Obsessive-Compulsive Disorder

Overview

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an illness that causes people to have unwanted thoughts (obsessions) and to repeat certain behaviors (compulsions) over and over again. We all have habits and routines in our daily lives, such as brushing our teeth before bed. However, for people with OCD, patterns of behavior get in the way of their daily lives.

Most people with OCD know that their obsessions and compulsions make no sense, but they can’t ignore or stop them.

What are obsessions?

Obsessions are ideas, images and impulses that run through the person’s mind over and over again. A person with OCD doesn’t want to have these thoughts and finds them disturbing, but he or she can’t control them. Sometimes these thoughts come just once in a while and are only mildly annoying. Other times, a person who has OCD will have obsessive thoughts all the time.

What are compulsions?

Obsessive thoughts make people who have OCD feel nervous and afraid. They try to get rid of these feelings by performing certain behaviors according to "rules" that they make up for themselves. These behaviors are called compulsions. (Compulsive behaviors are sometimes also called rituals.) For example, a person who has OCD may have obsessive thoughts about germs. Because of these thoughts, the person may wash his or her hands repeatedly. Performing these behaviors usually only makes the nervous feelings go away for a short time. When the fear and nervousness return, the person who has OCD repeats the routine all over again.

How common is OCD?

For many years, OCD was thought to be rare. Some recent studies show that as many as 3 million Americans ages 18 to 54 may have OCD at any one time. This is about 2.3% of the people in this age group. OCD affects men and women equally.

Symptoms

What are some common obsessions?

The following are some common obsessions:

  • Fear of dirt or germs

  • Disgust with bodily waste or fluids

  • Concern with order, symmetry (balance) and exactness

  • Worry that a task has been done poorly, even when the person knows this is not true

  • Fear of thinking evil or sinful thoughts

  • Thinking about certain sounds, images, words or numbers all the time

  • Need for constant reassurance

  • Fear of harming a family member or friend

What are some common compulsions?

The following are some common compulsions:

  • Cleaning and grooming, such as washing hands, showering or brushing teeth over and over again

  • Checking drawers, door locks and appliances to be sure they are shut, locked or turned off

  • Repeating actions, such as going in and out of a door, sitting down and getting up from a chair, or touching certain objects several times

  • Ordering and arranging items in certain ways

  • Counting to a certain number, over and over

  • Saving newspapers, mail or containers when they are no longer needed

  • Seeking constant reassurance and approval

Causes & Risk Factors

What causes OCD?

No one has found a single, proven cause for OCD. Some research shows that it may have to do with chemicals in the brain that carry messages from one nerve cell to another. One of these chemicals, called serotonin (say "sair-a-tone-in"), helps to keep people from repeating the same behaviors over and over again. A person who has OCD may not have enough serotonin. Many people who have OCD can function better when they take medicines that increase the amount of serotonin in their brain.

Treatment

How is OCD treated?

Combining therapy with medication is usually considered the most effective way to treat OCD.

Several medicines are available to treat OCD. These medicines are also often used to treat depression and include: clomipramine, fluoxetine, sertraline, paroxetine and fluvoxamine. These drugs can cause side effects such as dry mouth, nausea and drowsiness. Sometimes they also have sexual side effects. It may be several weeks before you see an improvement in your behavior.

Under the guidance of a trained therapist, behavioral therapy can also be used to treat OCD. In behavioral therapy, people face situations that cause or trigger their obsessions and anxiety. Then they are encouraged not to perform the rituals that usually help control their nervous feelings. For example, a person who is obsessed with germs might be encouraged to use a public toilet and wash his or her hands just once. To use this method, a person who has OCD must be able to tolerate the high levels of anxiety that can result from the experience.

Complications

Are other illnesses associated with OCD?

People who have OCD often have other kinds of anxiety, like phobias (such as fear of spiders or fear of flying) or panic attacks.

People who have OCD also may have depression, attention deficit hyperactivity disorder (ADHD), an eating disorder or a learning disorder.

Having one or more of these disorders can make diagnosis and treatment more difficult, so it’s important to talk to your doctor about any symptoms you have, even if you’re embarrassed.

Other Organizations

Questions to Ask Your Doctor

  • What is causing my OCD?

  • What is the best treatment for me?

  • Should I go into therapy?

  • Should I see a psychiatrist or psychologist?

  • Am I more likely to have depression or other mental health issues?

  • How can I best deal with my compulsions?

  • Will a medicine help?

  • Will I have to take medicine and be in therapy the rest of my life?

  • Is there anything I can do to help myself at home?