Obsessive-Compulsive Disorder

When Unwanted Thoughts or Repetitive Behaviors Take Over

• What is OCD?

  Obsessive-compulsive disorder (OCD) is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both. People with OCD have time-consuming symptoms that can cause significant distress or interfere with daily life. However, treatment is available to help people manage their symptoms and improve their quality of life.

• What are the signs and symptoms of OCD?

  People with OCD may have obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that are intrusive, unwanted, and make most people anxious. Common obsessions include:

  • Fear of germs or contamination

  • Fear of forgetting, losing, or misplacing something

  • Fear of losing control over one’s behavior

  • Aggressive thoughts toward others or oneself

  • Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm

  • Desire to have things symmetrical or in perfect order

  Compulsions are repetitive behaviors a person feels the urge to do, often in response to an obsession. Common compulsions include:

  • Excessive cleaning or handwashing

  • Ordering or arranging items in a particular, precise way

  • Repeatedly checking things, such as that the door is locked or the oven is off

  • Compulsive counting

  • Praying or repeating words silently

• Recognizing OCD: How to know if your symptoms are OCD

  Everyone rethinks or double-checks things sometimes. Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions. However, people with OCD generally:

  • Can’t control their obsessions or compulsions, even when they know they’re excessive.

  • Spend more than 1 hour a day on their obsessions or compulsions. 

  • Don’t get pleasure from their compulsions but may feel temporary relief from their anxiety. 

  • Experience significant problems in daily life due to these thoughts or behaviors. 

  Some people with OCD also have a tic disorder involving repetitive movements or sounds. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Vocal tics include things like repetitive throat-clearing, sniffing, or grunting sounds. It is common for people with OCD to also have a diagnosed mood disorder or anxiety disorder.

  OCD symptoms may begin anytime but usually start between late childhood and young adulthood. Most people with OCD are diagnosed as young adults.

  The symptoms of OCD may start slowly and can go away for a while or worsen as time passes. During times of stress, the symptoms often get worse. A person’s obsessions and compulsions also may change over time.

  People with OCD might avoid situations that trigger their symptoms or use drugs or alcohol to cope. Many adults with OCD recognize that their compulsive behaviors do not make sense. However, children may not realize that their behavior is out of the ordinary and often fear that something terrible will happen if they do not perform certain compulsive rituals. Parents or teachers typically recognize OCD symptoms in children.

  If you think you or your child may have OCD, talk to a health care provider. If left untreated, OCD symptoms can become severe and interfere with daily life.

• What are the risk factors for OCD?

  Although the exact causes of OCD are unknown, various risk factors increase the chances of developing the disorder.

  • Genetics: Studies have shown that having a first-degree relative (parent or sibling) with OCD is associated with an increased chance of developing the disorder. Scientists have not identified any one gene or set of genes that definitively leads to OCD, but studies exploring the connection between genetics and OCD are ongoing.

  • Biology: Brain imaging studies have shown that people with OCD often have differences in the frontal cortex and subcortical structures of the brain, areas of the brain that impact the ability to control behavior and emotional responses. Researchers also have found that several brain areas, brain networks, and biological processes play a key role in obsessive thoughts, compulsive behavior, and associated fear and anxiety. Research is underway to better understand the connection between OCD symptoms and parts of the brain. This knowledge can help researchers develop and adapt treatments targeted to specific brain locations.

  • Temperament: Some research has found that people who exhibit more reserved behaviors, experience negative emotions, and show symptoms of anxiety and depression as children are more likely to develop OCD.

  • Childhood trauma: Some studies have reported an association between childhood trauma and obsessive-compulsive symptoms. More research is needed to understand this relationship.

  Children who suddenly develop OCD symptoms or experience a worsening of OCD symptoms after a streptococcal infection may be diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). Learn more about PANDAS.

• How is OCD diagnosed?

  Diagnosing OCD can be difficult because symptoms such as worry, anxiety, and low mood—which are often people’s most distressing concerns—can be similar to those of other mental illnesses. Also, people with OCD may not tell their health care provider about their obsessions and compulsions out of fear of judgment. 

  If you are experiencing symptoms, the first thing you should do is speak with a health care provider. They will examine you and ask about your health history to ensure other illnesses or conditions are not causing your symptoms. A health care provider may refer you to a mental health professional for further evaluation or treatment.

• How is OCD treated?

  Treatment helps many people, even those with the most severe forms of OCD. Mental health professionals treat OCD with medications, psychotherapy, or a combination of treatments. A mental health professional can help you decide which treatment option is best for you and explain the benefits and risks of each.

  Following your treatment plan is important because psychotherapy and medication can take some time to work. Although there is no cure for OCD, treatments help people manage their symptoms, engage in day-to-day activities, and lead full, active lives.

Provided by the National Institute of Mental Health