Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

1.2% of U.S. adults experience OCD each year.

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What Is It?

Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don't make sense, they are often unable to stop them.

The Science Behind It

The exact cause of obsessive-compulsive disorder is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other. Genetics are thought to be very important. If you, your parent or a sibling, have obsessive-compulsive disorder, there's around a 25% chance that another immediate family member will have it.

Warning Signs

Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them. Some examples of obsession include:

  • Thoughts about harming or having harmed someone
  • Doubts about having done something right, like turning off the stove or locking a door
  • Fear of contamination
  • Unpleasant sexual images
  • Fears of saying or shouting inappropriate things in public

Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don't make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety.

  • Hand washing due to a fear of germs
  • Counting and recounting money because a person is can't be sure they added correctly
  • Checking to see if a door is locked or the stove is off

Common Misconceptions

If you're really neat, you have OCD

One common sign of OCD is an obsession with cleanliness — such as constantly washing your hands or excessively cleaning household items. But a cleanliness complex can also be a personality trait, says Jeff Szymanski, PhD, executive director of the International OCD Foundation and one of the world’s leading authorities on OCD. “And that’s part of the confusion. If it’s a personality trait, you have control — you can choose to do it or not. If you have obsessive compulsive disorder, you’re doing it out of unrelenting debilitating anxiety.”

Stress causes OCD

Think people with OCD should just relax and stop obsessing? Szymanski says it’s not that simple. OCD incites uncontrollable fears and anxiety — and while stressful situations can exacerbate symptoms in people with obsessive compulsive disorder, stress alone does not cause it.

OCD isn’t treatable

Many people don’t seek OCD treatment because they’re embarrassed, and that may be why people think it can’t be treated. “OCD is definitely treatable,” Szymanski says. The first line of OCD treatment is exposure and response prevention, a face-your-fears therapy. Some people need a combination of behavioral therapy and medications.


A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.

  • Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.
  • Psychotherapy is also helpful in relieving obsessions and compulsions. In particular,cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.

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