Last reviewed:
Nov 21st 2022
PharmD, BCPS
Obsessive-compulsive disorder (OCD) is a long-term mental health disorder in which a person experiences obsessive thoughts, compulsive behaviors, or both. Symptoms vary from person to person but often develop slowly, so they can be hard to spot at first, which can delay diagnosis. With effective treatment, however, it is possible to live well with OCD.
Obsessive-compulsive disorder is a relatively common and poorly understood chronic mental health disorder.
OCD is defined via the regularity of obsessive thoughts, sometimes called ruminations or intrusive thoughts, and the level to which they distress the person or stop them from getting on with day-to-day life.
Some people with OCD will also experience compulsions – a need to act on a specific behavior, often ritualistic, to deal with their thoughts and how they make them feel.
It is important to remember that neither set of symptoms are a choice - most people with OCD do not want to experience them.
People with obsessive-compulsive disorder often live in a heightened state of anxiety when left untreated. This is because their obsessions focus on fears that are believed to be stopped by doing certain behaviors (or compulsions) repeatedly and in a specific way.
For example, someone with OCD might obsess over the idea that someone will break into their house but believe that if they check the locks a certain number of times and test them in a specific way, they can stop this from happening.
Even for people who don’t have severe obsessive-compulsive disorder, these symptoms can be incredibly exhausting and time-consuming, taking up hours of their day. This makes it hard to get on with daily life and connect with the world around them.
OCD symptoms vary, but the diagnosis is characterized by experiencing obsessions, compulsions, or both. There is some debate among researchers about people who only experience obsessions, which is sometimes called 'Pure O'. [1]
Obsessive thoughts might include, but are not limited to, any of the following:
Compulsions might include, but are not limited to, any of the following:
There is evidence that specific obsessive-compulsive symptoms are more commonly experienced among children and young people. If you are concerned your child may be developing OCD, look out for things like:
About half of the people with obsessive-compulsive disorder first experience symptoms in childhood, but it can take a long time before someone is diagnosed. Be careful not to jump to conclusions but be alert to whether your child’s behavior could be a symptom of OCD because the earlier it is treated, the more effective the treatment will be. [2]
The exact causes of obsessive-compulsive disorder are unknown, but a combination of factors can mean that some people are more likely to experience it than others.
Some studies have shown that it is common for someone with OCD to be closely related to others who also have it, regardless of their diagnosis.
Some research has shown that people with obsessive-compulsive disorder may have experienced different brain development as children, with some parts of the brain not functioning at the same levels as people without OCD. [3]
Serotonin is a chemical in the brain that plays a role in many psychiatric disorders because it is responsible for helping us regulate our mood, sleep, and manage other vital bodily functions. For example, low levels of serotonin can be a trigger for OCD.
Sudden life changes can trigger obsessive-compulsive disorder, for example, the break-up of a significant relationship, grief, or work-related stress. In addition, some studies show a link between experiences of abuse and trauma, particularly in childhood, and the development of OCD.
One recent study also showed a link between people experiencing a head injury and developing obsessive-compulsive disorder symptoms. [4]
Some research suggests children are more likely to develop OCD symptoms after having ‘strep’ (a streptococcal infection), but no study has yet been able to identify why this happens. [5]
There is no way prevent OCD completely, but the earlier you seek help for your symptoms, the more likely you are to be able to manage them well and stop them from becoming severe.
Once you have agreed on a treatment plan with your doctor, do your best to try to follow it for the time you have decided before reviewing it again. Some people find it easier to stick to a plan when they are part of a peer support network where they can talk to others having similar experiences.
As far as possible, try to manage the stresses in your life and limit anything that you know can trigger obsessive-compulsive disorder symptoms, like working lots of overtime.
One type of treatment for OCD focuses on preventing and managing responses to triggers. It is called Exposure and Response Prevention (ERP). It is a talking therapy in which someone is gradually exposed to something that is a focus of their obsession, for example, a toilet that hasn’t been cleaned, and talks about how it is making them feel.
Over time, the person should learn to independently manage the distress that being near the object causes them without acting on the compulsion that accompanies it. Eventually, they should be able to apply this to real-life situations.
The earlier your start treatment for OCD, the more likely it is to work well. Different treatment works best depending on the person. Still, most people with obsessive-compulsive disorder find therapy, medication, or a combination of the two, to be an effective way to manage their symptoms.
A typical talking therapy that is prescribed to people with obsessive-compulsive disorder is Cognitive Behavioral Therapy (CBT), which addresses thought patterns and behavior. By addressing how your thoughts play out, your therapist can help you change the behavior that come from them.
Exposure and Response Prevention (ERP) is a type of CBT in which someone is gradually exposed to something that is a focus of an obsession until it becomes normalized.
You will most likely be prescribed antidepressant or anti-anxiety medication for OCD, alongside therapy. There are different varieties of OCD medication, but a commonly prescribed type is called selective serotonin reuptake inhibitors (SSRIs). These include:
Your doctor will work with you to determine the correct dose for you to start, and it can take several weeks of treatment to be fully effective. Because of this, patience is vital if you don’t see an immediate change. Similarly, do not stop your medication too quickly or without your doctor’s support if you think you no longer need to take it.
If you are concerned about any side effects you are experiencing from the medication, you should speak to your doctor or pharmacist immediately.
Some doctors might prescribe other forms of treatment if therapy and medication are ineffective. These can include:
There are lots of things you can do to look after yourself if you have obsessive-compulsive disorder, which will help to manage your symptoms and feel more in control of your diagnosis:
Don’t be too hard on yourself if you still find yourself acting on compulsions. Sharing your journey with another person can help to put this into perspective based on where you are at with your treatment.
Getting enough sleep has impacts on OCD symptoms, so try to get a similar amount of sleep each night at around the same time.
Other things that can make a difference in managing your symptoms are following a balanced diet and regularly exercising. This can begin with simple things like eating an extra piece of fruit each day or taking a walk around the block.
A meaningful way to practice self-care is to stick to your treatment plan. Some people find sharing their plan with a close friend or someone in their family, who will regularly check in on how they are getting on with it, can help with this.
Meditation and mindfulness can also be a good way to focus your mind and reduce the anxiety attached to this diagnosis.
Obsessive-compulsive disorder is a complex mental health condition, and knowing how best to support someone with this diagnosis can be challenging.
The most important thing to remember is that you don’t need to be a clinician or an expert. You simply need to listen to the person, do your best to understand what they are going through and not be judgmental.
If you can, try to work with the person to agree on a joint approach to their symptoms. For example, do they find it helpful for you to challenge them every time they act on a compulsion? Should you agree not to engage with particular questions about some of their obsessions, for example, if you are in a romantic relationship and they question your fidelity?
Though it might seem counterintuitive, helping someone with their compulsions can reduce anxiety around them because they become a shared process. This is called ‘accommodation.’
It is also important to look after yourself if someone close to you is experiencing OCD. Some people find it helpful to find a group of others caring for someone with this diagnosis, as it requires a lot of patience, and treatment can take time.
Obsessive-compulsive disorder can be successfully treated, lessening the impact on someone’s day-to-day life.
According to the DSM-5, people who believe more strongly in their obsessions and compulsions may have worse treatment outcomes. Similarly, without treatment, there is a limit to the extent someone with OCD will be able to engage in day-to-day life, like maintaining relationships and working. [7]
People with obsessive-compulsive disorder need to find ways to cope with the symptoms that work for them. This might mean a lot of planning or building up to things like taking public transport, but with the proper support from a therapist, who they can talk to about these experiences afterward, these things can become more normalized.
According to the American Psychiatric Association, around 2 to 3 percent of the U.S. population has OCD. No definitive data that suggests men or women are more likely to experience it, but symptoms usually start in childhood. [7]
Many people with obsessive-compulsive disorder have other mental health disorders, like depression, anxiety, or an eating disorder. [8]
Both OCD and anxiety are similar, but there are many key differences between the two. To find out more, read our article on OCD vs Anxiety.
It can be difficult to tell the difference between someone with obsessive-compulsive disorder (OCD) and someone with obsessive-compulsive personality disorder (OCPD).
The distinguishing factors can be:
There can be a lot of stigma and shame attached to the idea that any personality disorder is inherent in who someone is, as opposed to a mental health disorder they are experiencing. For this reason, it is important to be sensitive to someone who has this diagnosis or is in the process of seeking it.
Yes there are - obsessive compulsive disorder is a term that covers a broad spectrum of disorders. Other obsessive compulsive disorders include:
It’s important to note, whether you have been diagnosed with obsessive-compulsive disorder or are supporting someone with this mental health disorder, that it is a highly stigmatized and misunderstood mental health disorder. It is common in popular culture and general conversation to hear references to ‘being a bit OCD,’ for example.
While society’s understanding of some mental health disorders, like depression and anxiety, has developed a lot in recent years, OCD is not well understood, which may mean you face more barriers when explaining your diagnosis. This is why getting the right support is so important.
Recent research focused on the impact of the COVID-19 pandemic on OCD. Studies have evaluated those who were already struggling with symptoms and how these were managed during the height of the pandemic, and whether it contributed to an increase in diagnosis rates.
Many studies found the pandemic worsened symptoms for those who were previously experiencing them at a lower intensity, because of the prominence of public health guidance on contamination and rituals like hand washing, as well as the overall level of state control, for example, through lockdowns.
It is still unclear whether more people have developed OCD due to the pandemic. Many may not have recognized they were already experiencing low-level symptoms or had a predisposition to developing them. [9] [10]
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