Obsessive-Compulsive Disorder (OCD): Signs and Treatment

Medically Reviewed by Jabeen Begum, MD on April 04, 2024
Written by Lisa Fields, Stephanie Langmaid
10 min read

Obsessive-compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or urges (obsessions). It also can cause you to do certain actions over and over again (compulsions). You may have both obsessions and compulsions.

OCD isn’t about habits such as biting your nails or thinking negative thoughts. An obsessive thought might be that certain numbers or colors are "good" or "bad." For example, a compulsive habit might be to wash your hands seven times after touching something that could be dirty. Although you don't want to think or do these things, you feel like you can't stop.

OCD can be very upsetting and disruptive to your life. But treatments and coping strategies can help.

Is OCD an anxiety disorder?

OCD used to be classified as an anxiety disorder. But that changed with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 2013. It's now in a category called "Obsessive-Compulsive and Related Disorders." However, most people with OCD also have an anxiety disorder.

OCD vs. OCPD

OCPD stands for obsessive-compulsive personality disorder. People with it have a concern for order, detail, and perfection that's extreme, making them inflexible and controlling. Intrusive thoughts and repetitive behaviors aren't part of it.

Unlike people with OCD, people with OCPD usually aren't bothered by their obsessions and don't recognize that they have a problem. The disorder tends to cause issues in relationships.

Most people with OCD have both obsessions and compulsions, but you could have just one symptom or the other. Some people also have a tic disorder, where they make movements or sounds they can't control.

Obsessions

These are unwanted thoughts, urges, or mental images that you have over and over again. You may try to ignore them or stop yourself from having them, but you can't. Some of the same kinds of obsessive thoughts are common among people with OCD. Examples include:

  • Worries about yourself or other people getting hurt
  • Constant awareness of blinking, breathing, or other body sensations
  • Worries about germs and dirt touching your body
  • Fear of losing or forgetting things 
  • Worries about losing control of what you do or say
  • Upsetting thoughts about sex, religion, or violence
  • Need for things to be symmetrical or orderly

Compulsions

These are physical or mental acts you feel like you have to do, even though you don't want to. They're usually related to an obsession; you may believe that by doing them you'll stop the unwanted thoughts or keep something bad from happening. These behaviors may combine several actions into elaborate rituals. Examples include:

  • Doing tasks in a specific order every time or keeping rigid routines
  • Needing to count things, such as steps or bottles, and assigning significance to certain numbers
  • Rituals of washing and cleaning
  • Arranging items in a particular order
  • Checking multiple times that doors are locked, appliances are turned off, etc.
  • Repeating certain words or praying silently
  • Constantly seeking reassurance or approval

Another common symptom of OCD is avoiding situations that trigger obsessions.

Symptoms can range from mild to so serious they're disabling. They can sometimes get better or worse with time. The things you obsess about and the behaviors you're compelled to do may also change.

While there aren't clinically recognized types of OCD, obsessions and compulsions tend to revolve around certain common themes.

These include:

Checking. This involves constantly worrying that you've done something wrong or that something bad is going to happen, so you check the locks, alarm system, oven, or light switches, over and over.

Contamination. This is the fear of things that might be dirty or having a compulsion to clean. You may refuse to touch doorknobs, use public toilets, or shake hands. Mental contamination involves feeling like you’ve been treated like dirt.

Symmetry and ordering. This is the need to have things lined up in a certain way. It also involves compulsive counting or repetitive actions. It may be based on an obsession that's completely unrelated -- like worrying someone will die unless you tap the table a certain number of times.

Ruminations and intrusive thoughts. This is an obsession with a line of thought. Some of these thoughts might be violent or disturbing.

Postpartum OCD

A change in hormones during and after pregnancy plus the added responsibilities of being a parent are sometimes thought to bring on a specific kind of OCD. Postpartum or perinatal OCD involves thoughts and behaviors centered around the baby, like constantly fearing that something bad will happen to them, or excessively sanitizing baby items.

It's important to recognize that all new parents have some level of anxiety about their babies. As with other forms of OCD, it rises to the level of a disorder if it keeps you from living normally or taking care of your baby, or if you rely on compulsive behaviors to manage your obsessions.

PANDAS

One rare form of OCD in children is believed to be linked to infection with the group A streptococcus bacteria. With pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), OCD symptoms come on suddenly and dramatically, soon after a child has had an infection such as strep throat or scarlet fever.

Besides obsessions and compulsions, symptoms of PANDAS can include tics (both verbal and physical), irritability, and clinginess. Antibiotics to cure the strep infection can help with PANDAS, along with standard treatment for OCD symptoms.

Experts aren’t sure why some people have OCD.

They believe it has to do with the way your brain manages certain chemicals called neurotransmitters, particularly serotonin. But they don't know what causes the differences.

Genetics may play a role. There appears to be a family connection, although no specific gene has been identified.

Stress doesn't cause OCD, but it can worsen the symptoms, especially when you're dealing with change. OCD may appear for the first time after a traumatic event or a life transition such as a move, the birth of a sibling, or a marriage or divorce.

OCD is a bit more common in women than in men. Symptoms usually start between late childhood and early adulthood, and most people receive their diagnosis as young adults.

Other 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

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.

OCD test

Your doctor may give you a questionnaire that asks whether you think or do certain things that are common with OCD and how much they bother you. They may also talk to your family or friends.

Many psychological issues have similar symptoms, so it can take time to get the right diagnosis.

OCD diagnosis criteria

According to the DSM-5, having OCD means:

  • You have obsessions, compulsions, or both that you can't control.
  • You may feel forced to carry out a compulsion in response to a particular obsession, and it may give you temporary relief from the stress caused by that obsession.
  • Obsessions and compulsions take up at least 1 hour a day.
  • Symptoms interfere with work, your social life, or another part of life.
  • There isn't another physical or psychological explanation for your symptoms.

OCD in children

While adults usually recognize they have a problem, often children don't have that understanding. They don't realize their thoughts and fears are unreasonable, and they think they have to act out their compulsions to prevent something terrible from happening.

If you or your child's teacher notices unusual behavior, you might attribute it to something like ADHD, but there are significant differences in the symptoms. A thorough exam by a mental health specialist can lead to the correct diagnosis.

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.

Other types of therapy that may be helpful include acceptance and commitment therapy, inference-based cognitive behavioral therapy, and mindfulness.

If your symptoms are so serious that you have a hard time managing your daily life, it may be best to participate in either an intensive outpatient or residential therapy program for several weeks.

OCD medication

Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are the main medications used to help people control obsessions and compulsions. They're usually prescribed in a higher dose than what's used to manage depression. Common ones include:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Clomipramine (Anafranil) is a different kind of antidepressant that is sometimes used. These drugs may take may take 2-4 months to start working. If you've tried them and still have symptoms, your doctor might give you antipsychotic drugs such as aripiprazole (Abilify) or risperidone (Risperdal).

If medication helps you, you'll take it for at least a year or two, or possibly the rest of your life. Make sure your doctor knows every other medication you take, including supplements, to avoid potentially dangerous interactions.

Other OCD treatments

While psychotherapy and SSRIs are the standard treatment, researchers are working to find new drugs and other treatment methods to help people with OCD.

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, uses magnetic fields to stimulate nerve cells. A more complicated procedure, deep brain stimulation, uses electrodes that are implanted in your head.

Surgery. It's experimental, but brain surgery may be an option for people whose OCD symptoms are debilitating. Brain cells in regions linked to OCD are destroyed using one of several procedures.

Relaxation. Things such as meditation, yoga, and massage can help with stressful OCD symptoms.

Some separate conditions are classified as obsessive-compulsive–related disorders. They involve obsessions with things such as:

  • Your looks (body dysmorphic disorder)
  • Collecting, arranging, or ordering things (hoarding disorder)
  • Pulling out/eating your hair (trichotillomania)
  • Picking at your skin (excoriation)
  • Other kinds of picking or chewing, like nail biting (body-focused repetitive behavior disorder)
  • Body odor or how you smell (olfactory reference disorder)

OCD is something you'll likely have to deal with for the rest of your life. Here are some tips to help you live better with OCD:

Stick with your treatment plan. OCD symptoms may come and go, and if your treatment is working, you may think you're "cured." But it's important to keep practicing what you've learned in therapy and taking your medication. If you stop, you may feel worse. And it can be dangerous to suddenly stop taking an SSRI. Focusing on your goals can help keep you motivated.

Watch out for triggers. Work with your doctor to understand what situations can make your symptoms worse, and come up with a strategy to handle them. That doesn't mean avoiding those situations -- OCD shouldn't stop you from having a career, hobbies, and a social life. And staying busy can distract you from obsessive thoughts.

Celebrate successes and expect setbacks. You'll probably have plenty of both. Try to remember that managing OCD will be an ongoing process. Don't expect it to get better immediately. But do recognize whatever amount of progress you make.

Pay attention to your overall mental health. Many people with OCD also have other psychological issues, such as anxiety disorders, depression, or substance abuse, and are at high risk of suicide attempts. Let your doctor know if your symptoms seem worse, or if you're having new symptoms.

Educate yourself. Learn everything you can about OCD and how to manage it. Keep an eye out for news about the latest treatment strategies.

Take care of yourself. If you eat healthy food, get enough sleep, and exercise regularly, you'll likely feel better in general. Stress can trigger OCD symptoms, so be aware of when it's building up and learn techniques to manage it.

Get support. It can be helpful to connect with others who have OCD. Ask your doctor or check online for support groups in your area.

When a family member has OCD, it can be very disruptive and stressful for the entire household. You can play an important role in supporting your loved one and minimizing the impact the disorder has on your lives.

Start by educating yourself about OCD. Learn what to expect and what things you can do that will or won't be helpful.

Families often make the mistake of enabling loved ones with OCD. For example, you cancel social plans to help your spouse avoid coming in contact with germs, or you arrange things just so on your child's plate to prevent a meltdown.

While that's done out of care, it isn't really helping -- it just reinforces the behavior and makes it harder to change. It's better to encourage your family members to seek or stick to treatment and for you to participate in therapy with them. A therapist can help you learn to change the way you respond to their symptoms.

You may be able to spot problem behaviors before a loved one does, especially with children. If you suspect a loved one has OCD but hasn't been diagnosed, tell them what you've noticed and ask whether they think there's an issue. You may be able to steer them toward a diagnosis or help with treatment.

There are also support groups for people who have a loved one with OCD.

Obsessive-compulsive disorder (OCD) is a mental illness in which you have uncontrollable patterns of thinking and/or behaviors. You may feel forced to perform certain physical or mental acts to relieve the stress of unwanted thoughts. While OCD can't be cured, many people are able to manage the disorder with therapy, medication, or both.