Obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, oftentimes distress behaviors or thoughts. It is treated through a combination of psychiatric medications and psychotherapy.
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. The majority of people with OCD have both obsessions and compulsions, but a minority (about 20 percent) have obsessions alone or compulsions alone (about 10 percent).
The person with OCD usually tries to actively dismiss the obsessions or neutralize them by engaging in compulsions or avoiding situations that trigger them. In most cases, compulsions serve to alleviate anxiety. However, it is not uncommon for the compulsions themselves to cause anxiety — especially when they become very demanding.
A hallmark of OCD is that the person recognizes that their thoughts or behaviors are senseless or excessive.
However, the drive can be so powerful that the person caves in to the compulsion even though they know it makes no sense. One woman spent hours each evening sifting through the household trash to ensure that nothing valuable was being discarded. When asked what she was looking for, she nervously admitted, “I have no idea, I don’t own anything valuable.”
Some people who have had OCD for a long time may stop resisting their compulsive drives because they feel it’s just easier to give in to them.
Most OCD sufferers have multiple types of obsession and compulsion. Someone with OCD may complain primarily of obsessive-compulsive symptoms involving asbestos contamination, but a detailed interview may disclose that he/she silently counts floor tiles and hoards junk mail.
Examples of Obsessions
Common types of obsessions include concerns with contamination (e.g., fear of dirt, germs or illness), safety/harm (e.g., being responsible for a fire), unwanted acts of aggression (e.g., unwanted impulse to harm a loved one), unacceptable sexual or religious thoughts (e.g., sacrilegious images of Christ) and the need for symmetry or exactness.
Examples of Compulsions
Common compulsions include excessive cleaning (e.g., ritualized hand washing); checking, ordering, and arranging rituals; counting; repeating routine activities (e.g., going in/out of a doorway) and hoarding (e.g., collecting useless items). While most compulsions are observable behaviors (e.g., hand washing), some are performed as unobservable mental rituals (e.g., silent recitation of nonsense words to vanquish a horrific image).
According to the American Psychiatric Association (2013), OCD is characterized by a combination of obsessions and/or compulsions in most people. Obsessions are persistent thoughts or urges that a person experiences that are strange, intrusive, and not wanted. An obsession isn’t simply worrying about something a lot — it is overwhelming and constant. Attempts to stop the thoughts are usually unsuccessful. Some people find the only way to put the thought to bed is to engage in a compulsion.
A compulsion is a repetitive kind of behavior — like counting or hand-washing — that a person feels like they must perform in order to prevent something bad from happening, or to stop an obsessive thought. The compulsions are aimed at reducing anxiety and the associated feelings of distress that accompany obsessions.
Causes & Diagnosis
Wondering if you may have OCD?
Researchers aren’t clear on what causes obsessive-compulsive disorder. Although written about for hundreds of years, we are only now starting to understand some of the underlying brain structures and possible risk factors that make a person more susceptible to being diagnosed with OCD. No single factor is likely to blame. Rather, a complex combination of factors likely contributes to a person being more likely to be diagnosed with this condition.
OCD, like most mental disorders, is best diagnosed by a specialist — a mental health professional such as a psychologist, psychiatrist, or clinical social worker. While a family physician or general practitioner may offer a preliminary diagnosis, only a mental health specialist offers the experience and skills necessary to diagnose this condition reliably.
Treatment for OCD
According to the National Institute of Mental Health, there are a variety of effective treatment strategies professionals employ to help a person with OCD. Typically these strategies include a comprehensive treatment plan that focuses on weekly individual psychotherapy, along with certain types of psychiatric medications (if appropriate).
Specific types of therapy used to treat this condition include cognitive-behavioral and behavioral techniques, such as Exposure and Response Prevention (EX/RP) therapy. Based upon decades’ worth of research, these techniques are highly effective in helping to eradicate the problematic behaviors and thoughts associated with OCD. Many people who try one of these types of therapy will find relief from their symptoms within 6 months to a year.
Living With & Managing OCD
A person who has chronic obsessive-compulsive disorder (OCD) may find that there are some symptoms they may have to get used to living with. Just like the main character in the movie classic, “What About Bob?”, there are people who can keep most of their symptoms under control with a combination treatment approach of psychotherapy and medication. But living with the condition presents its own unique set of challenges.