Obsessive-Compulsive Disorder (OCD): Symptoms, Characteristics, Causes, and Treatment

What Is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by intrusive obsessions and compulsions. OCD was formerly classified as an anxiety disorder because people affected by this mental illness often experience severe anxiety as a result of obsessive thoughts. They may also engage in extensive rituals in an attempt to reduce the anxiety caused by obsessions.

In the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), OCD was moved to its own disorder class of "Obsessive-Compulsive and Related Disorders." Related conditions in the class include body-dysmorphic disorder, hoarding disorder, and trichotillomania.

Symptoms

Symptoms of OCD usually appear gradually and can be long-lasting if not treated. People with OCD may experience symptoms of obsessions, compulsions, or both. Such symptoms interfere with many areas of life including school, work, relationships, and normal daily functioning.

Obsessions

Obsessions are thoughts, images, or ideas that won't go away, are unwanted, and are extremely distressing or worrying ("What if I become infected with a deadly disease?" or "What if I hurt someone?").

Some common symptoms of obsessions include:

•Aggressive thoughts about other people or one's self

•A need to have everything in a certain order

•Fear of germs

•Unwanted thoughts of forbidden or taboo topics such as sex, religion, or harming others

Compulsions

Compulsions are behaviors that have to be done over and over again to relieve anxiety. Compulsions are often related to obsessions. For example, if you are obsessed with being contaminated, you might feel compelled to wash your hands repeatedly. However, this is not always the case.

Some common compulsions include:

•Counting things over and over again

•Excessive washing or cleaning

•Ordering things in a particular or symmetrical way

•Repeated checking (such as checking that the door is locked or that the oven is off)

Diagnosis

It is important to be aware that not all habits or repetitive behaviors are synonymous with compulsions. Everyone has repeated thoughts or engages in double-checking things from time to time. In order to be diagnosed with OCD, their experience is characterized by:

•An inability to control their thoughts or behaviors, even when they recognize that they are excessive or irrational

•Spending an hour or more a day on these obsessions and compulsions

•Experiencing significant problems and disruptions in daily life because of these thoughts and behaviors

•Not gaining pleasure from thoughts or behaviors, but engaging in compulsive behaviors may provide a brief relief from the anxiety that the thoughts cause

OCD usually begins around late adolescence/young adulthood, although young children and teenagers can also be affected. Parents and teachers often miss OCD in young children and teenagers, as they may go to great lengths to hide their symptoms.

Causes

The exact causes of OCD are not known, but there are a few factors that are believed to play a role.

•Biological factors: One theory is that OCD comes from a breakdown in the circuit in the brain that filters or "censors" the many thoughts, ideas, and impulses that we have each day. If you have OCD, your brain may have difficulty deciding which thoughts and impulses to turn off. As a result, you may experience obsessions and/or compulsions. The breakdown of this system may be related to serotonin abnormalities.

•Family history: You may also be at greater risk if there is a family history of the disorder. Research has shown that if you, a parent, or a sibling have OCD, there is a 25% chance that another immediate family member will also have it.

•Genetics: Although a single "OCD gene" has not been identified, OCD may be related to particular groups of genes.

•Stress: Stress from unemployment, relationship difficulties, problems at school, illness, or childbirth can be strong triggers for symptoms of OCD.

People who are vulnerable to OCD describe a strong need to control their thoughts and a belief that strange or unusual thoughts mean they are going crazy or will lose control. While many people can have strange or unusual thoughts when feeling stressed, if you are vulnerable to OCD, it may be difficult to ignore or forget about these thoughts. In fact, because these thoughts seem so dangerous, you end up paying even more attention to them, which sets up a vicious cycle.

Types

Obsessive-compulsive disorder can present in a few different ways. Some people experience only obsessions, some only compulsions, while others experience both. There are no official subtypes of OCD, but research suggests that the most common obsessions and compulsions tend to center on:

•Cleanliness or fear of contamination

•A need for order, symmetry, or perfection

•Taboo thoughts

•Collecting or hoarding

Some other types of OCD that people may experience include symptoms that center on checking things repeatedly, counting certain objects, and ruminating on certain thoughts or topics.

Parents should also be aware of a subtype of OCD in children exacerbated or triggered by strep throat, in which the child's own immune system attacks the brain. This Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS) form of OCD accounts for 25% of the children who have OCD.

Treatment

Treatments for OCD may include medications, psychotherapy, or a combination of the two.

Medication

There are a variety of medications that are effective in reducing the frequency and severity of OCD symptoms. Many of the medications that are effective in treating OCD, such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Anafranil (clomipramine), and Luvox (fluvoxamine) affect levels of serotonin.

Psychotherapy

Psychological therapies are also highly effective treatments for reducing the frequency and intensity of OCD symptoms. Effective psychological treatments for OCD emphasize changes in behavior and/or thoughts.

When appropriate, psychotherapy can be done alone or combined with medication. The two main types of psychological therapies for OCD are cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy.

Coping

OCD is a chronic, long-lasting condition that may worsen with time, so it is important to get professional treatment. In addition to talking to your doctor or mental health professional, there are also a number of self-help strategies that you can use to help manage your symptoms:

•Practice good self-care strategies that will help you cope with stress. Stress can often trigger OCD symptoms, so it is important to rely on effective and healthy coping methods. Research has shown that sleep disturbances are linked to more severe OCD symptoms. In addition to sleep, regular physical exercise and a healthy diet are lifestyle choices you can make that will make it easier to manage the stress and worries that life throws at you.

•Try relaxation techniques. Add some effective tools such as meditation, deep breathing, visualization, and progressive muscle relaxation to your relaxation rituals.

•Find support. Consider joining a support group such as the International OCD Foundation's online support group. Such groups can be helpful to talk to people who have had the same experiences as you. Social support is important for mental well-being, and support groups can be a helpful resource.

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