What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder associated with obsessive, unwanted thoughts that cause feelings of significant distress and anxiety. OCD manifests as scary or uncomfortable intrusive thoughts and repetitive behaviors (compulsions), which serve to alleviate the anxiety.

For many sufferers with OCD, obsessions and compulsions can impair daily life and make it difficult to function normally. Although obsessive-compulsive disorder is common among the general public, less than 10% of individuals who experience obsessive thoughts and compulsive behaviors seek treatment for OCD.

What are the symptoms of OCD?

The symptoms of OCD can be divided into two categories: obsessions and compulsions. The severity of OCD symptoms can range from mild to severe.

Obsessions are persistent thoughts, mental images, sensations, or feelings that are uncomfortable, intrusive, and cause significant distress. Many individuals with OCD experience unwanted or scary thoughts or images. While individuals without OCD can dismiss unwanted thoughts without anxiety or discomfort, individuals with OCD cannot. The presence of obsessions can detrimentally affect the daily life of the sufferer. Common obsessions include:

• Contamination: Intrusive thoughts about being contaminated. Irrational fear of germs or chemicals.
• Hypochondriasis (illness anxiety): Irrational fear of having an illness. For example, individuals with illness anxiety may believe a small bump on the skin is cancer.
• Scrupulosity: Preoccupation with mortality or blasphemy.
• Losing control: Obsessive thoughts about losing control or going crazy, stealing, or breaking the law.
• Harm: Preoccupation with harming oneself or others or causing something terrible to happen.
• Perfectionism: Irrational fear of not doing something correctly or preoccupation with past mistakes and fears of failure.
• Transformation: Irrational fear of transforming into something or someone else or preoccupation with taking on the characteristics of friends, family members, or strangers.

Compulsions are behaviors performed to relieve the anxiety and discomfort associated with obsessive thoughts. Over time, individuals with OCD begin to associate the compulsion, or ritual, with the feeling of relief, making it difficult to resist impulses. Common compulsions include:

• Skin picking (dermatillomania): Repetitive picking at hangnails, blemishes, scabs, etc., even after bleeding or pain.
• Hair-pulling (trichotillomania): Pulling lashes, eyebrows, or hair from the scalp and other parts of the body.
• Cleaning: Excessive showering, cleaning, or handwashing, typically to avoid germs.
• Mental rituals: Reviewing events to ensure nothing terrible happened.
• Repetitive thoughts, words, or behaviors: For example, repeating your sibling’s name every time you pass by them to protect them.
• Eating rituals: For example, eating food in a specific order to avoid something bad from happening.
• Symmetry: For example, placing pens on a table at a 90-degree angle.
• Hoarding: Experiencing a significantly hard time when parting with items, even if the item is broken. Feelings of significant distress when parting with things.
• Repetitive behaviors: Repetitively touching, tapping or rubbing self or items. For example, bedtime routines may involve turning the lamp on and off five times before going to sleep.
• Self-damaging behaviors: Harmful behaviors such as obsessively and repeatedly hitting oneself.

How is OCD diagnosed?

Individuals must have recurring, irrational thoughts or mental images (obsessions) with behaviors that help relieve anxiety (compulsions). Under the Statistical Manual of Mental Disorders (DSM-5), the symptoms of OCD must take up an hour or more every day and cause impairment in daily life.

To meet the criteria outlined by the DSM-5, obsessions and compulsions must not be the result of related disorders. Examples include food rituals caused by an eating disorder, disturbing thoughts caused by schizophrenia, repetitive behaviors caused by tic disorders, or excessive phobias caused by panic disorder.

It’s important to note that not all repetitive behaviors or rituals are indications of OCD, and the diagnosis of OCD depends mainly on the function of the behavior. If behaviors or mental acts successfully reduce anxiety or distress, they are classified as compulsions under the DSM-5.

According to the American Psychiatric Association, OCD in early adulthood may appear to be inattention, not talking, acting out, or withdrawing. Because the symptoms of OCD can manifest differently in children and adolescents, it’s important to seek a diagnosis from a trained psychologist.

What is the best treatment for OCD?

The most effective treatment for OCD is exposure and response prevention (ERP), a form of cognitive-behavioral therapy (CBT). The treatment of OCD helps individuals identify the source of the mental disorder and how OCD is bothering them.

Exposure and response prevention involves a collaborative approach between an individual with OCD and their mental health provider, allowing individuals to realize how much control they have over their obsessions and compulsive rituals. Over time, the brain learns that anxiety can be relieved without compulsive behaviors.

Medication treatment options for OCD are also available. Depending on the severity of obsessive-compulsive symptoms, psychiatrists may prescribe selective serotonin reuptake inhibitors (SSRIs), antidepressants, or antipsychotics—including Prozac, fluvoxamine, and fluoxetine—to reduce OCD symptoms.

Other forms of psychotherapy, including acceptance and commitment therapy (ACT) and mindfulness, can also help individuals with OCD reduce obsessions, particularly intrusive thoughts. Support groups can also help sufferers realize that they are not alone in their struggles with OCD and eliminate stigma.

What should you look for in a therapist?

It’s important to find a mental health professional who’s been trained to treat individuals with OCD, anxiety disorders, substance abuse, and related disorders.

If you’re seeking treatment for OCD, consider reaching out to a psychologist through WithTherapy. WithTherapy connects each patient to a personalized shortlist of mental health professionals and uses science and research to match your preferences. We’ll connect you with a therapist you feel comfortable with, regardless of your preferences and requirements. One of the qualified therapists on the WithTherapy platform will help you understand your obsessions and compulsions and explore treatment options to help you live a fulfilling life.

Find a Therapist for Obsessive-Compulsive Disorder