Obsessive Compulsive Disorder (OCD)
The key features of Obsessive-Compulsive Disorder (OCD) are obsessions and compulsions. Most people have both, but for some it may seem as though they have only one or the other.
Obsessions are unwanted and distressing thoughts, ideas, or urges that keep entering your mind. They can feel intrusive, repetitive, and distressing. You may find yourself trying to ignore them. You may try to stop or undo them with a compulsion.
Compulsions are repetitive physical or mental acts that you feel you have to do to relieve the distress you feel because of the obsessions. They may reduce or prevent any anxiety, but in most cases, they do not help. Compulsions can take a lot of time to do, often more than one hour each day. They can interfere with personal relationships and normal activities at home, school, or work. Usually, people with OCD know the compulsion is senseless. However, he or she feels helpless to stop doing it and may need to repeat the compulsion over and over again. Sometimes this is described as a ritual.
Obsessive-Compulsive Disorder can begin in childhood, but it usually starts in young adulthood and continues throughout life. Many people with Obsessive-Compulsive Disorder also have depression or another mental health disorder.
Common Obsessions
Contamination
- Fear of contamination by germs, dirt, or other diseases (e.g. by touching an elevator button, shaking someone’s hand)
- Fear of saliva, feces, semen, or vaginal fluids
Doubting
- Fear of not doing something right which could cause harm to one’s self or another (e.g. turning off the stove, locking the door)
- Fear of having done something that could result in harm (e.g. hitting someone with a car, bumping someone on the subway)
- Fear of making a mistake (e.g. in an email, or when paying a bill
Ordering
- Fear of negative consequences if things are not “just right”, in the correct order or “exact” (e.g. shoes must be placed by the bed symmetrically and face north)
Religious
- Fear of having thoughts that go against one’s religion
- Preoccupation with religious images and thoughts
Aggressive
- Fear of harming others (e.g. harming a baby, stabbing someone with a kitchen knife, hurting someone’s feelings)
- Fear of harming self (e.g. jumping off a bridge, handling sharp objects)
- Fear of blurting out obscenities in public (e.g. saying something sacriligious in church)
Sexual
- Unwanted or forbidden sexual thoughts, images, or urges (e.g. urge to touch a parent in a sexually inappropriate way)
Sexual thoughts involving children or incest
Common Compulsions
Cleaning/Washing
- Washing hands too frequently or in a ritualized way
- Ritualized or excessive showering; bathing; grooming routines; cleaning of household items or other objects
- Although not a specific ritual, avoidance of objects or situations that are considered “contaminated” may be a major problem (e.g. will not shake hands with others or touch elevator buttons)
Checking
- Checking that nothing terrible did, or will, happen (e.g. checking driving routes to make sure you didn’t hit anyone with your car)
- Checking that you don’t make mistakes (e.g. rereading everything you have written, or asking oothers whether you said the “wrong” thing
Ordering/Arranging
- Ensuring that things are “just right” or consistent with a specific rule (e.g. everything in the kitchen must be perfectly lined up; can only wear certain coloured clothes on certain days)
Mental Rituals
- Needing to count to certain numbers, think certain ‘good’ or neutral thoughts in response to ‘bad’ thoughts, or pray repeatedly
Hoarding
- Collecting “useless” items such as newspapers, magazines, bottles, or pieces of garbage
- Difficulty parting with unnecessary or excessive belongings (e.g. items that may have been useful once, or have sentimental value even though they are not needed, or are simply excessive, such as 30 black sweaters)
- Inability to throw these items away
Obsessive-Compulsive Disorder Treatment
OCD may be treated with:
- Cognitive therapy. This is a form of talk therapy. The goal is to identify and change the irrational thoughts associated with obsessions.
- Behavioral therapy. A type of behavioral therapy called exposure and response prevention is often used. In this therapy, you will be exposed to the distressing situation that triggers your compulsion and be prevented from responding to it. With repetition of this process over time, you will no longer feel the distress or need to perform the compulsion.
- Medicine. Certain types of antidepressant medicine may help reduce or control OCD symptoms. Medicine is most effective when used with cognitive or behavioral therapy.
Treatment usually involves a combination of therapy and medicines. For severe OCD that does not respond to talk therapy and medicine, brain surgery or electrical stimulation of specific areas of the brain may be considered. Examples of electrical stimulation are:
- Deep brain stimulation (DBS).
- Transcranial magnetic stimulation (TMS).
- Transcranial direct current stimulation (tDCS).
This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.