What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or sensations (obsessions). It also can give you an urge to do something over and over again (compulsions). Some people have both obsessions and compulsions.
OCD isn’t about habits like biting your nails or thinking negative thoughts. An obsessive thought might be that certain numbers or colors are “good” or “bad.” A compulsive habit might be to wash your hands seven times after touching something that could be dirty. Although you may not want to think or do these things, you feel like you can't stop.
Everyone has habits or thoughts that repeat sometimes. People with OCD have thoughts or actions that:
- Take up at least an hour a day
- Are beyond your control
- Aren’t enjoyable
- Interfere with work, your social life, or another part of life
OCD Types and Symptoms
OCD comes in many forms, but most cases fall into at least one of four general categories:
- Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a medical condition like pregnancy or schizophrenia .
- Contamination, a fear of things that might be dirty or a having a compulsion to clean (you may hear this called "obsessive cleanliness disorder"). Mental contamination involves feeling like you’ve been treated like dirt.
- Symmetry and ordering, the need to have things lined up in a certain way.
- Ruminations and intrusive thoughts, an obsession with a line of thought. Some of these thoughts might be violent or disturbing.
Obsessions and Compulsions
Many people who have OCD know that their thoughts and habits don’t make sense. They don’t do them because they enjoy them, but because they can’t quit. And if they stop, they feel so bad that they start again.
Obsessive thoughts can include:
- Worries about yourself or other people getting hurt
- Constant awareness of blinking, breathing, or other body sensations
- Suspicion that a partner is unfaithful with no reason to believe it
- Worries about germs and dirt touching your body
Compulsive habits can include:
- Doing tasks in a specific order every time or a certain “good” number of times
- Needing to count things, like steps or bottles
- Fear of touching doorknobs, using public toilets, or shaking hands
- Rituals of washing and cleaning
OCD Causes and Risk Factors
Doctors aren’t sure why some people have OCD. Stress can make symptoms worse.
It’s a bit more common in women than in men. Symptoms often appear in teens or young adults.
OCD risk factors include:
- A parent, sibling, or child with OCD
- Physical differences in certain parts of your brain
- Depression, anxiety, or tics
- Experience with trauma
- A history of physical or sexual abuse as a child
Sometimes, a child might have OCD after a streptococcal infection. This is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.
What Causes the Compulsion to Wash?
Experts believe OCD is caused by an abnormality in the brain's circuitry. Brain scans show brain activity is different in people with OCD. There's probably a genetic component too, especially when OCD begins in childhood. Of all adults with OCD, 1/3 to 1/2 say their illness started in childhood or adolescence.
Why is someone with the disease compelled to wash, as opposed to check or count or hoard? That's not known. It's true that with all types of OCD, you may act out a compulsion to relieve anxiety produced by an obsessive, intrusive thought.
Your doctor may do a physical exam and blood tests to make sure something else isn’t causing your symptoms. They will also talk with you about your feelings, thoughts, and habits.
There’s no cure for OCD. But you may be able to manage how your symptoms affect your life through medicine, therapy, or a combination of treatments.
- Psychotherapy. Cognitive behavioral therapy (CBT) can help change your thinking patterns. In a form called exposure and response prevention, your doctor will put you in a situation designed to create anxiety or set off compulsions. You’ll learn to lessen and then stop your OCD thoughts or actions.
- Relaxation. Simple things like meditation, yoga, and massage can help with stressful OCD symptoms.
- Medication. Psychiatric drugs called selective serotonin reuptake inhibitors help many people control obsessions and compulsions. They might take 2 to 4 months to start working. Common ones include citalopram (Celexa), clomipramine (Anafranil), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft). If you still have symptoms, your doctor might give you antipsychotic drugs like aripiprazole (Abilify) or risperidone (Risperdal).
- Neuromodulation. In rare cases, when therapy and medication aren’t making enough of a difference, your doctor might talk to you about devices that change the electrical activity in a certain area of your brain. One kind, transcranial magnetic stimulation, is FDA-approved for OCD treatment. It uses magnetic fields to stimulate nerve cells. A more complicated procedure, deep brain stimulation, uses electrodes that are implanted in your head.
The Role of Family Members
Families often make the mistake of enabling loved ones with OCD. For instance, a person who sees their partner cleaning the house 3 or 4 hours a day may at first think they've got the world's greatest partner.
But that same person may later see their partner is irritable, exhausted, and their cleaning patterns are bizarre. So they may ask whether they think there's an issue. The partner may agree to get treatment because the person spoke up.
In this way, family members can play an important role in supporting a person with OCD. They may steer a loved one toward a diagnosis or help with treatment. They may participate in therapy. There are also support groups for people who have a loved one with OCD.
Some separate conditions are similar to OCD. They involve obsessions with things like:
- Your looks (body dysmorphic disorder)
- Collecting, arranging, or ordering things(hoarding disorder)
- Pulling out/eating your hair (trichotillomania)
- Picking at your skin (excoriation)
- Worrying about your physical health (hypochondriasis)
- Body odor or how you smell (olfactory reference syndrome)