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Obsessive-Compulsive Disorder (OCD) | Symptoms & Testing & Treatment

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Medically reviewed by
Last updated April 20, 2022

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Obsessive-compulsive disorder (OCD) causes repetitive, unwanted thoughts and behaviors that can be emotionally distressing and very disruptive. Treatments can help reduce OCD thoughts and behaviors.

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) traps people in a cycle of obsessions and compulsions. Obsessions are often repetitive thoughts and compulsions are repetitive behaviors.

People with OCD have repetitive, intrusive thoughts, images, or urges. They then perform compulsive behaviors or mental acts to try to relieve the anxiety caused by their obsessive thoughts. An example is constantly washing your hands because of an intense fear of germs. Or repetitively checking that the door is locked, rearranging things in a specific order, or repeating phrases out loud or in your head.

OCD is highly treatable with different types of therapy and medications.

Dr. Rx

The following are quite common for people with OCD: “It’s like my thinking gets stuck on this one thing.” “My mind keeps going back to it and I start to doubt myself.” “I know that I have already [checked, washed, adjusted, etc.], but I can’t help it, I just need to do it again and again.” “It just doesn’t feel right and I can’t shake that feeling.” —Dr. Lauren Parker

OCD symptoms

Many people have recurring thoughts that bother them now and then, like worrying about leaving a door unlocked or the stove on. But with OCD these thoughts are constant, upsetting, time consuming, and interfering with daily life. Someone with OCD who excessively cleans, for example, doesn’t actually love to clean—they feel forced to clean out of fear.

Keep in mind that obsessions are like beliefs, which can be very uncomfortable for people with OCD to challenge. Even if part of you knows that touching a doorknob won’t necessarily make you sick, an OCD obsession will make you doubt yourself.

Common obsessions:

  • Contamination: Fear of germs, bodily fluids, or disease
  • Losing control: Fear of acting on an impulse to harm yourself or others, fear of doing something horrible, fear of violent images in your mind
  • Perfectionism: Intense concern with things being “just right,” fear of forgetting or losing something
  • Harm: Fear of being responsible for something terrible happening, fear of harming others by not being careful
  • Other: Unwanted sexual thoughts or impulses, fear of offending God and morality, superstition (lucky/unlucky numbers, objects, etc.)

Common compulsions:

  • Cleaning: Excessive hand washing, showering, grooming, toileting, or cleaning objects to prevent contamination
  • Checking: Repeatedly checking that you didn’t or won’t harm yourself or others, or that you didn’t made a mistake, constantly monitoring your body or physical condition
  • Repeating: Rereading or rewriting, repeating routine activities like sitting and standing, repeating body movements like tics, repeating tasks in a set amount of times
  • Mental: Mentally reviewing events to prevent harming yourself or others, praying to prevent harm, counting tasks
  • Other: Avoiding situations that might trigger obsessions, rearranging items until they’re “right,” difficulty parting with possessions, constantly seeking reassurance

Is there a test for obsessive-compulsive disorder?

A mental health provider can diagnose OCD based on your symptoms. There is not a test that diagnoses OCD, but there are a range of assessments and screening tools doctors can use.

The severity and types of symptoms can vary greatly, making it difficult to diagnose in some people. When compulsive behaviors are more subtle or kept private, OCD is often diagnosed as anxiety. This may happen if you only tell your doctor about your fears but not about your behaviors. Some people with OCD feel ashamed of their compulsive behaviors and don’t want to admit them to others.

If you think you may have OCD, it can be helpful to take an online assessment, such as the Yale-Brown Obsessive Compulsive Scale. But these tests don’t diagnose OCD, so always talk to your primary care doctor or a mental health professional to confirm a diagnosis.

Pro Tip

It is important to consider relevant medical conditions, recent experiences, and family mental health history as contributing factors for OCD symptoms. These types of considerations are important in determining differential diagnoses and what the best course of treatment would be. —Dr. Parker

Causes

The exact cause of OCD is unknown. But research strongly show it comes from:

  • A deficiency in brain chemicals called neurotransmitters (mostly serotonin)
  • Poor communication between the front part of the brain and more central regions
  • Genetics

Studies have shown that stressors and trauma can trigger OCD. The average age that it shows up is 20 years old, but OCD can occur at any age. The risk of developing OCD is higher in people who have another mental health condition, like anxiety, depression, substance abuse, or tic disorder.

It’s not clear why people with OCD develop their particular set of obsessions and compulsions.

OCD in kids

About 1 in 200 children and adolescents have OCD, according to the American Academy of Child & Adolescent Psychiatry. OCD in children is very similar to OCD in adults.

Sometimes though, it may be trickier to tell the difference between typical childhood behavior and OCD behavior. For example, many children have some fears and may develop little rituals around them, like wearing a lucky pair of socks or having a comfort item. But these fears and behaviors are different from more severe obsessions and compulsions that mean a child has OCD.

Children with OCD may think or say something repeatedly, count, or do an activity over and over again. They may create certain rules that must be followed or become very rigid. Often, they develop changes in their mood and refuse to go to school.

A specific type of OCD that occurs suddenly in children is called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections). It’s triggered by an infection and causes very sudden, severe symptoms. You must talk to your pediatrician if you notice that your child has new and different behaviors.

Pro Tip

There are very few thoughts that will actually scare your mental health therapist. We understand that a thought is just a thought. Therapy can help you break free from the prison that these thoughts can create. —Dr. Parker

Treatment

Without treatment, OCD is usually a chronic condition that gets better and worse over time. But about 40–70% of people with OCD will have significant improvements in their symptoms with treatment.

The most effective OCD treatment is a combination of medication and therapy. People with more severe OCD may need to go to a partial hospitalization program, residential center, or inpatient hospital program.

Medication

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are the most effective for OCD. Most side effects of SSRIs, such as nausea and sleep problems, often go away over time or after changing the dose. But it’s still important that you tell your doctor about side effects right away.

Commonly prescribed SSRIs include:

  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil) for adults

Off-label medications

Some people with OCD may need to add another medication if symptoms aren’t improving enough. There are some medications prescribed off-label, meaning the drug is FDA approved but hasn’t been approved to treat OCD. These include:

  • Antidepressants like Effexor or Cymbalta
  • Benzodiazepines (Ativan, Xanax) for more severe anxiety and panic symptoms
  • Antipsychotic medications like risperidone (less commonly prescribed)

Therapy

There are three types of therapy that are commonly used. These therapies can be effective as teletherapy if you cannot meet in person.

  • Cognitive behavioral therapy (CBT) is the most studied therapy for OCD. CBT helps you identify your repetitive thoughts, feelings, and behaviors, and learn how to change these patterns. Psychotherapy can also be effective as teletherapy.
  • Exposure and response prevention (ERP) is a type of therapy that gradually exposes you to obsession triggers and teaches you how to control the compulsion.
  • Acceptance and commitment therapy (ACT) is a newer therapy that helps you accept OCD symptoms. You learn to become less affected by obsessions and have less of an urge to do compulsive behaviors.

Brain stimulation

For more severe or treatment-resistant OCD, brain stimulation techniques may be considered.

  • Transcranial magnetic stimulation (TMS) is a noninvasive approach, where an electromagnetic pulse stimulates nerve cells in the brain.
  • Deep brain stimulation (DBS) is an invasive treatment for adults that implants electrodes into certain areas of the brain to regulate impulses.

Support for OCD

OCD can feel very isolating and confusing, so finding emotional support is important. Most doctors or mental health providers can help you find local support groups. Online groups, including the International OCD Foundation, can also help you connect with others and learn about different treatment techniques.

Apps that offer OCD support can be used in addition to your therapy treatment, but shouldn't be your only treatment.

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I am a licensed clinical psychologist that practices with an integrative approach to psychotherapy. With a focus on well-being, my work is grounded in positive psychology, cognitive behavioral therapy and acceptance and commitment therapy. I strongly believe that we are so much more than just our diagnoses, whether mental, physical or behavioral, and I strive to help clients foster all areas of th...
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