Obsessive-Compulsive Disorder

Last Updated April 2024 | This article was created by familydoctor.org editorial staff and reviewed by Robert "Chuck" Rich, Jr., MD, FAAFP

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is mental health disorder, such as anxiety disorder or depression. It causes unwanted thoughts (obsessions) and repetitive behaviors (compulsions). We all have habits and routines in our daily lives, such as brushing our teeth before bed. However, for people with OCD, excessive repetitive behavior gets in the way of their daily lives.

Most people with OCD know that their obsessions and compulsions make no sense. Yet, 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 bothersome. Despite this, they can’t control them. Sometimes these thoughts occur occasionally and are mildly annoying. Other times, a person who has OCD will have obsessive thoughts all the time.

What are compulsions?

Obsessive thoughts cause people who have OCD to feel nervous and afraid. They try to get rid of these feelings by performing certain behaviors that follow “rules” or “steps” 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. As such, the person may wash their hands repeatedly even if they are already clean.

Performing these behaviors usually 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.

Symptoms of obsessive-compulsive disorder

For many years, OCD was thought to be rare. Some recent studies show that it is more common than once thought. OCD affects men and women equally.

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 rearranging 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

What causes obsessive-compulsive disorder?

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 is called serotonin. It 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. OCD tends to run in families. Symptoms often begin in children or teens.

How is obsessive-compulsive disorder diagnosed?

If you believe that you have OCD, you should see your family doctor. They can help diagnose and begin treatment for OCD. Your family doctor may also arrange for you to see other mental health professionals such as a counselor or psychiatrist. Sometimes OCD can be confused with other disorders and your family doctor, with the other members of your healthcare team, can help make an early and accurate diagnosis.

An OCD diagnosis will be based on your symptoms. This includes your behavior, your obsessions and/or your compulsions. A mental health care professional will also consider how these affect or interfere with your daily life.

Can obsessive-compulsive disorder be prevented or avoided?

You cannot prevent OCD from starting. And once you have OCD, you will always have it. OCD is a chronic condition. But you can prevent the symptoms of OCD by following your treatment plan. You should also take any OCD medications exactly as they are prescribed. You should do this even if you are feeling better.

Obsessive-compulsive disorder treatment

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 anxiety and include:

  • Clomipramine
  • Fluoxetine
  • Sertraline
  • Paroxetine
  • 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. After doing this, they would be asked to limit hand-washing to one time. 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.

Living with obsessive-compulsive disorder

People who have OCD often have other kinds of anxiety. These can include 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)
  • Eating disorder
  • Learning disorder

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

Questions to ask your doctor

  • 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?
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