- Obsessive-Compulsive Disorder (OCD)
- Are obsessive thoughts and compulsive behaviors interfering with your daily life? Explore the symptoms, treatment, and self-help for OCD.
- OCD obsessions and compulsions
- OCD signs and symptoms
- OCD self-help tip 1: Identify your triggers
- Tip 2: Learn to resist OCD compulsions
- Tip 3: Challenge obsessive thoughts
- Tip 4: Reach out for support
- Tip 5: Manage stress
- Tip 6: Make lifestyle changes to ease OCD
- Treatment for OCD
- How to help someone with OCD
- About Obsessive-Compulsive Disorder
- What’s an Obsession?
- What’s a Compulsion?
- Types of OCD
- About OCD
- What exactly are obsessions and compulsions?
- Learn More About OCD
- Obsessive-Compulsive Disorder
- What Is OCD?
- Why Do People Get OCD?
- What’s It Like for Kids With OCD?
- What Might Parents Notice?
- How Is OCD Diagnosed?
- How Is OCD Treated?
- What Can Parents Do?
- What is obsessive compulsive disorder?
- What are the symptoms and signs of obsessive compulsive disorder?
- What causes obsessive compulsive disorder?
- How is obsessive compulsive disorder treated?
- What Are Common Obsessions and Compulsions?
Obsessive-Compulsive Disorder (OCD)
Are obsessive thoughts and compulsive behaviors interfering with your daily life? Explore the symptoms, treatment, and self-help for OCD.
It’s normal, on occasion, to go back and double-check that the iron is unplugged or worry that you might be contaminated by germs, or even have an occasional unpleasant, violent thought. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life. OCD is an anxiety disorder characterized by uncontrollable, unwanted thoughts and ritualized, repetitive 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, OCD causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it’s really turned off because you’re terrified of burning down your house, or wash your hands until they’re scrubbed raw for fear of germs. While you don’t derive any sense of pleasure from performing these repetitive behaviors, they may offer some passing relief for the anxiety generated by the obsessive thoughts.
You may try to avoid situations that trigger or worsen your symptoms or self-medicate with alcohol or drugs. But while it can seem like there’s no escaping your obsessions and compulsions, there are plenty of things you can do to break free of unwanted thoughts and irrational urges and regain control of your thoughts and actions.
OCD obsessions and compulsions
Obsessions are involuntary 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 rituals and behaviors often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.
Most people with 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. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
OCD signs and symptoms
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 (at least one hour per day), and interfere with your daily life and relationships.
Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other.
Common obsessive thoughts in OCD include:
- Fear of being contaminated by germs or dirt or contaminating others
- Fear of losing control and harming 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
Common compulsive behaviors in 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
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 ADHD, 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.
OCD self-help tip 1: Identify your triggers
The first step to managing your OCD symptoms is to recognize the triggers—the thoughts or situations—that bring on your obsessions and compulsions. Record a list of the triggers you experience each day and the obsessions they provoke. Rate the intensity of the fear or anxiety you experienced in each situation and then the compulsions or mental strategies you used to ease your anxiety. For example, if you have a fear of being contaminated by germs, touching a railing at the mall might generate a fear intensity of 3, whereas touching the restroom floor in the mall might generate a 10 and require 15 minutes of hand washing to ease your anxiety.
Keeping track of your triggers can help you anticipate your urges. And 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 re-label it as “just an obsessive thought.”
Identifying and recording your triggers also provides an important tool for learning to resist your OCD compulsions.
Tip 2: Learn to resist OCD compulsions
It might seem smart to avoid the situations that trigger your obsessive thoughts, but the more you avoid them, the scarier they feel. Conversely, by repeatedly exposing yourself to your OCD triggers, you can learn to resist the urge to complete your compulsive rituals. This is known as exposure and response prevention (ERP) and is a mainstay of professional therapy for OCD.
ERP requires you to repeatedly expose yourself to the source of your obsession—and then refrain from the compulsive behavior you’d usually perform to reduce your anxiety. If you are a compulsive hand washer, for example, that could mean touching the door handle in a public restroom and then not allowing yourself to wash your hands. 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’ll learn that you don’t need the ritual to get rid of your anxiety and that you have some control over your obsessive thoughts and compulsive behaviors.
Tackling your biggest fears straight off might be too extreme, so ERP exercises start with you confronting lesser fears and then working your way up the “fear ladder.” Confront those situations that generate a low fear intensity and once you’re able to tolerate the anxiety you can move on to the next, more difficult exposure challenge.
Building your fear ladder. Think about your end goal (to be able to use a public restroom without fear of contamination, for example, or to drive to work without stopping to check if you’ve hit something) and then break down the steps needed to reach that goal. Using the information you recorded in identifying your triggers, make a list of situations from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you’re too intimidated to try it.
Sample fear ladder
|Goal: To drive to work without stopping to check if you’ve hit something|
|10||Drive all the way to work without stopping to check if you’ve hit something|
|8||Don’t phone your spouse to check they got to work safely|
|6||Leave the house, lock the front door and walk away without checking|
|4||Turn off the stove and leave the room without checking|
|2||Put milk in the refrigerator without checking the top is secure|
Using your fear ladder
Work your way up the ladder. Start with the first step and don’t move on until you start to feel more comfortable doing it. If possible, stay in the situation long enough for your anxiety to decrease. The longer you expose yourself to your OCD trigger, the more you’ll get used to it and the less anxious you’ll feel when you face it the next time. Once you’ve done a step on several separate occasions without feeling too much anxiety, you can move on to the next step. If a step is too hard, break it down into smaller steps or go slower.
As you’re resisting your compulsions, focus on the feelings of anxiety. Instead of trying to distract yourself, allow yourself to feel anxious as you resist the urge to engage in your compulsive behavior. You may believe that the discomfort you’re feeling will continue until you engage in the compulsion. But if you stick with it, the anxiety will fade. And you’ll realize that you’re not going to “lose control” or have some kind of breakdown if you don’t perform the ritual.
Practice. The more often you practice, the quicker your progress will be. But don’t rush. Go at a pace that you can manage without feeling overwhelmed. And remember: you will feel uncomfortable and anxious as you face your fears, but the feelings are only temporary. Each time you expose yourself to your trigger, your anxiety should lessen and you’ll start to realize that you have more control (and less to fear) than you thought.
Tip 3: Challenge obsessive thoughts
Everyone has troubling thoughts or worries from time to time. But obsessive-compulsive disorder causes the brain to get stuck on a particular anxiety-provoking thought, causing it to play over and over in your head. The more unpleasant or distressing the thought, the more likely you are to try to repress it. But repressing thoughts is almost impossible and trying usually has the opposite effect, causing the unpleasant thought to resurface more frequently and become more bothersome.
As with resisting compulsions, you can overcome disturbing, obsessive thoughts by learning to tolerate them through exposure and response prevention exercises. It’s also important to remind yourself that just because you have an unpleasant thought, that doesn’t make you a bad person. Your thoughts are just thoughts. Even unwanted, intrusive, or violent thoughts are normal—it’s only the importance you attach to them that turns them into damaging obsessions.
The following strategies can help you see your thoughts for what they are and regain a sense of control over your anxious mind.
Write down your obsessive thoughts. Keep a pad and pencil on you, or type on a smartphone. 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.
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.
- 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 go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions.
- When thoughts come into your head during the day, write them down and “postpone” them to your worry period.
Challenge your obsessive thoughts. Use your worry period to challenge negative or intrusive thoughts by asking yourself:
- What’s the evidence that the thought is true? That it’s not true? Have I confused a thought with a fact?
- Is there a more positive, realistic way of looking at the situation?
- What’s the probability that what I’m scared of will actually happen? If the probability is low, what are some more likely outcomes?
- Is the thought helpful? How will obsessing about it help me and how will it hurt me?
- What would I say to a friend who had this thought?
Create a tape of your OCD obsessions or intrusive thoughts. Focus on one specific thought or obsession and record it to a tape recorder 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.
Tip 4: Reach out for support
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. And just talking to an understanding person 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 will aggravate your OCD symptoms. It’s important to invest in relating to family and friends. Talking face-to-face about your worries and urges can make them feel less real and less threatening.
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.
Tip 5: Manage stress
While stress doesn’t cause OCD, it can trigger symptoms or make them worse. Physical exercise and connecting with another person face-to-face are two very effective ways to calm your nervous system. You can also:
Quickly self-soothe and relieve anxiety symptoms by making use of one or more of your physical senses—sight, smell, hearing, touch, taste—or movement. You might try listening to a favorite piece of music, looking at a treasured photo, savoring a cup of tea, or stroking a pet.
Practice relaxation techniques. Mindful meditation, yoga, deep breathing, and other relaxation techniques can help lower your overall stress and tension levels and help you manage your urges. For best results, try practicing a relaxation technique regularly.
Tip 6: Make lifestyle changes to ease OCD
A healthy, balanced lifestyle plays a big role in easing anxiety and keeping OCD compulsions, fears, and worry at bay.
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. Ten minutes several times a day can be as effective as one longer period especially if you pay mindful attention to the movement process.
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.
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.
Treatment for OCD
Cognitive-behavioral therapy is the most effective treatment for obsessive-compulsive disorder and generally involves two components:
- Exposure and response prevention, which requires repeated exposure to the source of your obsession, as explained above.
- Cognitive therapy, which 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.
Other OCD treatments
In addition to cognitive-behavioral therapy, the following treatments are also used for OCD:
Medication. Antidepressants are sometimes used in conjunction with therapy for the treatment of obsessive-compulsive disorder. However, medication alone is rarely effective in relieving the symptoms.
Family Therapy. Since OCD often causes problems in family life and social adjustment, family therapy can help promote understanding of the disorder and reduce family conflicts. It can also motivate family members and teach them how to help their loved one with OCD.
Group Therapy. Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.
Is unresolved trauma playing a role in your OCD?
In some people, OCD symptoms such as compulsive washing or hoarding are ways of coping with trauma. If you have post-traumatic OCD, cognitive approaches may not be effective until underlying traumatic issues are resolved.
How to help someone with OCD
The way you react to your loved one’s OCD symptoms can have a big impact on their outlook and recovery. Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment.
Avoid making personal criticisms. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
Don’t scold someone with OCD or tell them to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse.
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 rituals. Going along with your loved one’s OCD “rules,” or helping with their compulsions or rituals will only reinforce the behavior. Support the person, not their compulsions.
Keep communication positive and clear. Communication is important so you can find a balance between supporting your loved one and standing up to the OCD symptoms and not further distressing your loved one.
Find the humor. Laughing together over the funny side and absurdity of some OCD symptoms can help your loved one become more detached from the disorder. Just make sure your loved one feels respected and in on the joke.
Don’t let OCD take over family life. Sit down as a family and decide how you will work together to tackle your loved one’s symptoms. Try to keep family life as normal as possible and the home a low-stress environment.
About Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a brain-based anxiety disorder that causes considerable suffering and impairment.
What’s an Obsession?
Obsessions are ideas, thoughts, impulses, or images that keep coming back. They are not enjoyable, rather obsessions are unwanted and upsetting, causing severe anxiety or distress. The content of these obsessions is sometimes grouped into different areas, including: aggression (fears of harming others), contamination (fears of being dirty), sex, religion, and exactness. What separates OCD obsessions from normal obsessions experienced by everyone are the frequency, intensity, and discomfort. OCD sufferers attach much greater meaning and threat to these thoughts than others. The obsessions won’t just “go away.”
What’s a Compulsion?
In order to cope with the obsessions, people with OCD engage in repeated behaviors or thoughts, known as compulsions, to make themselves feel safer. Compulsions are rituals that the person believes reduce the risk of the obsessions coming true, or at least reduce the anxiety they produce. However, the compulsions are not really useful. They do not prevent the feared consequence or are clearly excessive. Compulsions or rituals take up so much time that they get in the way of work, school, and family obligations.
OCD has a wide range of varied symptom profiles. The table above presents a list of the most common obsessions and compulsions, as reported in the National Comorbidity Survey Replication (NCS-R), illustrating the breadth of symptom expression. Among those with OCD in the NCS-R study, 19% reported symptoms in just one area shown, 14.7% reported symptoms in two areas, 9.4% noted concerns in three areas, 30.3% endorsed concerns in four areas, and 26.6% identified concerns in five or more areas. And many people with OCD have more than one OCD type.
Types of OCD
Researchers have classified the many symptoms of OCD into four major categories:
- Contamination and Washing
- Doubts About Accidental Harm and Checking
- Symmetry, Arranging, Counting, and Just Right OCD
- Unacceptable Taboo Thoughts and Mental Rituals
Learn about the four types of OCD.
OCD is a disorder that has a neurobiological basis. It equally affects men, women, and children of all races, ethnicities and socioeconomic backgrounds. In the United States, about 1 in 40 adults and 1 in 100 children have OCD. And according to the World Health Organization, OCD is one of the top 20 causes of illness-related disability, worldwide, for individuals between 15 and 44 years of age.
What is OCD?
OCD is characterized by obsessions and compulsions that take up at least an hour a day – but usually longer – and cause significant distress.
Movies and television programs sometimes feature characters who are supposed to have OCD. Unfortunately, films and TV shows often mistake or exaggerate Obsessive Compulsive Disorder symptoms or play it for laughs. People with OCD know it’s no laughing matter.
Obsessions are persistent, uncontrollable thoughts, impulses, or images that are intrusive, unwanted and disturbing. They cause anxiety or discomfort that significantly interferes with normal life. A person who doesn’t have OCD is able to filter out recurring thoughts about germs, for example. But people with OCD who are obsessed with germs can’t stop thinking about being contaminated and may even avoid going into public places.
Individuals who have OCD feel compelled to perform repetitive actions called compulsions, or rituals, in an attempt to relieve the distress caused by the obsessions. For example, a person with an obsessive fear of intruders may check and recheck door locks repeatedly to ensure that no one can get in. Compulsions are frequently overt – something we can see. However, they may also be carried out mentally, such as mental praying or counting. And although we can’t observe them, mental rituals can be every bit as debilitating as those we can see.
Although most people with OCD realize their obsessions are irrational, they believe the only way to relieve their anxiety or discomfort is to perform compulsions. Unfortunately, any relief provided by the compulsions is only temporary and ends up reinforcing the obsession, creating a gradually-worsening cycle of OCD behavior.
Far too often, people with OCD suffer in silence, unaware that their symptoms are caused by a neurobiological problem. Like others who have illnesses such as asthma or diabetes, people with OCD can learn to manage their symptoms. The appropriate treatment produces changes in the brain by weakening old neurological pathways and strengthening new ones, allowing it to function more normally. Fortunately, research continually provides new information about finding ways to understand and treat OCD. And the prognosis for people who suffer from OCD is more hopeful than ever before.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides clinicians with official definitions of and criteria for diagnosing mental disorders.
- Read the Clinical Definition of OCD
Who is Affected by OCD?
Millions of people are affected by OCD. Current estimates are that approximately 1 in 40 adults in the U.S. (about 2.3% of the population) and 1 in 100 children have this condition.
- Learn more about who is affected by OCD
How Can I Tell If It’s OCD?
Obsessions are persistent and uncontrollable thoughts, impulses, or images that are intrusive, unwanted and disturbing. In response to the distress created by these obsessions, people with OCD perform certain mental or physical compulsions or rituals. Even though they usually realize that their obsessions are irrational, they feel compelled to carry out these rituals. Unfortunately, relief is only temporary, and the obsessive-compulsive cycle continues. And frustration, anger, and hopelessness often result.
- Learn more about OCD symptoms
What OCD Isn’t
To have a good understanding of what OCD is, it’s also important to understand what OCD is NOT. “OCD” is sometimes incorrectly used as a catch-all term to describe “obsessive” behaviors.
- Learn more about what OCD isn’t
What Causes OCD?
Current research reveals that the brains of individuals who have OCD function differently than the brains of those who do not.
- Learn more about what causes OCD
What Doesn’t Cause OCD
It’s only human nature to want to know what causes an illness. OCD is often misunderstood and, while researchers are now able to see physical differences in brain function in people with OCD, it’s also important to know what DOESN’T cause this disorder.
- Learn more about what doesn’t cause OCD
No laboratory test exists that can identify OCD. Mental health professionals frequently use diagnostic interviews to determine the presence of OCD as well as other tools that measure the severity of obsessions and compulsions, the most common of which is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
Although not a substitute for a formal evaluation and diagnosis provided by a qualified mental health professional, there is a self-screening test you can take to determine if you have symptoms similar to those associated with OCD and could benefit from professional help.
- Learn more about the OCD self-screening test
What Other Conditions May Co-exist with OCD?
A number of other mental health disorders frequently occur with OCD. In fact, people with OCD much more often than not have at least one other co-existing disorder. A trained mental health professional can diagnose and provide appropriate treatment for these conditions as well as OCD. These disorders include:
- Anxiety Disorders
- Major Depressive Disorder
- Bipolar Disorders
- Attention-Deficit/Hyperactivity Disorder (AD/HD)
- Feeding/Eating Disorders
- Autism Spectrum Disorder (ASD)
- Tic Disorders/Tourette Syndrome (TS)
Several disorders that tend to co-exist with OCD share many similarities with OCD and are listed in the same DSM-5 category as OCD: OCD and Related Disorders. These conditions should also be treated by a qualified mental health therapist:
- Body Dysmorphic Disorder
- Hoarding Disorder
- Trichotillomania (Hair-Pulling) Disorder
- Excoriation (Skin-Picking) Disorder
- Other Specified Obsessive-Compulsive and Related Disorders, e.g., body-focused repetitive behavior disorder (such as nail biting, lip biting, cheek chewing and obsessional jealousy).
Learn more about related conditions
What Kind of OCD Treatment Should I Look For?
Getting relief from OCD is possible with treatment that is available today. While there is no cure for the disorder, the most effective, evidence-based treatment for OCD is Cognitive Behavior Therapy (CBT). This treatment is recommended by nationally-recognized institutions such as the National Institutes of Mental Health, the Mayo Clinic, and Harvard Medical School.
- Learn more about Cognitive Behavior Therapy
Choosing A Therapist
Even mental health professionals with impressive credentials may lack the proper training to diagnose and treat OCD. Only a qualified cognitive behavior therapist can provide effective CBT. Before committing to treatment with any therapist, it’s critical to ask questions to help determine if he or she is competent to administer CBT for OCD.
- Learn more about choosing a therapist
Getting effective treatment can help most people with OCD achieve substantial relief from their symptoms and regain significant control over their daily lives. Unfortunately, getting the appropriate treatment, sticking with a treatment plan and maintaining treatment gains can be challenging. Knowing what to expect ahead of time can make a big difference in your success.
- Learn more about treatment challenges
Although the benefits of medication have not been shown to be as great as those of Cognitive Behavior Therapy, CBT in conjunction with medication is the most effective treatment for some individuals with OCD. Medications can help lower the anxiety associated with obsessions and reduce the urge to perform compulsions.
- Learn more about medication and OCD
- Clinical Definition of OCD
- Who Is Affected by OCD?
- What Is OCD?
- What OCD Isn’t
- What Causes OCD?
- What Doesn’t Cause OCD
- Related Conditions
- Cognitive Behavior Therapy
- Choosing A Therapist
- Treatment Challenges
- OCD Medication Information
- Medications Approved for Treatment of OCD
- OCD Self Screening Test
Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.
Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of obsessive compulsive disorder to be made, this cycle of obsessions and compulsions becomes so extreme that it consumes a lot of time and gets in the way of important activities that the person values.
What exactly are obsessions and compulsions?
Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.
Unfortunately, “obsessing” or “being obsessed” are commonly used terms in every day language. These more casual uses of the word means that someone is preoccupied with a topic or an idea or even a person. “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it. You can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession. In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms.
Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD. While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on. In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning.
Common Obsessions in OCD
Obsessions Related to Perfectionism
Unwanted Sexual Thoughts
Religious Obsessions (Scrupulosity)
Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.
Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions. You have to look at the function and the context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life. Behaviors depend on the context. Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Similarly, you may have “compulsive” behaviors that wouldn’t fall under OCD, if you are just a stickler for details or like to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like. In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions
Common Compulsions in OCD
Washing and Cleaning
Learn More About OCD
Who Gets OCD?
What Causes OCD?
How is OCD Diagnosed?
How is OCD Treated?
How Do I Find Help for OCD?
A compulsion is a behavior designed to reduce psychic distress or discomfort due to factors such as depression or anxiety. Individuals engaging in compulsions typically feel an irresistible need to engage in the compulsive behavior. Everyday behaviors such as hand-washing, praying, and counting can become compulsions.
Compulsions are commonly associated with substance abuse and obsessive-compulsive disorder. Individuals with these conditions engage in the compulsive behavior not because they want to, but because they feel that they have to. Compulsions may also be minor and not rise to the level of mental illness. Many people have mild compulsions such as the need to regularly exercise, to engage in a certain amount of work, or to count their steps. Compulsions only become a part of a mental health diagnosis when they create distress, interfere with normal life, and/or endanger a person’s health.
People with substance dependencies engage in compulsive use of substances despite health, financial, and emotional consequences. In the case of substance abuse, the compulsion is frequently engaged in to avoid obsessive thoughts of the substance or to alleviate the symptoms of withdrawal.
What is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is named for its obsessive and compulsive components. Obsessions are persistent, intrusive, and frequently unwanted thoughts that are usually the product of anxiety. Compulsions are the behaviors used to mitigate the obsessive thoughts. People with OCD engage in the compulsive behavior to relieve themselves of their obsessive thoughts. When they do not engage in the compulsive behavior, the obsessive thoughts persist.
Common examples of compulsive behaviors include:
- Performing actions according to particular intervals or patterns, such as bathing a particular number of times, tapping an object, or ensuring that a person has a certain number of a particular item
- Compulsive cleanliness such as repeated hand-washing, disinfecting, or cleaning
- Compulsive skin picking or hair pulling
Routines are not the same as compulsions. People may feel some mild discomfort when they deviate from their regular routines such as bedtime rituals, driving patterns, or grooming routines. However, people without OCD who engage in routines do them out of habit rather than to avoid obsessive thoughts.
Last Updated: 08-4-2015
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What Is OCD?
Obsessive-compulsive disorder (OCD) is a condition that causes kids to have unwanted thoughts, feelings, and fears. These are called obsessions, and they can make kids feel anxious. To relieve the obsessions and anxiety, OCD leads kids to do behaviors called compulsions (also called rituals).
What Are Obsessions?
Obsessions are fears that kids with OCD can’t stop thinking about. They may realize their thoughts don’t make sense, but they still feel anxious about certain things.
These fears might include whether:
- they, or someone else, will get sick, hurt, or die
- they said a bad word, had a bad thought, or made a mistake
- they have broken a rule, done a bad thing, or sinned
- something is clean, dirty, or germy
- something is straight, even, or placed in an exact way
- something is lucky or unlucky, bad or good, safe or harmful
What Are Compulsions?
Compulsions (rituals) are behaviors that kids with OCD do repeatedly. OCD causes kids to feel they have to do rituals to “make sure” things are clean, safe, in order, even, or just right. To kids with OCD, rituals seem to have the power to prevent bad things from happening.
Rituals include things like:
- washing and cleaning
- often erasing things, re-writing, re-doing, or re-reading
- repeating a word, phrase, or question much more than necessary
- going in and out of doorways several times in a row
- checking to make sure a light is off, a door is locked, or checking and re-checking homework
- touching or tapping a certain number of times, or a set way
- having things in a specific order
- counting to a certain ‘good’ number, avoiding “unlucky” numbers
Why Do People Get OCD?
Scientists don’t yet know why people get OCD, but they know biological factors play a role. Kids may get OCD because it’s in their genes or they had an infection. There may be differences in brain structures and brain activity in people with OCD. But whatever caused OCD, it’s not the child’s or parent’s fault.
What’s It Like for Kids With OCD?
Kids don’t always talk about the fears and behaviors OCD causes. They may feel embarrassed or confused about their fear and keep it to themselves. They may try to hide rituals they do. They may worry that others will tease them about their fears and rituals.
Kids with OCD feel unable to stop focusing on their obsessions. They feel like they have to do the rituals to guard against bad things they worry could happen. For some kids, doing a ritual is the only way they feel “everything’s OK.”
What Might Parents Notice?
Many kids have OCD for a while before parents, teachers, or doctors realize it. Parents might only learn about the OCD if their child tells them, or if they notice the child seems overly worried or is doing behaviors that seem like rituals.
Sometimes, parents may notice other difficulties that can be a result of OCD. For example, OCD can cause kids to:
- have trouble concentrating on schoolwork, or enjoying activities
- feel and act irritable, upset, sad, or anxious
- seem unsure of whether things are OK
- have trouble deciding or choosing
- take much too long to do everyday tasks, like getting dressed, organizing a backpack, completing homework, or taking a shower
- get upset and lose their temper if they can’t make something perfect or if something is out of place
- insist that a parent say or do something an exact way
How Is OCD Diagnosed?
To diagnose OCD, you’ll meet with a child psychologist or psychiatrist, who will interview you and your child to learn more details. You and your child also may fill out checklists and questionnaires. These will help the psychologist or psychiatrist make a diagnosis. There are no lab tests to diagnose OCD.
When OCD is diagnosed, it can be a relief to kids and parents. OCD can get better with the right attention and care.
How Is OCD Treated?
OCD is treated with medicine and therapy. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors), like Zoloft, Prozac, and Luvox.
Therapists treat OCD with cognitive behavioral therapy. During this kind of talk-and-do therapy, kids learn about OCD and begin to understand it better. They learn that doing rituals keeps OCD going strong, and that not doing rituals helps to weaken OCD. They learn ways to face fears, cope with them, and resist doing rituals. Learning these skills helps stop the cycle of OCD.
Part of treatment is coaching parents on how they can help kids get better. Parents learn how to respond to OCD situations, and how to support their child’s progress without giving in to rituals.
What Can Parents Do?
Talk with your child about what’s going on. Talk supportively, listen, and show love. Say something that works for your child’s situation like, “I notice you worry about your covers being smooth, your socks being even, and your shoes lined up. I notice it gets you stressed if you can’t fix things just so.”
Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what’s going on. Reassure your child that this can get better, and that you want to help.
Make an appointment with a child psychiatrist or psychologist. Your child’s doctor can help you find the right person.
Take part in your child’s therapy. Learn all you can about how parents can help when their child has OCD. Overcoming OCD is a process. There will be many therapy appointments, and it’s important to go to them all. Practice the things the therapist recommends. Encourage your child.
Get support, and give it. There are lots of resources and support for parents and families dealing with OCD. Knowing that you’re not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.
Reviewed by: Shirin Hasan, MD Date reviewed: June 2017
What is obsessive compulsive disorder?
Obsessive compulsive disorder (OCD) is a chronic anxiety disorder characterized by recurrent intrusive thoughts (obsessions) that may result in repetitive behaviors (compulsions).
Obsessive compulsive disorder is common. It affects over 2% of the population, more than one in 50 people. More people suffer from OCD than from bipolar depression.
Obsessions themselves are the unwanted, intrusive thoughts or impulses that seem to “pop up” repeatedly in the mind. These intruding thoughts can be fears, unreasonable worries, or a need to do things. When a person is tense or under stress, the obsessions can worsen.
Compulsions are the behaviors that may result from the obsessive thoughts. The most common compulsions include repetitive washing (hands or objects) and “checking” behaviors. Compulsions may be rituals, repeating certain actions, counting, or other recurrent behaviors. Some people with obsessive compulsive disorder are obsessed with germs or dirt.
What are the symptoms and signs of obsessive compulsive disorder?
People with obsessive compulsive disorder can have mild or severe symptoms. Those with mild obsessive compulsive disorder may be able to control their compulsive behaviors for certain periods of time (for example, at work) and may successfully hide their condition. However, in severe cases, obsessive compulsive disorder can interfere with social and occupational functioning and cause disability.
The symptoms of obsessive compulsive disorder often appear early in life. They most commonly begin in childhood, the teen years, or early adulthood. Males and females of all races are equally affected, and obsessive compulsive disorder generally persists throughout life, with fluctuations in severity.
What causes obsessive compulsive disorder?
While the exact cause of obsessive compulsive disorder is not known, scientific evidence points to a possible biological abnormality. Levels of brain chemicals called neurotransmitters have been shown to be imbalanced in people with OCD.
Obsessive compulsive disorder can also be accompanied by other anxiety disorders, depression, eating disorders, or other psychological conditions. Some people with obsessive compulsive disorder are able to understand that their thoughts and actions are unrealistic and inappropriate, while others lack this insight.
How is obsessive compulsive disorder treated?
Antidepressants that affect the neurotransmitter serotonin can provide relief for up to 75% of people with obsessive compulsive disorder. The most commonly prescribed drugs are the selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), sertraline (Zoloft), and fluoxetine (Prozac). Behavioral therapy can also be an effective treatment option. Psychotherapy for obsessive compulsive disorder may involve insight into the disruptive thoughts and impulses and confrontation with them in an attempt to control the associated compulsions.
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What Are Common Obsessions and Compulsions?
Everyday Health: What are some common obsessions and compulsions of people living with OCD?
Jeff Szymanski, PhD (ocfoundation.org)
Obsessions: Thoughts, images, or impulses that occur over and over again and feel out of the person’s control. The person does not want to have these ideas. He or she finds them disturbing and unwanted, and usually knows that they don’t make sense. They come with uncomfortable feelings, such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” They take a lot of time and get in the way of important activities the person values. Compulsions: Repetitive behaviors or thoughts that a person engages in to neutralize, counteract, or make their obsessions go away. People with OCD realize this is only a temporary solution, but without a better way to cope, they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values.
Common Obsessions in OCD
- Fear of acting on an impulse to harm oneself
- Fear of acting on an impulse to harm others
- Fear of violent or horrific images in one’s mind
- Fear of blurting out obscenities or insults
- Fear of stealing things
- Fear of being responsible for something terrible happening (examples: fire, burglary)
- Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself)
- Concern about evenness or exactness
- Concern with a need to know or remember
- Fear of losing or forgetting important information when throwing something out
- Inability to decide whether to keep or to discard things
- Fear of losing things
Unwanted Sexual Thoughts:
- Forbidden or perverse sexual thoughts or images
- Forbidden or perverse sexual impulses about others
- Obsessions about homosexuality
- Sexual obsessions that involve children or incest
- Obsessions about aggressive sexual behavior towards others
Religious Obsessions (Scrupulosity):
- Concern with offending God, or concern about blasphemy
- Excessive concern with right/wrong or morality
- Concern with getting a physical illness or disease (not by contamination, e.g., cancer)
- Superstitious ideas about lucky/unlucky numbers, certain colors
Common Compulsions in OCD
Washing and Cleaning:
- Washing hands excessively or in a certain way
- Excessive showering, bathing, tooth brushing, grooming or toilet routines
- Cleaning household items or other objects excessively
- Doing other things to prevent or remove contact with contaminants
- Checking that you did not/will not harm others
- Checking that you did not/will not harm yourself
- Checking that nothing terrible happened
- Checking that you did not make a mistake
- Checking some parts of your physical condition or body
- Rereading or rewriting
- Repeating routine activities (examples: going in or out doors, getting up or down from chairs)
- Repeating body movements (example: tapping, touching, blinking)
- Repeating activities in “multiples” (examples: doing a task three times because three is a “good,” “right,” “safe” number)
- Collecting items that results in significant clutter in the home (also called hoarding)
- Putting things in order or arranging things until it “feels right”
- Telling, asking, or confessing to get reassurance
- Avoiding situations that might trigger your obsessions
Jonathan Abramowitz, PhD (jabramowitz.com)
Common obsessions include: fears of contamination/germs, causing harm (perhaps by hitting someone with a car that you don’t mean to), making mistakes (leaving the door unlocked), disasters (causing a fire), certain numbers (such as 13 and 666), unwanted violent thoughts (thought of harming a loved one), blasphemous thoughts (cursing God), sexual thought (what if I’m a child molester, gay, or want to have sex with my mother?), need for symmetry and exactness, and thoughts that something is terribly wrong with your body (what if I have cancer?). A general theme is that obsessions concern situations where there is some degree of uncertainty (what if “X” happens and I didn’t do enough to prevent it?) Compulsive rituals are all about trying to get reassurance and certainty. For example, washing to remove germs, praying to counter blasphemous or sacrilegious thoughts that could result in going to hell, checking for assurances that doors are locked or people are OK, putting things in order (arranging), repeating other behaviors to get rid of a thought (turning a light off and on until a bad thought goes away). Also common are mental rituals that take place purely in the person’s mind.
Steven J. Brodsky, PsyD (OCDHotline.com)
There are thousands of forms of OCD, as unique as each individual. They are not limited to the ones you see on TV with themes of checking, germaphobic cleaning, ordering, perfectionism, hoarding, and hypochondriasis, etc. They can also involve body dysmorphic disorder, scrupulosity, religious OCD, relationship OCD (ROCD) in which people wonder if they love their partner or vice versa, HOCD (homosexuality OCD) in which the sufferer doubts his or her sexual orientation. OCD can even take a nonsense form, with unanswerable metaphysical questions, a song that sticks in your mind, thinking about one’s swallowing or blinking, etc.
Charles H. Elliott, PhD, and Laura L. Smith, PhD (psychology4people.com)
Common obsessions include fears about contamination, worries about having left appliances on or doors unlocked, fear of acting in shameful or humiliating ways, discomfort about things being out of order, extreme concerns about superstitions such as unlucky numbers or colors, and excessive worries about keeping objects of all kinds. Common compulsions include excessive cleaning and hand washing; repeatedly checking doors, locks, appliances, and such; rituals designed to ward off contact with superstitious objects; using prayers or chants to prevent bad things from happening; arranging and rearranging objects; and hoarding huge numbers of ordinary objects.
Kenneth Schwarz, PhD (DutchessPsychology.com)
Some common obsessions have to do with becoming contaminated, being or becoming too aggressive, having persistent sexual thoughts, being susceptible to injury or disease. There is also religious scrupulosity, where a person has unwanted, blasphemous thoughts that she must work hard to keep under control, and out of her mind, so she doesn’t just blurt them out – which is what makes her so anxious. The common element in all these obsessions are persistent, unwanted thoughts that cause a person considerable anxiety. Common compulsions used to get rid of these obsessions come under the headings of checking, cleaning, decontamination rituals, counting, and putting or keeping things in a certain order.
Charlotte M. Scott (custommovesolutions.com)
Common obsessions and compulsions that many are familiar with include the fear of germs and sickness, constant hand washing, using bleach wipes to handle everyday objects that other people have touched, and an overwhelming compulsion to clean and possibly hoard. A person may be filled with anxiety walking across a soccer field and seeing orange peels, candy wrappers, or empty water bottles and desperately wants to rid the field of the trash and clutter, yet the stronger obsession of not touching the items because of germs and bacteria creates the need to control others to pick up the items. Many people with OCD become hoarders triggered by the death of a loved one and the feeling that they must keep everything to protect the memories.
Barbara Tako (clutterclearingchoices.com)
Someone with OCD might be afraid to throw anything away and have strong emotional attachments to many things they own. On the other end of the scale, someone with OCD might turn down a coffee date or other social activity to stick with their cleaning schedule.
Allen H. Weg, EdD (stressandanxiety.com)
The most common obsessions are worries that something is “contaminated” which results in excessive avoidance or excessive washing. Another common compulsion is checking behavior, which results when a person’s obsession makes him not feel sure about something (e.g., “Is it locked?” “Is it turned off?” “Did I leave that thing behind?”) Other obsessions may have to do with sexual identity (“Am I gay?”) which results in attempts to seek reassurance that one is not gay. Also, fear of loss of impulse control, or a sense that one will act out and do something “crazy,” resulting in obsessions such as “maybe I will grab a knife and kill someone before I realize what I am doing,” or ” maybe I will just fling my body off of a high place and kill myself.” These obsessions result in people avoiding sharp objects or knives, or places of perceived danger, such as the kitchen, or high places. Besides Checkers, Hoarders, and Aggressive OCD, as depicted above, there is also ordering OCD, counting OCD, symmetry OCD, and hoarding OCD (though research has of late been demonstrating that this last form may be a different disorder altogether).
Obsessive Compulsive Disorder (OCD) is an anxiety disorder. It involves intrusive and unwanted thoughts and the repetition of certain actions. Although people with OCD may understand their thoughts and actions are irrational, they cannot seem to stop them.
What are Obsessions?
Obsessions are thoughts or images that will not go away. An obsession is intrusive and normally seen as irrational, but the person with OCD is not able to stop or ignore these thoughts. Some common obsessions include the fear of becoming sick from germs or consistently worrying about whether the stove was turned off when they left the house. People with OCD often feel fear along with the obsessive thoughts.
Sometimes obsessions will be mild, only occurring once in a while. Other times obsessive thoughts will be constant. The thoughts can sometimes intrude into a person’s daily life and are unwanted.
Obsessive thoughts can interfere with daily life, causing strain in relationships and in the workplace.
Some common obsessions include:
- Fear of dirt
- Fear of becoming ill
- Constant thoughts of a certain number
- Need to have something done in a certain order or a certain way
- Fear of germs
- Worry about whether something has been done “right”
What are Compulsions?
While obsessions are recurring thoughts, compulsions are recurrent actions. Mostly these will be quite mild but in more extreme cases they may develop as a means for people to try to relieve themselves from their obsessive thoughts. For example, when there is an obsession with germs, a person may continually wash their hands, even to the point their hands become raw from so much washing. When a person continues to repeat an action, obsessions may go away for a short period of time, however, they will normally return. Once they return, the compulsion will begin again, starting a cycle of obsession-compulsion.
Compulsions can interfere with a person’s life. For example, a person may need to check to see if they locked the doors before going to bed. They may lose sleep continuing to check over and over.
Some common compulsions include:
- Washing hands
- Brushing teeth
- Checking to see if appliances are turned off
- Checking to see if doors are locked
- Arranging items in a certain way
- Keeping items, such as containers, even if they are no longer needed
- Requiring constant approval from people around them.
OCD impacts between 2 and 3 percent of the population. It is an anxiety disorder and can be treated with medications and behavioral therapy.