Obsessive-compulsive disorder (OCD) is an anxiety disorder affecting around 1% of the adult population in the United States each year. OCD can range from mildly disruptive to severely distressing symptoms. These symptoms may lead to other problems like depression, work problems, relationship strain, and a lower quality of life. If left untreated, OCD can represent a serious impediment in your life.
Severe OCD may make it hard to attend to even routine daily activities. However, OCD is treatable, and treatment can lead to better-managed symptoms and a higher quality of life. Learn more about the signs, symptoms, and treatment options for obsessive-compulsive disorder.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is a mental health disorder characterized by obsessive thoughts and compulsive actions. It’s under the broader category of anxiety disorders, which are mental health issues that cause excessive worry, stress, fear, and panic. The anxiety that may come with OCD will center on obsessive, unwanted thoughts that are hard to shake off or stop thinking about. To relieve these thoughts, you may engage in compulsive actions. Not following through on compulsions can cause distress, anxiety, and even panic.
Ignoring obsessions can worsen the distress you experience. Urges and compulsions will continue to come back, even if you ignore them for a certain amount of time. OCD often works in a cycle. Stress may worsen obsessive thoughts, and the recurring obsessive thoughts and behaviors will cause more stress in your life, leading to more OCD symptoms.
OCD symptoms may focus on specific areas. Many people experience OCD symptoms that center on disease, germs, or contamination. It’s common for people to relieve this kind of OCD by compulsively washing their hands or their living space more than what would be necessary.
OCD can come with several consequences. Excessive compulsions can sometimes lead to medical complications. For instance, compulsive hand washing can cause your hands to be dry, chapped, and sore. Obsessive thoughts can make it difficult to focus on obligations in your daily life, and compulsive actions may make you late for important activities. Severe and even moderate OCD can harm your career, relationships, and other areas of your life.
You may be embarrassed by social stigma or otherwise reluctant to address OCD in your life, but it can be treated. Treatment can help you better manage symptoms and increase your quality of life.
Is OCD a Delusion?
There’s an important distinction between the obsessive thoughts of OCD and delusional thoughts that occur with mental health issues like schizophrenia or bipolar disorder. Delusional thoughts and beliefs are contrary to reality and maybe illogical. A person with a delusional thought will have a false belief that resists attempts to contradict it with logic, facts, and evidence. A person experiencing an obsessive thought because of OCD will know that it’s illogical or excessive. For instance, a paranoid delusion may cause you to truly believe there are germs everywhere and that you are in serious danger. Someone with OCD may have an obsessive thought that they are contaminated with germs, but they are also aware they are not really in mortal danger.
A person with OCD is not experiencing delusions, and they are likely fully aware that their obsessive thoughts and compulsive behaviors are illogical and unnecessary. Still, it is difficult to control their impulses, and compulsions may feel necessary if only to calm obsessive thoughts.
This awareness may cause people with OCD to become frustrated with their condition. For instance, someone compulsively washing their hands may have the desire to stop, they may be aware they are late for something, and yet they still cannot control the compulsion to continue washing.
What Are the Signs and Symptoms of Obsessive-Compulsive Disorder?
OCD symptoms are separated into two categories: obsessive symptoms and compulsive symptoms. These symptoms often play off one another. Though they are in separate categories, obsessive symptoms often play into compulsive symptoms. In some cases, it is possible to have only obsessive or only compulsive symptoms. Some people don’t realize their obsessive or compulsive symptoms are excessive, but managing them may take up a lot of time throughout your day. The “disorder” part of obsessive-compulsive disorder means your symptoms will interfere with functioning at school, work, or at home.
Obsessive symptoms involve repeated, persistent, and unwanted thoughts. The unwanted aspect of OCD is important. Many people who are enthusiastic about their work or hobbies may find their thoughts dominated by repeated and persistent thoughts about things they enjoy. However, this doesn’t count as an OCD symptom. Obsessive thoughts may be unpleasant, unnecessary, or disruptive. People often experience obsessive thoughts when they are trying to think about or focus on something else. They can make working, having a conversation, and many other activities more difficult. Obsessions can feed into compulsions. In an attempt to gain relief from obsessive thoughts, someone with OCD may engage in compulsive rituals.
Obsessive thoughts can cover a wide range of topics, but there are some common ones among people with OCD, including:
- Fear of germs or contamination
- Intolerance of uncertainty
- Discomfort with disorder or asymmetry
- Frightening thoughts about harming yourself or someone else
- Intrusive violent or sexual thoughts
Several signs and symptoms come with obsessive thoughts, including:
- Worry about touching and being contaminated by objects, especially if others frequently touch the object
- Doubts about routine habits like turning off the stove or locking the doors
- Discomfort with disorders like crooked picture frames or a disorganized desk
- Fear of losing control by acting violently, like driving your car into traffic
- Fear of losing control by acting inappropriately, like yelling something offensive
- Imagining unpleasant sexual images
- Imagining unpleasant violent images
- Avoidance of situations and places that could cause potential triggers
In mild cases, obsessions can become annoying or disruptive, but in more severe cases, they can be distressing. OCD can cause severe anxiety, sleeplessness, and even panic attacks. Without treatment, it can lead to worsening physical and mental health.
Compulsive symptoms involve actions you might take as rituals. These rituals are usually performed to address obsessive thoughts, but they may also reduce anxiety and self-soothe. While compulsive behaviors may offer temporary relief from compulsive thoughts, they aren’t pleasurable. In fact, compulsions may be disruptive, annoying, or even painful. While compulsions may be momentary, they may also involve highly regimented behaviors that you take throughout your day. For instance, you may feel compelled to count every stop sign on the way to work. If you miss one, you may feel obsessive thoughts about it.
In many cases, the rituals may not logically solve the problem presented by an obsessive thought, but you feel compelled to do them anyway. Again, a person with OCD is likely fully aware that compulsive rituals are unhelpful. Their need to do them may be more frustrating than soothing.
Compulsive symptoms can include the following:
- Ritualistic or excessive cleaning
- Excessive hand washing
- Persistent checking (stove, locks)
- Compulsive straightening up
- Repetitive words or phrases
- Rearranging items to face the same way
- Strict routines
People who are neat, orderly, or perfectionists may joke that they have OCD. However, there is a difference between being orderly and experiencing compulsive symptoms. Disorder may bother a neat person, and consistent disorder may even lead to stress, but not following through on compulsions to clean or straighten up won’t lead to significant distress. OCD compulsions can feel out of control and unstoppable to someone with the disorder. Ignoring compulsions can make it so that you can’t think about anything else.
As with other mental health problems, the major difference is disorder. If symptoms cause a disorder that hinders your functioning or quality of life, it’s time to see a doctor.
How Is Obsessive-Compulsive Disorder Diagnosed?
A doctor can diagnose OCD. No medical tests can definitively uncover OCD, but you should go through a medical exam and lab tests to check for other possible causes. For instance, some vitamin deficiencies can cause psychological issues, including anxiety.
Your doctor may also ask you a series of questions about your symptoms. It’s important to present your symptoms as accurately as possible to get an accurate diagnosis. You may want to make notes about your symptoms, when they occur, and how frequently they occur in the days leading up to your doctor’s visit.
Obsessive-compulsive disorder is an officially diagnosed mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition (DSM-5) offers the most recent set of criteria to help doctors diagnose patients that may have OCD. The fifth edition has also made changes since the DSM-4 that have broadened what could be diagnosed as OCD. The first criterion is the presence of obsessions, compulsions, or both. Obsessions and compulsions are further defined in the DSM.
Obsessions are recurrent and persistent thoughts that cause anxiety or distress. OCD also involves trying to ignore or neutralize obsessive thoughts with other thoughts or actions.
The fifth edition of the DSM dropped the requirement that the thoughts and impulses could not be related to real-life problems. In many cases, OCD symptoms center on real-life problems, though the obsessive thoughts about them will be excessive and disruptive.
The DSM defines compulsions as repetitive behaviors or mental acts that you feel driven to perform because of obsessive thoughts or strict self-determined rules. These compulsive tasks are done to relieve distress or prevent a feared outcome, even though the behaviors aren’t connected to what they are intended to address realistically.
A major component of an OCD diagnosis is distress. To be diagnosed with OCD, obsessive or compulsive symptoms must cause clinically significant distress or impairment in several aspects of life, including social or occupational functioning.
As with most mental health issues, the DSM includes the stipulation that your symptoms must not be better explained by other mental health disorders to be diagnosed with OCD. For instance, OCD may share many symptoms with other anxiety or mood disorders like generalized anxiety disorder, bipolar disorder, panic disorders, and others. It’s important to explore these other possible diagnoses with your doctor. It’s also important to explore physiological or substance-related causes.
Your doctor may also explore your thoughts on the beliefs you may have during obsessive-compulsive episodes. For instance, you may have the obsessive thought that you will contract a rare, deadly disease if you touch a doorknob and fail to wash your hands exactly 10 times. Your doctor may ask if you think those beliefs are probably false, probably true, or definitely true. OCD is distinct from delusional beliefs, and delusions may be better explained by another disorder.
What Are the Risk Factors?
Mental health disorders like OCD usually come with multiple contributing risk factors, rather than a single cause. As with most mental health problems, OCD is likely caused by a combination of genetic, environmental, and developmental factors. Like most mental health disorders, plenty of research must still be done to determine the exact causes and risk factors for OCD. But some factors are likely to contribute to the development of the disorder. Still, it’s important to note that the existence of OCD risk factors does not mean that OCD is inevitable. But knowing the risk factors can help you learn more about the disorder so that you can speak with your doctor when seeking an accurate diagnosis.
Here is a breakdown of the potential risk factors for OCD:
Genetics refers to traits inherited from your parents and grandparents through biology, rather than through learned behaviors. Though OCD is a psychological disorder, it likely involves biochemical components that you can inherit from your genes. As with many mental and behavioral disorders, genetics can play a major role in your potential risk factor for OCD. There is no definitive OCD gene that you can pinpoint to determine if you will experience the disorder. However, there are some alleles (variations of specific genes) that may make you more vulnerable to the development of OCD.
Genetic vulnerability doesn’t guarantee that you will develop OCD, but it can make you more vulnerable to environmental or developmental causes of OCD. Other diseases work this way as well. For instance, a genetic predisposition to lung cancer may not cause lung cancer to develop until a person smokes cigarettes.
Still, a genetic predisposition to OCD can serve as a warning to take care of your mental health and learn to avoid or cope with environmental and developmental risk factors that can trigger it. But how do you know if you have a genetic predisposition to OCD? Generally, a parent or grandparent with the disorder is a good indication that OCD is in your genes. There is still the possibility that those genes weren’t passed on.
Environmental factors can include influences in your home life, neighborhood, work, school, culture, country, and other outside influences. A major environmental factor in the development of OCD is stress. Stress can have a significant impact on mental health, and it frequently contributes to anxiety and mood disorders. Sources of stress that could contribute to the development of OCD include:
- Divorce (yours or your parents)
- A loved one’s death
- Difficulties at school
- Problems in your relationship
Traumatic events can also contribute to mental health problems like OCD. A 2011 study looked at childhood trauma and its effects on the development of OCD. The study found that trauma didn’t increase the severity of OCD symptoms. While there is a relationship between childhood trauma and OCD, the link may not be direct. Instead, it may have to do with problems with attachment and processing emotions.
A childhood disease called pediatric autoimmune neuropsychiatric disorder associated with strep (PANDAS) is also associated with higher OCD rates. This is a rare form of OCD that affects children after the strep bacteria leads to an autoimmune response that causes OCD symptoms. Childhood-onset OCD may be different from OCD in adults. In most cases, children can develop OCD symptoms between the ages of 8 and 12. However, PANDAS causes OCD.
Development is a combination of environmental and biological factors that occur during crucial periods of growth during childhood and adolescence. In some cases, internal or external factors can influence the way a child develops, which can have an impact on their OCD risk factors.
How Is OCD Treated?
There is no cure for OCD, and the condition’s symptoms may come and go throughout your life. However, treatment can help you better manage symptoms or clear them up altogether. However, even with treatment, it’s possible for OCD symptoms to return. Treatment for mental health disorders can be an ongoing process. It’s unlikely to find perfect treatment options right away, but it’s important not to get discouraged if the treatment process takes some trial and error. As you and your team of doctors and clinicians learn more about your symptoms and diagnosis, you may find more effective treatment options. But there is no one-size-fits-all treatment approach.
Getting the Diagnosis
OCD treatment will begin with a diagnosis. Your doctor will likely use the diagnostic criteria mentioned above. In addition to a physical examination to rule out other potential causes for your symptoms, you’ll go through a psychological evaluation. You’ll discuss thoughts, feelings, and emotions and how they may relate to behavior patterns. As your doctor learns more about your experience with your symptoms, they will get closer to a diagnosis. Once you have been diagnosed, your doctor will suggest treatment options. If your symptoms change or no longer seem consistent with your diagnosis, speak with your doctor. The most effective treatment will come with an accurate diagnosis.
Medications used to treat anxiety disorders may be effective in treating OCD. Antidepressants like fluoxetine may boost your mood and prevent anxiety-related symptoms from occurring. They may also improve your mood when dealing with OCD symptoms. The FDA has approved antidepressants to treat OCD. These medications are generally safe and well-tolerated with a low risk of dependence or substance use problems.
There are several psychotherapeutic options for treating OCD. These therapies can be used alongside or without the use of medications. Behavioral therapies, especially cognitive behavioral therapy, are used to treat many mental health issues, including OCD. CBT is used to help identify thoughts that lead to unhelpful behaviors. It’s also used to develop better-coping responses to the triggers that might cause OCD symptoms to develop.
Exposure and response prevention may also be used to treat OCD. This therapy involves exposing you to potential triggers to learn ways to cope with the negative emotions and symptoms they cause. For someone with OCD, this may involve something like exposure to dirt and effective coping mechanisms to avoid compulsive actions. You may also learn how to deal with triggered obsessive thoughts.