

The two main symptoms of OCD are:

• Obsessions: Unwanted, intrusive thoughts, urges or mental images that cause strong anxiety
• Compulsions: Repetitive actions or mental rituals you feel you must do to ease or get rid of the obsessions

It’s possible to have an obsession without a compulsion and a compulsion without an obsession.

Obsession symptoms

Common obsessions include:

• Contamination: Fear of germs, dirt or body fluids
• Harm: Fear of hurting yourself or others
• Perfection: Strong need for order, neatness or symmetry and fear of making mistakes
• Religion or morality: Worry about offending a higher power or about what’s right and wrong
• Relationship: Doubting your romantic partner’s attraction or love
• Responsibility: Fear that something terrible will happen because of you
• Sexual thoughts: Unwanted, intrusive sexual thoughts that feel disturbing or out of character
• Somatic: Focus on body sensations or automatic functions, like breathing or heart rate
• Violence: Fear of harming yourself or others

Compulsion symptoms

Common compulsions include:

• Arranging: Putting items in a very specific order until it feels “right”
• Checking: Constantly making sure nothing bad happened, you didn’t make any mistakes and everyone’s safe
• Magical/undoing: Belief that your thoughts or actions can cause real-life events, even when there’s no logical connection
• Mental rituals: Saying words, phrases or prayers in your head while doing unrelated tasks
• Protective: A behavior or mental act performed to prevent a feared outcome
• Repeating: Doing things over and over, like tapping, walking through doors or repeating actions a certain number of times
• Washing and cleaning: Repeatedly washing your hands, objects or household items

These symptoms often:

• Interfere with normal activities, like making you late for work or school
• Feel impossible to stop or control
• Provide only short-term relief from anxiety
• Make you feel like the anxiety will get worse if you don’t perform the behavior
• Get worse with stress

OCD symptoms can come and go, improve for a while or get worse over time. If you or your child has symptoms that interfere with daily life, talk to a healthcare provider.

What causes OCD?

The exact cause of obsessive-compulsive disorder isn’t known. But several factors may play a role, including:

• Brain changes: People with OCD often show differences in brain areas that control thinking and behavior.
• PANDAS syndrome (PANS): Some children develop symptoms after infections, like strep throat or scarlet fever. This link is still being studied.
• Stressful life events: Difficult experiences or certain personality traits (like being very detail-oriented, perfectionistic) may also play a role in triggering symptoms.

Is OCD genetic?

Studies show that OCD can run in families. If you have a parent or sibling who has OCD, you’re more likely to develop it yourself. The risk is higher if your relative developed OCD as a child or teen. But this isn’t the case for everyone, since many people don’t have a history of OCD in their biological family.

Risk factors

Anyone can develop this condition, but your risk may be higher if you:

• Are in your early teens or early adulthood
• Have a biological family history of OCD
• Experienced childhood trauma (like abuse or neglect)
• Have other mental health conditions, like anxiety, depression or tic disorders
• Are under significant stress

Complications of obsessive-compulsive disorder

Obsessive-compulsive disorder can take a heavy toll on your daily life. Compulsions use up time and energy, leaving you physically and mentally exhausted. They can strain relationships, since others may not understand what you’re going through.

Possible complications include:

• Anxiety disorders
• Depression
• Financial difficulties (trouble keeping a job or paying bills)
• Not taking care of yourself
• Physical injuries from compulsions (like skin damage from constant washing)
• Substance use disorders and alcohol use disorder
• Suicidal thoughts or self-harm

If you’re ever in a difficult spot and you’re not sure what to do, know that help is available 24/7. You can call or text the Suicide and Crisis Lifeline at 988. If you’re in immediate danger, contact 911 or your local emergency services number.

How doctors diagnose obsessive-compulsive disorder

A healthcare provider will diagnose this condition by asking about your symptoms, your medical history and your mental health. A diagnosis is usually made by a psychiatrist or psychologist, but your primary care provider can start the evaluation and refer you.

Sometimes, the symptoms themselves (like needing extra time to get ready or feeling anxious about leaving home) can make it hard to get to appointments. If that’s the case, ask your provider if a virtual visit is an option.

Many healthcare providers find that there’s a delay in seeking help. It averages about seven to eight years before someone reaches out to a psychiatrist or a doctor about OCD symptoms. Naturally, the longer you wait, the harder it may be to manage. It’s important to talk to a healthcare provider if you notice symptoms so they can make an accurate diagnosis.

OCD diagnostic criteria

There’s no single test for OCD. Providers diagnose it using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

The criteria include:

• Having obsessions, compulsions or both
• Spending a lot of time on them, more than an hour per day (children may not reliably report this, and severe cases may take many hours)
• Feeling stressed, or having symptoms interfere with school, work or daily life
• Alcohol, addictive substances, medications or another medical condition not causing the symptoms
• Symptoms not being better explained by another mental health condition, like anxiety, an eating disorder, etc.

Providers may also use structured questionnaires to measure how severe symptoms are and track changes over time, like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) or CY-BOCS for children.

OCD treatment

The most common treatments for obsessive-compulsive disorder are:

• Exposure and response prevention (ERP) therapy: A type of therapy that helps you face fears without doing compulsions. This helps you learn that anxiety decreases naturally over time and that you don’t need rituals to feel safe.
• Medications: SSRIs may reduce the intensity and frequency of obsessions and compulsions. Antidepressants may lessen obsessive thoughts that lead to compulsive behaviors.
• A combination of ERP therapy and medications: Using both together may work better than either one alone.

Your provider might also add these treatments to your plan:

• Acceptance and commitment therapy (ACT): This helps you accept obsessive thoughts as just thoughts, so they have less power over you.
• Dialectical behavioral therapy (DBT): This therapy focuses on building skills like mindfulness, emotional regulation and coping with tough situations to manage intense feelings.
• Neuromodulation: This uses devices to change brain activity when other treatments don’t work. It includes transcranial magnetic stimulation (TMS). TMS uses magnetic pulses on the outside of your head. Deep brain stimulation (DBS) uses implanted electrodes to send electrical signals inside your brain.

OCD medications

Medications may reduce OCD symptoms. The most common ones are selective serotonin reuptake inhibitors (SSRIs). These affect serotonin, a brain chemical that helps control mood and anxiety.

The U.S. Food and Drug Administration (FDA) approved these SSRIs for OCD:

• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline

Another option is clomipramine, a tricyclic antidepressant. It can work well, but it often causes more side effects, so providers usually try SSRIs first.

It may take eight to 12 weeks to feel the full benefits, though some people notice improvement earlier. Once symptoms get better, most people stay on medication for 12 to 24 months or longer, since stopping too soon can bring symptoms back. Your provider will monitor you closely and adjust your dose if needed.

When should I see my healthcare provider?

If you or your child has an OCD diagnosis, you’ll likely need regular visits with your healthcare provider or a mental health professional to check that treatment is working. Let them know if you have new or worsening symptoms.

If you take medication for OCD and notice side effects, let your provider know right away.

What is the prognosis for obsessive-compulsive disorder?

The outlook for OCD is different for each person. Early treatment can sometimes make habits easier to change, but even if you weren’t diagnosed early, there’s still hope.

There isn’t one treatment that works for everyone. Your provider will help you find the plan that fits you best. Many people see their symptoms improve with therapy, medication or both. Treatment takes effort, and progress often depends on sticking with it.

OCD can cause serious complications if it isn’t managed, but you don’t have to face it alone. Your care team is there to support you.