Obsessive-Compulsive Behaviors and Disorders: Symptoms, Treatment, and Support

Defining obsessive-compulsive disorder (OCD)

What is obsessive-compulsive disorder (OCD)? Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent, unwanted, disturbing thoughts (obsessions) and/or repetitive, ritualized behaviors that a person feels driven to perform (compulsions). Like a needle getting stuck on an old LP, OCD causes the brain to get stuck on a particular thought or action that it just can’t let go. People with OCD often say the symptoms feel like a case of mental hiccups that won’t go away.

The Obsessive Compulsive Foundation reports that 1 in 50 adults in the United States currently experiences OCD, and twice as many have experienced it at some point in their lives. Symptoms of OCD occur in people of all ages and may change in severity over time. Most people with OCD have both obsessions and compulsions, but a minority have obsessions alone (about 20 percent) or compulsions alone (about 10 percent). Compulsions generally accompany obsessions as a result of the brain’s attempt to dismiss or neutralize the obsessions.

Understanding obsessions

What are obsessions? Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in a person’s mind. The person does not want to have these ideas, finds them disturbing and intrusive, and usually recognizes that they don’t really make sense. They commonly crop up when someone is trying to focus on an intentional thought or activity.

People with OCD may worry excessively about dirt and germs and be obsessed with the idea that they are contaminated or may contaminate others. Or they may have obsessive fears of having inadvertently harmed someone else (perhaps while pulling the car out of the driveway), even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a particular way.

Some common obsessions include:

Fear of being contaminated by germs or dirt
Fear of causing harm to oneself 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

For a more detailed list of common obsessions, visit OCD symptom Inventory, and for a detailed discussion of how obsessions are experienced, visit Obsessions.

Understanding compulsions

What are compulsions? A compulsion is a repetitive behavior – a ritual – that a person feels driven to do and cannot seem to stop doing. Compulsions represent an attempt to manage an obsession by doing something to resolve it. For example, if someone is obsessed with being contaminated, that person might develop elaborate hand-washing rituals. If an obsessive worry is whether or not the door was locked, then a compulsive response might be to check the lock a certain number of times before leaving the house or going to bed.

The ritual is meant to bring relief from the anxiety caused by the obsession, though the ritual itself can cause anxiety if it becomes too demanding or time-consuming. Even if the ritual eases the discomfort caused by the obsession, it will probably return, and the person with OCD feels compelled to repeat the behaviors over and over again.

Some common compulsive behaviors are:

excessive double-checking
counting
hand washing
cleaning

ordering/arranging
touching
praying
hoarding

For a detailed list of common compulsions, visit OCD Symptom Inventory (scroll down to Compulsions on Page 3). For a fuller discussion of compulsion, visit Compulsions.

Signs and symptoms of obsessive-compulsive disorder (OCD)

What are the signs and symptoms of obsessive-compulsive disorder (OCD)? Most people, from time to time, go back and double-check that the iron is unplugged or the door is locked before leaving the house. That’s normal, but when someone worries constantly that the door is unlocked and makes a ritual out of checking the lock 40 times before being able to get in the car, that’s an indication that the person’s thoughts and behaviors have risen to the degree of obsessive-compulsive disorder (OCD). The adult with OCD recognizes his or her repetitive thoughts and behaviors as irrational but feels unable to break free from them.

OCD may be diagnosed when compulsive behaviors take up excessive time (an hour or more a day), begin to interfere with your normal activities, or cause great anxiety because they’re so demanding. See Symptoms for a more detailed description of OCD symptoms.

While the onset of obsessive compulsive disorder usually occurs during adolescence or young adulthood, younger children can manifest symptoms of OCD by showing the same behaviors adults with OCD exhibit.

It’s often misdiagnosed in youngsters and adults as another condition such as autism or is overlooked because it occurs with other disorders, such as depression, eating disorders, attention deficit disorders or Tourette’s syndrome. In addition, OCD is often underdiagnosed because people with OCD may feel embarrassed by their thoughts and behaviors and try (often successfully) to hide the signature behaviors of their condition or because they lack access to effective health care. On average, people with OCD see three to four doctors and spend over nine years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of seventeen years from the time OCD begins for people to obtain appropriate treatment.

For a fuller discussion of recognizing OCD in children and adolescents, see Obsessive-Compulsive Disorder in Children and Adolescents (general overview) and When Your Child Has Obsessive-Compulsive Disorder (specific advice).

Causes of obsessive compulsive disorder (OCD)

What are the causes of obsessive compulsive disorder (OCD)? Doctors aren’t certain of the causes of OCD. Many believe that all anxiety disorders are associated with feeling a lack of control that can be traced to the experience of insecure attachment in infancy and early childhood. The experience of insecure attachment can effect changes in the brain and also account for how the disorder may occur across generations in one family.

There is evidence that the brains of people with OCD are different from people who do not have the disorder. Recent research suggests a link between OCD and how the brain chemical serotonin is distributed among the brain’s synapses. One group of scientists using PET scans noted inappropriate activity in the basal ganglia of the brains of people with OCD. What doctors do know is that OCD is a medical disorder; it isn’t the fault of the person with OCD or the result of a weak or unstable personality.

Other factors that may influence the onset of OCD include:

Genetics: Links are still being studied, but the disorder does sometimes run in families, and identical twins have a 70 chance of sharing the disorder.
Becoming a mother: A woman may sometimes develop OCD or see a mild condition worsen after having a baby.
Illness may intensify fears about health and cleanliness and increase the compulsive activities associated with those fears, and abuse may lead to obsessions about violence or danger.
Major life changes: problems in work or school, changes in residence, relationship changes and other major life transitions can create new worries, fears and obsessions or stir up old feelings.
Streptococcal infection: Recent studies have shown that a streptococcal infection may trigger OCD in children.

Treatment and help for obsessive-compulsive disorder (OCD)

What treatment is available for OCD? OCD is not usually curable, but it is highly treatable, in that effective treatment can greatly reduce the occurrence of obsessive thoughts and compulsive rituals. A combination of behavior therapy and medication seems to offer the best long-term improvement.

Exposure Treatment and Response Prevention

A type of behavioral therapy called exposure and response prevention is generally the first line of treatment for OCD. In this treatment, you are repeatedly exposed to the source of your obsession. Then you are prevented from engaging in whatever compulsive ritual you use to reduce the anxiety brought about by your obsession. 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 up. 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.

Exposure treatment and response prevention is carefully planned out and controlled, with your therapist at your side to provide support. You will begin with a situation that provokes only a low level of anxiety. Once you’ve been exposed to this situation and have waited out the anxiety without engaging in your compulsion, you will move on to a more challenging situation. Continuing with the previous example, you might progress from touching the bathroom door handle to touching the toilet flush lever or even the toilet seat itself. With each successful exposure and response prevention, you’ll feel a greater sense of control over your obsessions and compulsions. Studies show that exposure and response prevention can actually “retrain” the brain to function differently, permanently reducing the occurrence of OCD symptoms. This type of behavioral therapy can even extinguish compulsive behaviors entirely.

According to the Academy of Cognitive Therapy, 75% of people who complete exposure and response prevention treatment experience improvement of their OCD symptoms.

For more information about this behavioral treatment, read What Is Exposure & Response Prevention? and Exposure and Response Prevention (ERP).

Cognitive Therapy

A cognitive component is often combined with the behavioral approach of exposure and response prevention. Cognitive therapy targets the OCD sufferer’s catastrophic thoughts and exaggerated sense of responsibility. According to OCD Action, “Cognitive therapy suggests that OCD results when an individual misinterprets intrusive thoughts or urges as a sign that not only will harm occur, but that they may be responsible for it through what they do or what they fail to do.” Therefore, a central task of therapy is to address these irrational thoughts and challenge them. See Treatments for OCD: Cognitive Therapy for an overview of the cognitive approach and useful treatment tools, including thought records. For more on how OCD leads to biased and unproductive ways of thinking, visit Cognitive Therapy for OCD: What It is, When to Use It and When Not!

To review the main ideas involved in a combined cognitive-behavioral approach to OCD treatment, read OCD-UK’s What is Cognitive Behavioural Therapy (CBT)?

Medication

Antidepressants that affect the neurotransmitter serotonin are the primary drugs used in the treatment of OCD. Antidepressants that affect both norepinephrine and serotonin are also effective. OCD medications can take 10 to 12 weeks to provide full symptom relief, so it’s important to give the drugs a full three month trial. Effective doses for OCD are usually higher than those needed for the treatment of depression. Although medication reduces symptoms in the majority of OCD sufferers, very few experience complete relief. Relapse rates are also high when the drug is discontinued. It is generally recommended that medication be combined with behavior therapy.

Selective Serotonin Reuptake Inhibitors (SSRIs) – SSRIs used to treat OCD include Prozac, Paxil, Luvox, Celexa, and Zoloft. These medications work by increasing the level of serotonin in the brain. Common side effects include decreased sex drive, nausea, agitation, and sleepiness. Luvox was the first SSRI approved by the FDA for OCD treatment.
Clomipramine – Clomipramine, also known by the brand name Anafranil, is a tricyclic antidepressant used to treat OCD. It works by inhibiting the reuptake of norepinephrine and serotonin. According to the University of Pennsylvania, while clomipramine is more effective than the SSRIs in treating OCD, it has more side effects. These include sleepiness, dry mouth, decreased sex drive, constipation, and difficulty urinating. Weight gain can also be a problem.

Visit the Obsessive Compulsive Foundation’s OCD Medication: Adults for a Q&A about dosages, side effects, and treatment success rates. To find additional facts about OCD drugs, including secondary medications used to augment the primary medication, see Treatments for OCD: Medications. For an overview of the pros and cons of treating your OCD with medication, read Helpguide's Anxiety Medications: Benefits and Risks.

Other Treatments for OCD

In addition to traditional behavioral therapy and medication, the following treatments are also used for OCD:

Family Therapy – Because OCD often causes problems in family life and social adjustment, family therapy is often advised. Family therapy promotes understanding of the disorder and can help reduce family conflicts. It can also motivate family members and teach them how to help their loved one.
Group Therapy – Group therapy is another helpful adjunct to individual therapy. Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.
Herbal Treatments – Certain herbal supplements such as kava, valerian, ginkgo biloba, and St. John’s Wort may be beneficial for mild cases of OCD. However, the effectiveness of these alternative OCD remedies has not yet been rigorously tested.
Psychosurgery – For severe, crippling cases of OCD that have not responded to medication or behavioral therapy, psychosurgery is a possibility. Cingulotomy is the most common technique used. This surgery involves removing a section of the brain called the cingulate cortex. Approximately 25-30% of people who undergo psychosurgery experience substantial improvement in their condition. However, this is a last-resort OCD treatment that is only considered after all other treatment possibilities have been exhausted. Psychosurgery also comes with the risk of serious side effects including seizures and personality changes.

See Obsessive-Compulsive Disorder Treatment and Treatment Options for OCD for more details, including strategies for treatment-resistant OCD. For questions to ask a potential therapist and a guide to finding professional help, read How to Choose a Therapist.

Coping with obsessive-compulsive disorder (OCD)

What self-help tips can help me cope with OCD? If you have OCD, you can help yourself in many ways. Educating yourself about the disorder is a vital first step. It’s also important to practice the cognitive-behavioral techniques you’ve learned from therapy on your own. Renowned OCD researcher Jeffrey Schwartz emphasizes the importance of self-treatment on a day-to-day basis. Visit The Four Steps to learn about his techniques for managing your responses to OCD. For more self-help skills you can practice on your own, read What to Do During Obsessing and Stopping Your Compulsions.

Self-Help Strategies for OCD
Educate yourself.	Learn everything you can about OCD. Read books on the disorder and talk to your therapist and doctor. The more you know, the better able you will be to manage your symptoms. You can find many books about OCD at local or online bookstores.
Practice the skills you’ve learned in therapy.	Using the skills you’ve learned in therapy, actively work toward eliminating your obsessions and compulsive behaviors. This is a challenge that requires commitment and daily practice.
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. 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.
Practice relaxation techniques.	Meditation, yoga, deep breathing, and other stress relief techniques may help reduce the symptoms of anxiety brought on by OCD. A form of meditation known as mindfulness may be particularly helpful to OCD sufferers. Read Helpguide's Stress Relief: Yoga, Meditation, and Other Relaxation Techniques to learn more.
Join a support group.	You’re not alone in your struggle with OCD, and participating in a support group is an effective reminder of that. In a support group, you can share your experience and learn from others who are going through the same thing you are. Visit Search for a Support Group to locate OCD support groups in your area.

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

How can I help a friend or family member with OCD? If your friend or family member has OCD, your most important job is to educate yourself about the disorder. Learn everything you can about the disorder and make sure your loved one has access to information about it as well. Share what you’ve learned with your friend or family member and let them know there is help available. Simply knowing the condition is treatable may provide enough motivation to get them into a therapist’s office.

The way you react to your loved one’s OCD symptoms also has a big impact. Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment. There’s no point in scolding someone with OCD or telling the person to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse. The best way to help a loved one cope with OCD is to be as kind and patient as possible. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person’s life.

The Mayo Clinic suggests the following tips if you live with someone with OCD:

Bring relevant books, tapes and other literature into your home. Encourage your loved one to read or listen to these presentations about obsessive-compulsive disorder. Often, your loved one already knows his or her behavior is irrational.
Be patient about the pace of progress. The severity of obsessive-compulsive disorder varies, as do recovery times.
Praise small successes. At first, decreasing hand washing time by 10 minutes a day may seem insignificant to some, but it may be a giant first step for a person with obsessive-compulsive disorder.
Refuse to participate in the person's rituals. Explain that doing so would only make the condition worse.
Don't become a baby sitter. Your loved one needs to know you trust him or her to be left alone at times — to not always be under your watchful eye.

Visit Help for Partners and Families and Family and Friends for more information on how to take care of yourself while helping your loved one with OCD.

Obsessive-compulsive personality disorder

What is obsessive-compulsive personality disorder (OCPD)? According to the National Institute of Mental Health, obsessive compulsive personality disorder (OCPD) is a condition characterized by a chronic preoccupation with rules, orderliness, and control. Individuals with OCPD are rigid perfectionists who believe there is one right way to do things, and any other way is wrong. They will do anything to avoid making an error, which means they have trouble making decisions, since they might make the wrong choices; completing tasks, because the final product might not be perfect; and delegating responsibility, as the persons to whom they assign tasks might not do them perfectly. They come off as judgmental, inflexible, emotionally withholding, stubborn, and lacking in generosity. These qualities, of course, can have devastating effects on personal and workplace relationships. See Obsessive-Compulsive Personality Disorder for a list of OCPD symptoms, and Obsessive Compulsive Personality Disorder: A Defect of Philosophy, not Anxiety for a detailed discussion of how obsessive compulsive personality disorder manifests itself and affects relationships with others, how it is different from obsessive compulsive disorder (OCD), and how it can be treated.

Although a person with OCPD may engage in compulsive rituals such as repetitive checking or ordering of objects, OCPD and OCD are very different problems. While OCD is an anxiety disorder, OCPD is a personality disorder in which seemingly compulsive behavior comes from the perfectionism and rigidity of the person with OCPD, not as a way to alleviate the anxiety caused by obsessions; a better name for the syndrome might be perfectionistic personality disorder. Most importantly, the person with OCD recognizes that his or her thoughts and behaviors are irrational and excessive. The person with OCPD, believing his or her way of life to be correct, doesn’t perceive a problem and often doesn’t seek help until or unless someone forces the issue.

OCPD is usually treated with individual psychotherapy or counseling that focuses on helping persons with this personality disorder accept themselves, change inflexible thinking, and get more in touch their feelings. While some people with OCPD are helped with SSRIs, medications generally are not part of the treatment. See Obsessive-Compulsive Personality Disorder Treatment for a fuller explanation of treatment for OCPD.

To Learn More: Related Helpguide Articles

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