Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive thoughts (obsessions) and repetitive actions aimed at easing distress from these thoughts (compulsions). Therapies like cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and acceptance and commitment therapy (ACT) are frontline treatments for OCD. In some cases, medications like SSRIs and antipsychotics may be added to therapy to target OCD symptoms.
- Obsessive-compulsive disorder is a mental health condition that causes someone to experience cyclical symptoms, including intrusive thoughts and/or repetitive actions.
- There are several OCD subtypes, including religion, sex, contamination, perfectionism, harm, and hoarding.
- Therapies like CBT, ACT, and ERP are frontline treatments for OCD that can help someone change how they view feared stimuli.
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What is Obsessive-Compulsive Disorder (OCD)?
Obsessive-compulsive disorder, also known as OCD, is a mental health condition that leads someone to ruminate and worry over intrusive thoughts and engage in repetitive behaviors to cope. In cases of OCD, someone’s intrusive thoughts (known as obsessions) are closely related to their compulsive actions (referred to as compulsions). Individuals with OCD often experience continual distress and significant functional concerns as a result of their symptoms. [1] OCD commonly exists with other psychiatric conditions, which can lead someone to present with additional symptoms and have more difficulty seeking treatment.
OCD symptoms and subtypes
There are several subtypes within OCD, each of which is termed based on the content of their intrusive thoughts and the types of repetitive actions they engage in. Contamination-based OCD is one of the most well-known subtypes in the media, though there are others that lead someone to have entirely different presentations:
| OCD subtype | Intrusive thoughts | Compulsions |
|---|---|---|
| Harm OCD | Thoughts or urges to harm oneself or others | Repetitive reinforcement or checking of security measures, hiding sharp items |
| Religious OCD | Doubt regarding religious beliefs | An overt focus on morality, excessive online research |
| Symmetry or “Just Right” | Symmetry and perfectionism | Continual ordering or counting |
| Contamination OCD | Contamination via germs or contracting illnesses | Excessive cleaning, sanitizing, or hand-washing |
| Sexual OCD | Overly sexual thoughts or taboo sexual fantasies | Avoiding sex and intimacy, body or sensation checking |
| Relationship OCD | Doubting a relationship or excessively worrying about a partner cheating | Excessive reassurance seeking or online research |
While the focus of OCD thoughts and behaviors varies depending on the subtype someone has, people with this condition will display many of the same symptoms. As we mentioned earlier, someone must demonstrate two main symptoms in order to be diagnosed with OCD: obsessions and compulsions. Obsessions must be recurrent, intrusive, and unwanted images, urges, or thoughts, and compulsions are thoughts or actions used to suppress or cope with them. [1] In order to be classified as compulsions, the main purpose of these actions or thoughts must be to reduce distress or anxiety caused by the obsessive thoughts.
Both obsessions and compulsions must be time-consuming and should not stem from a medical condition, substance use, or another mental health concern. Specifically, OCD is diagnosed when a person’s obsessions and compulsions take more than one hour per day and interfere with their daily routine or ability to function.
Pediatric OCD
It’s not uncommon for the onset of OCD symptoms to begin in childhood. Sometimes, the onset is preceded by a traumatic or stressful event, or even an illness. Some children with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) may be mistaken for having OCD due to their similar presentations. [1] Children with PANDAS or PANS exhibit a drastic and severe onset of emotional lability, though the generalized anxiety they can also display may mimic that associated with OCD.
Research shows that children with OCD have difficulty describing their obsessions and lack insight into their condition. This understandably impacts the treatment process, as do co-occurring mental health concerns. Children with co-occurring mental health concerns also tend to have more severe OCD symptoms. [2]
Causes and risk factors
Women are around 1.6 times more likely to experience OCD than men. However, up to 25% of men with this condition show symptoms before the age of 10, whereas females tend to experience the onset during adolescence. [1] There may be a hormonal component to the condition, as women are at a greater risk of developing OCD during late pregnancy and the postpartum period. It is common for women whose OCD begins during this time to be misdiagnosed with postpartum depression, as the presentations may be similar and the two conditions can co-occur. [2]
Research shows that dysfunction in the basal ganglia may contribute to the development of OCD in some people. A few studies conducted on deceased individuals show structural differences in the orbitofrontal cortex of individuals who had OCD. [1] More research is needed to definitively locate neurological differences in this population. There is also a genetic component to OCD, and people who have a family history of OCD are more likely to develop the disorder.
How OCD disrupts daily life
The World Health Organization (WHO) notes that OCD is one of the top 10 conditions that cause disability, lowers quality of life, and leads to financial loss. [1] Individuals with OCD may experience impaired social engagement, as they may avoid situations or places that make them anxious.
It is common for people with OCD to struggle seeking treatment, and not addressing this condition leads to poorer outcomes. If OCD is not treated, it is more difficult for someone to manage their symptoms and break the repetitive cycle of obsessions and compulsions.
How OCD is diagnosed
Someone will receive an OCD diagnosis if they experience the above symptoms, which are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Mental health professionals will conduct a thorough clinical assessment to determine what symptoms are present, how they impact someone’s life, and the person’s family history. It is also a mental health professional’s responsibility to assess someone’s safety, as compulsions may pose a risk to individuals. [1]
In order to receive a diagnosis of OCD, someone must experience obsessions or compulsions (it is possible to have one and not the other) that significantly interfere with their daily life and engage in related behaviors that occupy one hour or more each day. Like all mental health disorders, only appropriately licensed providers are able to diagnose OCD, which usually occurs during the first scheduled appointment. In some instances, formal assessments and screenings may be used to determine an OCD diagnosis.
Differentiating OCD from other disorders
OCD may be confused with a similar condition called obsessive-compulsive personality disorder (OCPD). Individuals with OCD have cyclical symptoms, causing them to engage in compulsions to relieve the distress they feel from obsessions. Those with obsessive-compulsive personality disorder do not have obsessions or compulsions; they experience rigidity, control, and perfectionism. Someone with OCPD engages in behaviors they believe are more logical, whereas someone with OCD usually recognizes the disconnect between their actions and thoughts.
OCD may also be mistaken for generalized anxiety disorder (GAD), though compulsions are not characteristic of anxiety disorders. These two conditions share persistently anxious thoughts, though OCD is associated with the presence of compulsive behaviors and routines used to cope. [1]
OCD and SUD
Studies have explored the connection between OCD and substance use disorders (SUD), with research showing that 90% of individuals with OCD meet criteria for one or more other mental health concerns. Substance use disorders are among the most common types of conditions that co-occur with OCD. [1]
Some experts suggest that individuals with OCD may self-medicate with substances, which can lead to conditions such as SUD. However, there isn’t much research to support this theory. Regardless of the connection between these two conditions, OCD treatment is often complicated by the presence of another psychiatric condition, especially if that condition is not being managed.
Treatment options for OCD
Only 30-40% of individuals with OCD seek treatment, though professional mental health intervention is one of the best ways to manage symptoms and improve outcomes. [5]
Most mental health professionals recommend therapy, sometimes in addition to a selective serotonin reuptake inhibitor (SSRIs), as first-line treatments to treat OCD. SSRI is a type of antidepressant that, when prescribed in higher doses and for longer periods of time, is effective in managing OCD symptoms. Second-line pharmaceuticals for OCD include low-dose neuroleptic medications (often used to treat psychotic disorders) and tricyclic clomipramine (another type of antidepressant). [3]
In terms of psychotherapy options, the first-line treatments include exposure and response prevention (ERP), cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT). ERP has proven especially effCoping strategies and supportective in treating pediatric and adult cases of OCD. The goal of exposure and response prevention is to educate patients about their condition, challenge how they respond to feelings of distress, and learn that the content of their intrusive thoughts is not a threat. [4] CBT focuses on targeting unhelpful and inaccurate thought patterns and teaching more effective behavioral responses, and ACT works to help people respond more effectively to unwanted thoughts and distressing feelings.
Coping strategies and support
As with any mental health condition, individuals with OCD may struggle with feelings of isolation and hopelessness. Social support from trusted individuals can help people with OCD manage these feelings and receive encouragement throughout the treatment process. Some individuals with this condition also benefit from support groups, which can help them feel accepted and understood. In addition, techniques such as thought challenging, journaling, and mindfulness can supplement OCD treatment.
Loved ones of those with OCD should educate themselves about the condition in order to better understand how it affects a person. Parents of children with OCD may want to participate in family therapy, which offers specific parenting strategies and can increase communication among all parties.
When to seek professional help
Individuals with OCD should seek professional help if they find their symptoms are disrupting their daily life on a major scale. This may present as having difficulty performing at work or in school, experiencing changes in their ability to socialize, or other functional changes that are out of the norm for them. It is important to remember that individuals with OCD can lead a healthy, long life if they seek treatment and establish the proper support.
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