What is obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder (OCD) is a mental illness, with a chronic (long-lasting) state of anxiety. It traps people in a constant cycle of repeated obsessions and compulsions:
- OCD obsessions: People with OCD have repetitive and distressing fears or urges they can’t control. These obsessive thoughts cause intense anxiety.
- OCD compulsions: To control obsessions and anxiety, people with OCD turn to certain behaviors, rituals or routines. They do so repeatedly. They don’t want to perform these compulsive behaviors and don’t get pleasure from them. But they feel like they have to follow along or their anxiety will get worse. Compulsions only help temporarily, though. The obsessions soon come back, triggering a return to the compulsions. This loop leads to a constant cycle of anxiety.
Who gets obsessive-compulsive disorder (OCD)?
Everyone experiences obsessions and compulsions at some point. For example, it’s common to occasionally double-check the stove or the locks. Some people also just like things neat. But OCD is more extreme. It can take up hours of a person’s day. It gets in the way of normal life and activities.
OCD is fairly common, affecting about 1% of the population. It happens among people of all races and backgrounds, as well as both sexes. It usually starts when people are younger, from childhood to early adulthood.
Symptoms and Causes
What causes obsessive-compulsive disorder?
Scientists don’t understand exactly what causes OCD. Certain factors or events may increase a person’s chances of developing the condition, or cause an episode of OCD:
- Changes in living situation, such as moving, getting married or divorced, or starting a new school or job.
- Death of a loved one or other emotional trauma.
- History of abuse.
- Illness (if you get the flu, for example, you may start a cycle of obsessing about germs and washing compulsively).
- Low levels of serotonin, a natural substance in the brain that maintains mental balance.
- Overactivity in areas the brain.
- Problems at work or school.
- Problems with an important relationship.
What are the symptoms of obsessive-compulsive disorder?
The symptoms of OCD are obsessions and compulsions that interfere with normal activities. For example, symptoms may often prevent you from getting to work on time. Or you may have trouble getting ready for bed in a reasonable amount of time. A person with OCD may know they have a problem but can’t stop.
What are examples of obsessive thoughts?
Obsessions are unwanted, intrusive thoughts that cause intense anxiety. Examples include:
- Fear of germs or dirt.
- Fear of causing harm to someone else.
- Fear of making a mistake.
- Fear of being embarrassed in public.
- Feelings of doubt or disgust.
- Need for order, neatness, symmetry or perfection.
- Need for constant reassurance.
- Sexual thoughts that society may consider unacceptable.
What are examples of compulsive behaviors?
Compulsions are actions someone takes in an attempt to get rid of obsessions or anxiety. Examples include:
- Arranging things in a very specific way, such as items on your dresser.
- Bathing, cleaning or washing hands over and over.
- Checking certain things repeatedly, such as a lock or the stove.
- Collecting or hoarding things that have no personal or financial value.
- Constantly checking that you haven’t done someone harm.
- Counting repeatedly or saying certain words or prayers while doing other tasks.
- Eating food in a specific order.
- Refusing to shake hands or touch objects that other people touch a lot, like doorknobs.
- Performing a task a specific number of times, such as always flipping a light switch seven times.
People with OCD may also have tics — brief, sudden, repetitive movements or actions, like:
- Blinking their eyes.
- Jerking their head.
- Shrugging their shoulders.
- Sniffling their nose or clearing their throat.
Diagnosis and Tests
How is obsessive-compulsive disorder (OCD) diagnosed?
There’s no test for OCD. A healthcare provider makes the diagnosis after asking you about your symptoms. The provider uses criteria explained in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V).
People often use the phrases “obsessing,” “obsessed” and “OCD” very casually in everyday conversations. But OCD, according to the DSM-V, is diagnosed based on specific factors:
- The person has obsessions, compulsions or both.
- The obsessions or compulsions take up a lot of time (more than an hour per day).
- The obsessions or compulsions cause distress or affect participation in social activities, work responsibilities or other life events.
- The symptoms aren’t caused by drugs, alcohol, medications or another medical problem.
- The symptoms aren’t explained by another mental disorder (such as generalized anxiety disorder, eating disorder or body image disorder).
Management and Treatment
What treatments are available for obsessive-compulsive disorder (OCD)?
If you have symptoms of OCD that interfere with your daily life, you should talk to a healthcare provider. A professional who is specially trained in mental illness can offer several strategies:
- Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy is a type of psychotherapy. You will talk to a therapist, who will help you examine and understand your thoughts and emotions. Over several sessions, CBT can help you stop negative habits, perhaps replacing them with healthier ways to cope.
- Medications: Drugs called serotonin reuptake inhibitors (SRIs), selective SRIs (SSRIs) and tricyclic antidepressants may help. They increase levels of serotonin. Examples include clomipramine, fluoxetine, fluvoxamine, paroxetine and sertraline.
- Exposure and response prevention (EX/RP): With this therapy, you do the thing that causes anxiety. The healthcare provider then prevents you from responding with a compulsion. For example, the provider may ask you to touch dirty objects but then stop you from washing your hands.
What happens if CBT and medications don’t work for OCD?If OCD doesn’t respond to CBT and medication, a healthcare provider may try to improve mood, specifically depression, with these therapies:
- Electroconvulsive therapy (ECT): Electroconvulsive therapy uses electrodes that get attached to the head. These wires deliver electric shocks to the brain. The shocks cause small seizures, which help the brain release helpful chemicals.
- Transcranial magnetic stimulation (TMS): Transcranial magnetic stimulation uses a magnetic device placed on the head. It delivers electrical impulses to the brain. The impulses cause the brain to release chemicals known to improve mood.
Your provider might suggest using mindfulness to treat OCD and to improve the usefulness of other OCD treatments.
Can I prevent obsessive-compulsive disorder (OCD)?
You can’t prevent OCD. But early diagnosis and treatment can help you reduce its symptoms and its effects on your life.
Outlook / Prognosis
What is the outlook for people with obsessive-compulsive disorder (OCD)?
With medication, CBT or both, most people with OCD can manage obsessions and compulsions and enjoy life.
When should I talk to my healthcare provider about obsessive-compulsive disorder (OCD)?
Talk to your healthcare provider if you have obsessions or compulsions. Make sure to mention:
- How often you have symptoms.
- How long they last.
- Whether they make you late for work or social activities.
- Whether you avoid social situations because of anxiety.
- Whether you are using drugs or alcohol to cope.
- Be honest with your healthcare provider about how the symptoms influence your life. Treatments are more effective when your provider understands how the condition affects you.
A note from Cleveland Clinic
OCD doesn’t go away by itself, so talk to your healthcare provider about your symptoms. Be honest about any obsessions and compulsions and how they’re affecting your life. CBT and medications can help control your symptoms, so you can work, enjoy social activities and feel more productive.