What Is Obsessive-Compulsive Disorder (OCD)?

Table of Contents
View All
Table of Contents

Obsessive-compulsive disorder (OCD) is considered a chronic (long-term) mental health condition. This psychiatric disorder is characterized by obsessive, distressful thoughts and compulsive ritualistic behaviors.

A person with OCD commonly performs the same rituals (such as handwashing) over and over and may feel unable to control these impulses. These repetitive behaviors are often performed in an effort to reduce distress and anxiety.

How to Treat Obsessive-Compulsive Disorder (OCD)

Brianna Gilmartin / Verywell

Characteristics / Traits / Symptoms

The symptoms of OCD may involve characteristics of obsessions, behaviors that would indicate compulsions, or both. Symptoms are often associated with feelings of shame and concealment (secretiveness).

Common Obsessive Symptoms

In OCD, obsessions are defined as repetitive thoughts, urges, impulses, or mental images that cause anxiety or distress. These obsessions are considered intrusive and unwanted.

Common obsessions exhibited by those with OCD may include things such as:

  • Fear of getting germs from touching items perceived as being contaminated is exhibited by fear of touching things that others have touched, the fear of shaking hands, and more.
  • A strong need for order is exhibited by feelings of extreme anxiety when things are out of order or asymmetrical or when objects are moved by someone else and/or difficulty leaving the house (or the room) until objects are deemed perfectly placed.
  • Taboo thoughts often involve very troubling thoughts about topics such as sex or religion.
  • Aggressive thoughts often involve fear of harming others or self and may manifest as compulsive behaviors, such as being obsessed with news reports about violence.

A person who has OCD may attempt to ignore or suppress the thoughts, urges, or images via some other thought or action (such as performing compulsive actions).

Common Compulsive Symptoms of OCD

Compulsions can be defined as specific types of repetitive behavior or mental rituals that a person with OCD often engages in, to the point of being ritualistic. These repetitive behaviors help reduce distress that comes from obsessive thoughts.

There is a very strong compulsion to perform these repetitive actions and behaviors, and over time, they become automatic. A person feels driven to perform these repetitive behaviors as a way of either lowering anxiety or preventing a dreaded event from occurring

Compulsive behaviors may include repeatedly checking things, handwashing, praying, counting, and seeking reassurance from others.

Specific examples of common compulsions in people with OCD include:

  • Excessive handwashing or cleaning may include taking repetitive showers or baths each day.
  • Excessive organizing can include putting things in exact order or having a strong need to arrange things in a very precise manner.
  • Ritualistic counting numbers on the clock, the number of steps taken to reach a certain place or floor or ceiling tiles.
  • Repetitively checking on things may include checking doors and windows to ensure they are locked or checking the stove to make sure it’s turned off.

Most people (even those without OCD) have some mild compulsions—such as the need to check the stove or the doors a time or two before leaving the house.

With OCD, there are some specific symptoms that go along with these compulsions such as:

  • The inability to control the behaviors, even when the person with OCD is able to identify the thoughts or behaviors as not true or irrational
  • Spending at least one hour each day on the obsessive thoughts or behaviors
  • Engaging in behavior that results in distress or anxiety or erodes the normal function of important activities in life, such as work or social connections
  • Experiencing a negative impact in day-to-day life as a direct result of the ritualistic behaviors and obsessive thoughts

Common Traits of People With OCD

Some adults, and most children with OCD, are unaware that their behaviors and thoughts are abnormal. Young children are not usually able to explain the reason they have disturbing mental thoughts or why they perform ritualistic behaviors. In children, the signs and symptoms of OCD are usually detected by a teacher or a parents.

Commonly, people with OCD may use substances (such as alcohol or drugs) to lessen the stress and anxiety associated with their symptoms. The symptoms of OCD may change over time; for example, some symptoms will come and go, others may lessen, or they may get worse over time.

If you or a loved one are struggling with obsessive-compulsive disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see this National Helpline Database.

Diagnosis or Identifying OCD

There are no lab tests, genetic tests, or other formal physical tests for diagnosing OCD. A diagnosis is made after an interview with a skilled clinician who has been trained in diagnosing mental health conditions. This could be a licensed clinical social worker, a licensed psychologist, or a psychiatrist (a medical doctor specializing in the field of psychiatry). 

Here are the traits and symptoms that a qualified clinician will look for when formulating a diagnosis of OCD:

  • Does the person have obsessions?
  • Does the person exhibit compulsive behaviors?
  • Do the obsessions or compulsions take up a significant amount of the person’s time/life?
  • Do the obsessions or compulsions interfere with important activities in life (such as working, going to school, or socializing)?
  • Do the symptoms (obsessions or compulsions) interfere with a person’s values?

If the clinician finds that the obsessive, compulsive behaviors take up a lot of the person’s time and interfere with important activities in life, there may be a diagnosis of OCD. For this diagnosis to be made, the symptoms should not be attributable to a substance or other medical or psychiatric condition.

If you suspect that you or a friend or family member may have OCD, be sure to consult with your healthcare provider about the symptoms as soon as possible. When left untreated, OCD can impact all aspects of a person’s life. Also, keep in mind that early diagnosis and intervention equates to better treatment outcomes.

Causes

The exact cause of OCD is unknown, but new research is uncovering some evidence that points to why OCD occurs. This may help to provide insight into treatment options for OCD in the future.

Studies

A 2019 study examined the literature that has identified specific areas of the brain and the processes associated with the repetitive behaviors of those with OCD. This involved hundreds of brain scans of people with OCD and compared them with the brain scans of those who did not have OCD.

This is what the researchers discovered:

  • MRI brain scans revealed structural and functional differences in nerve circuits in the brains of those with OCD.
  • The brains of those with OCD were unable to use normal stop signals to quit performing the compulsive behaviors, even when the person with OCD knew they should stop.
  • Error processing and inhibitory control are important processes that were altered in the brain scans of those with OCD. These functions normally enable a person to detect and respond to the environment and adjust behaviors accordingly.

According to the lead study author, Luke Norman, Ph.D., “These results show that, in OCD, the brain responds too much to errors, and too little to stop signals. By combining data from 10 studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” says Norman.

Treatment

Early identification and prompt treatment of OCD is important. Treatment may be more effective when the disorder is diagnosed early. In many instances, a diagnosis of OCD is delayed. The symptoms of OCD often go unrecognized, partially because of the wide range of diverse symptoms. Also, many manifestations, such as obsessive thoughts, are kept secret by people who have OCD.

In fact, according to ­­­­­­­­­an older study published in the Journal of Clinical Psychiatry, it takes a person an average of 11 years to start treatment after meeting the diagnostic criteria for the disease.

A 2014 study, published by the Journal of Affective Disorders, discovered that early detection and treatment are known to result in better treatment outcomes.

Often, people with OCD experience significant improvement in symptoms with proper and timely treatment. Some people even achieve remission.

Cognitive Therapy

There are a variety of cognitive therapy modalities used to treat OCD.

Exposure and Response Prevention (ERP)

Exposure and response prevention is one type of cognitive therapy that is used to treat OCD. ERP aims to help people break the cycle of obsessions and compulsions to help improve their overall quality of life. This type of therapy encourages people with OCD to face their fears without engaging in compulsive behaviors.

Exposure and response therapy begins with helping people confront situations that cause anxiety. When a person has repeated exposure, it helps to lower the intensity of anxious feelings associated with certain situations that normally engender distress.

Starting with situations that cause mild anxiety, the therapy involves moving on to more difficult situations (the ones that cause moderate and then severe anxiety).

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy is a type of therapy that offers elements of ERT, and also includes a focus on the cognitive distortions and other problematic behaviors that are part of OCD.

The therapy can include 1-to-1 sessions with a therapist or group therapy; it’s also offered online by some providers.

Motivational Interviewing

Using motivational interviewing has been shown to increase engagement in therapy and improve outcomes for people with OCD in some studies.

In contrast to cognitive-behavioral therapies such as ERP. more open-ended and exploratory psychotherapies are generally not effective in the treatment of OCD.

Medication

There are several types of medication that can be prescribed to treat OCD. Selective serotonin reuptake inhibitors (SSRIs) are the preferred initial pharmacotherapy for OCD.

SSRIs include Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine). Tricyclic antidepressants such as Anafranil (clomipramine) may be used.

When taking SSRI’s, there are some basic guidelines that apply, these include:

  • People with OCD need a higher dosage of SSRIs compared to those with other types of diagnoses.
  • The dosage should start low and gradually increase, often over a four- to six-week time span until the maximum dosage is reached. 
  • Careful monitoring by the prescribing physician is important (particularly when higher than usual dosages are given).
  • The medication should be given for a trial period of eight to 12 weeks (with at least six weeks of taking the maximum dose). It usually takes at least four to six weeks, and sometimes up to 10 weeks to see any type of significant improvement.

Other medications, such as the atypical antipsychotics or clomipramine may be given to help potentiate the SSRI medication regime.

If you are prescribed medication for OCD, it’s important to:

  • Be closely monitored by a healthcare provider (such as a psychiatrist) for side effects and symptoms of comorbidities (having two or more psychiatric illnesses at one time) such as depression, as well as being monitored for suicidal ideation (thoughts of suicide).
  • Refrain from suddenly stopping your medication without the approval of your healthcare provider.
  • Understand the side effects and the risks/benefits of your medication. You can find some general information about these medications on the NIMH (Mental Health Medications) website.
  • Report any side effects to your healthcare provider as soon as they are noticed. You may need a medication change.

Coping

Coping with OCD can be challenging, for the person who is diagnosed with the disorder, as well as for the family members. Be sure to reach out for support (such as participating in an online support group) or talk to your healthcare provider or therapist about your needs.

You may need to educate friends and family members about OCD. Keep in mind that OCD is not something to be ashamed of. It is a medical problem that is not anyone's fault.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Fenske J, Petersen K. Obsessive-compulsive disorder diagnosis and management. American Family Physician. 

  2. Beyond OCD.org. Clinical definition of OCD.

  3. Beyond OCD.org. Clinical definition of OCD.

  4. International OCD Foundation. How is OCD diagnosed?

  5. National Institute of Mental Health. Obsessive-compulsive disorder.

  6. Gavin K. Stuck in a loop of wrongness: Brain study shows roots of OCD. University of Michigan (UOFM) Health Lab.

  7. Norman LJ, Taylor SF, Liu Y, et al. Error processing and inhibitory control in obsessive-compulsive disorder: a meta-analysis using statistical parametric maps. Biological Psychiatry. 2019;85(9):713-725. doi:10.1016/j.biopsych.2018.11.010

  8. Parmar A, Sarkar S. Neuroimaging studies in obsessive compulsive disorder: a narrative review. Indian Journal of Psychological Medicine. 2016;38(5):386-394. doi:10.4103/0253-7176.191395

  9. Pinto A, Mancebo MC, Eisen JL, et al. The Brown Longitudinal Obsessive Compulsive Study. J Clin Psychiatry. 2006;67(5):703–711. doi:10.4088/jcp.v67n0503 

  10. Visser HA, van Oppen P, van Megen HJ, et al. Obsessive-compulsive disorder. J Affect Disord. 2014;152–154:169–174. doi:10.1016/j.jad.2013.09.004

  11. OCD UK. What is exposure response prevention (ERP)?

  12. Lambert M. APA releases guidelines on treating obsessive-compulsive disorder. Am Fam Physician; 78 (1):131-135.

By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.