Obsessive-Compulsive Disorder (OCD): Symptoms and Treatments

Obsessive-compulsive disorder (OCD) is a chronic condition in which a person has uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions):

  • Obsessions are recurring thoughts, mental images, or urges that trigger anxiety.
  • Compulsions are behaviors that a person with OCD feels the overwhelming urge to repeat, often to alleviate the anxiety associated that accompanies an obsession.

OCD Symptoms

OCD symptoms include obsessions, compulsions, or both:

  • Obsessions may include:
    • Fear of germs
    • Unwanted sexually explicit or violent thoughts or images
    • Fear of hurting yourself or others
    • Excessive thinking about religion or morals
    • A need to have everything in perfect order
    • A fear of losing what you have or not having what you need
  • Compulsions may include:
    • Excessive cleaning or handwashing
    • Arranging items in a precise manner
    • Repeatedly checking on things (such as whether the door is locked or the oven is off)
    • Counting (for example, repeating numbers in a certain pattern to yourself)
    • Collecting or hoarding things you don’t use or need and the inability to stop buying more

Not all repetitive thoughts are obsessions, and not all habits are compulsions. For a person to receive a diagnosis of OCD, his or her symptoms must meet the following conditions:

  • An inability to control the obsessive thoughts and compulsive behaviors even after the person recognizes them as excessive
  • Spending at least one hour daily on these obsessions and compulsions
  • The absence of any pleasure from the thoughts or behaviors, although the compulsive behaviors may provide some temporary relief of anxiety
  • The obsessions and compulsions inhibit the person’s ability to function normally at home, work, or school

People with OCD may also suffer from a tic disorder, with symptoms such as:

  • Motor tics (body movements): Eye blinking, facial grimacing, shoulder shrugging, or head or shoulder jerking
  • Vocal tics: Repetitive throat clearing, sniffing, or grunting

OCD Risk Factors

Although we do not yet know what causes OCD, certain factors increase the likelihood that someone will develop OCD:

  • Genetics: You have a higher risk of developing OCD if a first-degree relative (a parent, sibling, or child) has it, especially if they developed it as a child or teen.
  • Brain structure/function: Brain images suggest a connection between OCD symptoms and abnormalities in certain areas of the brain, including the frontal cortex and subcortical structures.
  • Environment: Physical or sexual abuse during childhood places a person at a greater risk of developing OCD.
  • Illness: Children who develop OCD symptoms following a streptococcal infection may be suffering from Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

OCD Treatments

As with other anxiety disorders, OCD is typically treated with medication, psychotherapy, or a combination of the two:

  • Medications: Various medications can be helpful in alleviating the underlying anxiety, such as the following:
    • Anti-anxiety medications, such as benzodiazepines and buspirone (BuSpar)
    • Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
    • Beta blockers, which are commonly used to control high blood pressure but may also be helpful in treating anxiety
  • Psychotherapy: Certain psychotherapies, such as cognitive behavioral therapy (CBT) and mindfulness training may help to adjust the thought processes that give rise to the anxiety at the root of the obsessions and compulsions.

Other treatments, such as deep brain stimulation (DBS) may also be helpful in cases in which medications, psychotherapy, or a combination of the two are proven to be ineffective.