Obsessive Compulsive Disorder

OCD

What is OCD

Obsessive-compulsive disorder (OCD) is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both. People with OCD have time-consuming symptoms that can cause significant distress or interfere with daily life. However, treatment is available to help people manage their symptoms and improve their quality of life.

What are the signs and symptoms of OCD?

People with OCD may have obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that are intrusive, unwanted, and make most people anxious. Common obsessions include:

  • Fear of germs or contamination

  • Fear of forgetting, losing, or misplacing something

  • Fear of losing control over one’s behavior

  • Aggressive thoughts toward others or oneself

  • Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm

  • Desire to have things symmetrical or in perfect order

Compulsions are repetitive behaviors a person feels the urge to do, often in response to an obsession. Common compulsions include:

  • Excessive cleaning or handwashing

  • Ordering or arranging items in a particular, precise way

  • Repeatedly checking things, such as that the door is locked or the oven is off

  • Compulsive counting

  • Praying or repeating words silently

Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions. However, people with OCD generally:

  • Can’t control their obsessions or compulsions, even when they know they’re excessive.

  • Spend more than 1 hour a day on their obsessions or compulsions.

  • Don’t get pleasure from their compulsions but may feel temporary relief from their anxiety.

  • Experience significant problems in daily life due to these thoughts or behaviors.  

Some people with OCD also have a tic disorder involving repetitive movements or sounds. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Vocal tics include things like repetitive throat-clearing, sniffing, or grunting sounds. It is common for people with OCD to also have a diagnosed mood disorder or anxiety disorder.

OCD symptoms may begin anytime but usually start between late childhood and young adulthood. Most people with OCD are diagnosed as young adults.

The symptoms of OCD may start slowly and can go away for a while or worsen as time passes. During times of stress, the symptoms often get worse. A person’s obsessions and compulsions also may change over time.

People with OCD might avoid situations that trigger their symptoms or use drugs or alcohol to cope. Many adults with OCD recognize that their compulsive behaviors do not make sense. However, children may not realize that their behavior is out of the ordinary and often fear that something terrible will happen if they do not perform certain compulsive rituals. Parents or teachers typically recognize OCD symptoms in children.

If you think you or your child may have OCD, talk to a health care provider. If left untreated, OCD symptoms can become severe and interfere with daily life.

How is OCD treated?

Treatment helps many people, even those with the most severe forms of OCD. Mental health professionals treat OCD with medications, psychotherapy, or a combination of treatments. A mental health professional can help you decide which treatment option is best for you and explain the benefits and risks of each. 

Following your treatment plan is important because psychotherapy and medication can take some time to work. Although there is no cure for OCD, treatments help people manage their symptoms, engage in day-to-day activities, and lead full, active lives.

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavioral therapy and other related therapies, can be as effective as medication for many people. For others, psychotherapy may be most effective when combined with medication.

  • Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that helps people recognize harmful or untrue ways of thinking so they can more clearly view and respond to challenging situations. CBT helps people learn to question these negative thoughts, determine how they impact their feelings and actions, and change self-defeating behavior patterns. CBT has been well studied and is considered the “gold standard” of psychotherapy for many people. CBT works best when customized to treat the unique characteristics of specific mental disorders, including OCD.

  • Exposure and response prevention therapy (ERP): Research shows that ERP, a specific type of CBT, effectively reduces compulsive behaviors, even for people who do not respond well to medication. With ERP, people spend time in a safe environment that gradually exposes them to situations that trigger their obsession (such as touching dirty objects) and prevent them from engaging in their typical compulsive behavior (such as handwashing). Although this approach may initially cause anxiety, creating a risk of dropping out of treatment prematurely, compulsions decrease for most people as they continue treatment.

Children with OCD may need additional help from family members and health care providers to recognize and manage their OCD symptoms. Mental health professionals can work with young children to identify strategies for managing stress and increasing support so they can control their OCD symptoms.

Medication

Health care providers may prescribe medication to help treat OCD. The most common medications prescribed for OCD are antidepressants that target serotonin, a chemical transmitter in the brain involved in depression and OCD. The largest category of antidepressants is called selective serotonin reuptake inhibitors.

Antidepressant treatment can take 8–12 weeks before symptoms begin to improve, and treatment for OCD may require higher doses than are typically used to treat depression. For some people, these medications may cause side effects such as headaches, nausea, or difficulty sleeping. Most people with OCD find that medication, often in combination with psychotherapy, can help them manage their symptoms.

Your health care provider can adjust medication doses over time to minimize side effects or withdrawal symptoms. Do not stop taking your medication without first talking to your health care provider. They can work with you to monitor your health and adjust your treatment plan safely and effectively.

The most up-to-date information on medications, side effects, and warnings  is available on the U.S. Food and Drug Administration (FDA) website.