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Obsessive-Compulsive Disorder (OCD)

Symptoms and Treatment of Compulsive Behavior and Obsessive Thoughts

Obsessive-Compulsive Disorder (OCD)

It’s normal, on occasion, to go back and double-check that the iron is unplugged or your car is locked. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so excessive they interfere with your daily life. No matter what you do, you can’t seem to shake them. But help is available. With treatment and self-help strategies, you can break free of the unwanted thoughts and irrational urges and take back control of your life.

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational – but even so, you feel unable to resist them and break free.

Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a particular thought or urge. For example, you may check the stove twenty times to make sure it’s really turned off, wash your hands until they’re scrubbed raw, or drive around for hours to make sure that the bump you heard while driving wasn’t a person you ran over.

Understanding OCD obsessions and compulsions

Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.

Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive behaviors often end up causing anxiety themselves as they become more demanding and time-consuming.

Most people with obsessive-compulsive disorder (OCD) fall into one of the following categories:

  • Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
  • Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
  • Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.
  • Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
  • Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.

Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with your daily life and relationships.

Signs and symptoms of obsessive-compulsive disorder (OCD)

Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other.

OCD signs and symptoms: Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

  • Fear of being contaminated by germs or dirt or contaminating others.
  • Fear of causing harm to yourself or others.
  • Intrusive sexually explicit or violent thoughts and images.
  • Excessive focus on religious or moral ideas.
  • Fear of losing or not having things you might need.
  • Order and symmetry: the idea that everything must line up “just right.”
  • Superstitions; excessive attention to something considered lucky or unlucky.

OCD signs and symptoms: Compulsive behaviors

Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:

  • Excessive double-checking of things, such as locks, appliances, and switches.
  • Repeatedly checking in on loved ones to make sure they’re safe.
  • Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
  • Spending a lot of time washing or cleaning.
  • Ordering or arranging things “just so.”
  • Praying excessively or engaging in rituals triggered by religious fear.
  • Accumulating “junk” such as old newspapers or empty food containers.

Hoarding and other disorders

The compulsive behavior of hoarding—collecting and keeping things with little or no use or value—is a common symptom of people with OCD, even if the problem may not be severe. However, people with hoarding symptoms are more likely to also be suffering from other disorders, such as depression, PTSD, a specific phobia, skin picking, kleptomania, ADHD, tic disorders, or compulsive buying.

If you or a loved one has OCD, tell your doctor about any symptoms of hoarding, difficulty discarding junk, or obsessing about losing things.

Source: Journal of Psychiatric Research

Obsessive-compulsive disorder (OCD) symptoms in children

While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADD, autism, and Tourette’s syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.

Therapy as treatment for obsessive-compulsive disorder (OCD)

The most effective treatment for obsessive-compulsive disorder is often cognitive-behavioral therapy. Antidepressants are sometimes used in conjunction with therapy, although medication alone is rarely effective in relieving the symptoms of OCD.

Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD)

Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD) involves two components:

  1. Exposure and response prevention involves repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety. For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you learn that you don’t need the ritual to get rid of your anxiety—that you have some control over your obsessive thoughts and compulsive behaviors.
  2. Cognitive therapy focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.

Four Steps for Conquering Symptoms of Obsessive-Compulsive Disorder (OCD)

Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, offers the following four steps for dealing with OCD:

  • RELABEL – Recognize that the intrusive obsessive thoughts and urges are the result of OCD. For example, train yourself to say, "I don't think or feel that my hands are dirty. I'm having an obsession that my hands are dirty." Or, "I don't feel that I have the need to wash my hands. I'm having a compulsive urge to perform the compulsion of washing my hands."
  • REATTRIBUTE – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain. Tell yourself, "It's not me—it’s my OCD," to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
  • REFOCUS – Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior. Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior."
  • REVALUE – Do not take the OCD thought at face value. It is not significant in itself. Tell yourself, "That's just my stupid obsession. It has no meaning. That's just my brain. There's no need to pay attention to it." Remember: You can't make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behavior.

Source: Westwood Institute for Anxiety Disorders

Family therapy for OCD treatment

Because OCD often causes problems in family life and social adjustment, family therapy can often be beneficial.

  • Family therapy promotes understanding of the disorder and can help reduce family conflicts.
  • It can motivate family members and teach them how to help their loved one.

Group therapy for OCD treatment

Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.

Self-help for OCD tip 1: Challenge obsessive thoughts and compulsive behaviors

If you have obsessive-compulsive disorder (OCD), there are many ways you can help yourself in addition to seeking therapy.

Refocus your attention

When you’re experiencing OCD thoughts and urges, try shifting your attention to something else.

  • You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion.
  • At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change.

Write down your obsessive thoughts or worries

Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.

  • Keep writing as the OCD urges continue, aiming to record exactly what you're thinking, even if you’re repeating the same phrases or the same urges over and over.
  • Writing it all down will help you see just how repetitive your obsessions are.
  • Writing down the same phrase or urge hundreds of times will help it lose its power.
  • Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

Anticipate OCD urges

By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.

  • Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
  • When the urge to check arises later, you will find it easier to relabel it as “just an obsessive thought.”

Create an OCD worry period

Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.

  • Choose one or two 10 minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
  • During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
  • When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.
  • Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period.

Create a tape of your OCD obsessions

Focus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.

  • Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
  • Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.
  • By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.

Self-help for OCD tip 2: Take care of yourself

A healthy, balanced lifestyle plays a big role in keeping OCD behavior, fears, and worry at bay.

Practice relaxation techniques

While stress doesn’t cause OCD, a stressful event can trigger the onset of obsessive and compulsive behavior, and stress can often make obsessive-compulsive behavior worse.

  • Mindful meditation, yoga, deep breathing, and other stress-relief techniques may help reduce the symptoms of anxiety brought on by OCD.
  • Try to practice a relaxation technique for at least 30 minutes a day.

Adopt healthy eating habits

Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more anxious.

  • Eat plenty of complex carbohydrates such as whole grains, fruits, and vegetables. Not only do complex carbs stabilize blood sugar, they also boost serotonin, a neurotransmitter with calming effects.

Exercise regularly

Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise.

  • For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Aerobic exercise relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals.

Avoid alcohol and nicotine

Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Similarly, while it may seem that cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety and OCD symptoms.

Get enough sleep

Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.

Self-help for OCD tip 3: Reach out for support

Obsessive-compulsive behavior (OCD) can get worse when you feel powerless and alone, so it’s important to build a strong support system. The more connected you are to other people, the less vulnerable you’ll feel. Just talking about your worries and urges can make them seem less threatening.

Stay connected to family and friends

Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation can aggravate your OCD symptoms. It’s important to have a network of family and friends you can turn to for help and support. Involving others in your treatment can help guard against setbacks and keep you motivated.

Join an OCD support group

You’re not alone in your struggle with OCD, and participating in a support group can be an effective reminder of that. OCD support groups enable you to both share your own experiences and learn from others who are facing the same problems. For a searchable database of OCD support groups, see the Resources and References section below.

Helping a loved one with obsessive-compulsive disorder (OCD)

If a friend or family member has OCD, your most important job is to educate yourself about the disorder. Share what you’ve learned with your loved one and let them know that there is help available. Simply knowing that OCD is treatable can sometimes provide enough motivation for your loved one to seek help.

Tips for helping a friend or family member with OCD

The way you react to a loved one’s OCD symptoms can have a big impact.

  • Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment. Focus on the sufferer’s positive qualities and avoid making personal criticisms.
  • Don’t scold someone with OCD or tell the person to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
  • Be as kind and patient as possible. Each sufferer needs to overcome problems at their own pace. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person’s life.
  • Do not play along with your loved one’s OCD rituals. Helping the sufferer with rituals will only reinforce the behavior. Support the person, not their rituals.
  • Create a pact to not allow OCD to take over family life. Sit down as a family and decide how you will work together to tackle your loved one’s OCD symptoms. Try to keep family life as normal as possible and the home a low-stress environment.
  • Communicate positively, directly and clearly. Communication is important so you can find a balance between standing up to the OCD and not further distressing your loved one.
  • Find the humor. Seeing the humor and absurdity in some OCD symptoms can help the sufferer become more detached from the disorder. Of course, a situation is only humorous if the sufferer finds it funny, too.

More help for obsessive-compulsive disorder

Self-help for OCD

Treatment for OCD

Resources and references

General information about obsessive-compulsive disorder (OCD)

Obsessive-Compulsive Disorder: An Information Guide – Guide to the symptoms, causes, and treatment of OCD for people with the disorder and their loved ones. (Centre for Addiction and Mental Health)

OCD Guides – Download PDF guides for adults, teens, college students, and parents of children with OCD. The guides offer encouraging information about OCD and its treatment. (OCD Chicago)

What You Need to Know About Obsessive Compulsive Disorder (PDF) – Learn all about obsessive-compulsive disorder, including the signs, symptoms, and how it's treated. (International OCD Foundation)

Obsessive-compulsive disorder (OCD) in children

Obsessive-Compulsive Disorder in Children – Guide to obsessive-compulsive disorder in children, including common symptoms and behaviors. (KidsHealth)

Treatment for obsessive-compulsive disorder (OCD)

How to Find the Right Therapist – Guide to finding professional help for obsessive-compulsive disorder. Includes questions to ask a potential therapist. (International OCD Foundation)

OCD Medication – Fact sheet on medication for obsessive-compulsive disorder. Includes information about side effects and treatment success rates. (Understanding OCD)

Self-help and helping a loved one with obsessive-compulsive disorder (OCD)

What to Do During Obsessing and Stopping Your Compulsions – Offers self-help skills you can practice on your own and use to combat obsessions and compulsions. (Anxieties.com)

Dr. Jeffrey Schwartz's Four Steps – Overview of Dr. Jeffrey Schwartz’ four steps for dealing with obsessive thoughts and compulsive behaviors. (Westwood Institute for Anxiety Disorders)

Family and Friends – Information on how to take care of yourself while helping a loved one with obsessive-compulsive disorder. (OCD UK)

Help for Partners and Families – Advice on how to support a loved one with obsessive-compulsive disorder. (Centre for Addiction and Mental Health)

Support groups for obsessive-compulsive disorder (OCD)

Find a Support Group – A searchable database of OCD support groups. (International OCD Foundation)

Authors: Lawrence Robinson, Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: October 2014.