Highlights
- Obsessive-compulsive disorder (OCD) is a condition involving obsessive thoughts and compulsive behaviors
- The thoughts that OCD produces can become distressing and may prevent you from engaging with everyday activities
- OCD also involves rituals, which are used to distract from obsessive thoughts but can make life difficult
- Talking therapies and medications such as SSRIs are available to treat OCD
Throughout the United States, around 1.2 percent of adults experience obsessive-compulsive disorder (OCD). OCD can cause obsessive thoughts that become distressing. In order to manage those obsessive thoughts, rituals and habits that may make life difficult also become a common feature.
It’s possible to treat OCD through talking therapies, medications, or a combination of the two. The treatment method(s) used usually depend on how severe OCD is.
OCD Symptoms
OCD symptoms usually fall into three categories: obsessions, emotions, and compulsions.
Obsessions
Every person is capable of having an obsession. You may obsess about a particular sports team, for example. With OCD, obsessions can become distressing and all-encompassing.
Examples of obsessive symptoms include:
- Thoughts. You may think about situations and outcomes that are harmful. A common example is that someone will come to harm because of your actions. That thought may then stop you from taking certain actions.
- Images. Harmful images can include themes of infidelity or harming yourself or others. These images are often out of sync with your moral compass, so they can become traumatizing. You may worry about acting out the images, even when it’s unlikely you’ll do so.
- Ruminations. You may argue with yourself about decision making to the point where you can’t make a decision.
- Doubts. You might doubt that you’ve taken an action, so you need to return to be sure that you did it or make frequent checks. Or you might imagine that you have taken a harmful action, such as pushing someone into the road.
- Perfectionism. You might believe that not perfecting a task means that harm will come from it. Perfectionist beliefs can prevent you from engaging with everyday activities and meeting obligations.
Emotions
The anxiety associated with OCD can feel paralyzing. OCD can result in feelings of fear and tension. Depression, guilt, and disgust are also common.
When you suffer from OCD, you may find temporary comfort in rituals. When you engage in certain rituals, your negative emotions lift. However, the relief you feel is often temporary.
Compulsions
Compulsions are the actions that make it possible to gain temporary relief from the emotions associated with OCD. Although they may provide relief, they can impact day-to-day living.
Compulsions might include:
- Need for reassurance. You might seek repeated reassurance from others.
- Avoidance. When you’re aware that a certain situation or location causes distress, avoidance is common. A good example is driving; if you worry you’ll harm someone each time you’re behind the wheel, you may stop driving altogether.
- Thought correction. Replacing one thought with another can offer temporary relief. You may repeat a sentence over and over in your mind or go on a visual journey through a ritual.
- Checking. Performing multiple checks to ensure you’ve taken an action could become common. You might need to check that you’ve locked all the windows several times before going to work, for example.
- Hoarding. You may associate throwing away items, regardless of how useless they may be, with harm.
- Rituals. In order to feel comfortable with leaving the house, you might need to perform a ritual. A common example is arranging items in a particular order. When rituals become extreme, they can stop you from accomplishing tasks.
OCD Causes
Identifying what causes OCD is often complex. OCD’s roots can stem from life events, personality traits, or biological elements.
Life Events that Cause OCD
Both positive and negative life events can cause OCD.
- Pregnancy. Although pregnancy is a positive event for many, it has the potential to trigger OCD. OCD prevalence reaches nine percent by eight weeks and declines shortly after. Around nine percent also experience it by six months postpartum.
- Childhood. Experiencing childhood trauma, suffering from abuse, and being bullied can trigger OCD.
- Ongoing stress. Going through stressful events may either trigger OCD or make it worse.
- Familial links. Having a first-degree relative with OCD can raise a person’s risk by 11 to 32 percent.
Personality Traits
Although it’s important to not confuse being neat with having OCD, people who are meticulous may be more likely to develop it. Similarly, if you have exceptionally high standards, you may have the type of personality that OCD arises from.
Biological Causes of OCD
The biological links between certain genetics and neurotransmitters and OCD aren’t conclusive. However, there is evidence to suggest they exist.
- Brain structure. Links have been found between having a reduced left anterior cingulate cortex (ACC) and right orbitofrontal cortex (OFC) and experiencing OCD. The ACC and OFC are responsible for cognitive functions such as emotional expression and mood regulation.
- Neurotransmitters. Some evidence suggests that OCD sufferers have lower levels of oxytocin and other neurotransmitters in their cerebrospinal fluid (CSF). There is a link between having low serotonin levels and experiencing an increase in symptoms.
- Genetics. The high incidence of OCD diagnoses between first-degree relatives suggests a genetic link.
OCD Diagnosis
Doctors diagnose OCD using the criteria outlined in Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-V). As part of the diagnostic process, they will look for the following criteria:
- You’re experiencing obsessions and/or compulsions.
- Your obsessions and/or compulsions must take up more than an hour of your day.
- Obsessions and compulsions must also affect your work, educational, and/or personal life.
- The symptoms you experience aren’t stemming from medications, illicit substances, or alcohol.
- You’re not experiencing symptoms due to another disorder, such as schizophrenia or bipolar disorder.
OCD Complications
OCD can increase the risk of experiencing other psychological conditions. They can include:
- Depression. The ritualistic nature of OCD can result in a reduced ability to enjoy life, leading to depression.
- Eating disorder. Some rituals or fears surrounding foods may result in nutritional habits that constitute an eating disorder.
- Generalized anxiety disorder. Experiencing intrusive and obsessional thoughts can cause anxiety.
- Hoarding disorder. When OCD results in a person being unwilling to part with objects, they may develop a hoarding disorder. Around 1.5 to 6 percent of the population suffer from a hoarding disorder.
- Suicide. Eventually, the distress that accompanies OCD may result in suicide.
OCD Treatments
There are two main treatments for OCD: medications and talk therapies. Treatments usually require consistent commitment for a few weeks before they take effect. Evidence suggests that a combination of talking therapy and medication is necessary for severe OCD cases.
Therapies for OCD
Cognitive behavioral therapy (CBT) is a popular tool for treating OCD. It can be used on its own or alongside exposure and response prevention (ERP).
CBT aims to reduce the association between distress and the thoughts OCD causes. It also breaks the reliance on practicing rituals to reduce distress. CBT achieves this through challenging certain thought patterns.
Although ERP isn’t always used to treat OCD, it can prove successful. ERP requires the patient to encounter the thoughts and scenarios that trigger their symptoms, in a controlled environment. Over time, when the client learns that no harm comes to them, symptoms often lessen.
Medications for OCD
One frontline medication for treating OCD is a form of antidepressant medication: selective serotonin reuptake inhibitors (SSRIs). Drugs in this class include fluoxetine (Prozac), sertraline (Zoloft) and others.
A 2018 study found significant differences in the effectiveness of SSRIs, so talk to your doctor about which one might be right for you.
A review of existing studies suggests that targeting the endocannabinoid system can reduce OCD symptoms. Drugs that target the cannabinoid receptors in the body can reduce symptoms of anxiety and repetitive behaviors. However, only a very small number of human case studies specific to OCD exist, so it’s important to not experiment with such treatments without medical guidance.
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