Medically Reviewed

Chrysoula I. Liakou

MD, PhD, Internal Medicine Specialist and
Cancer Immunology Researcher.

What Is Obsessive Compulsive Disorder?

Obsessive-compulsive disorder, or OCD, is a mental health condition that affects how people think and act. People with OCD experience frequent, unwanted thoughts, ideas, or urges called obsessions. These obsessions often cause anxiety or stress, leading them to perform repetitive actions, known as compulsions, to try to feel better. These behaviours include hand washing, checking things multiple times, or following specific routines. Though these actions may temporarily relieve the stress, the unwanted thoughts often come back, creating a cycle that can be hard to break.

OCD isn’t just about habits, like biting your nails. For instance, some people might feel like they have to wash their hands a specific number of times to avoid germs or check if doors are locked repeatedly to feel safe. These rituals can be very upsetting and interfere with daily life, making simple tasks overwhelming or time-consuming.

Living with OCD can be frustrating, and it’s normal to feel embarrassed or even ashamed. However, OCD is a recognised condition, and effective treatments are available. With support, many people find ways to manage their symptoms, regain control, and improve their quality of life.

OCD Symptoms

People with OCD usually experience both obsessions and compulsions, although it’s possible to have just one. Obsessions are unwanted thoughts or fears that pop up repeatedly and cause anxiety or discomfort. Compulsions are actions people feel they must do to ease the distress caused by these obsessive thoughts. Even if someone knows these thoughts or behaviors don’t make sense, it can be tough to control them.

Common Obsessions

Obsessions are thoughts, images, or urges that come to mind repeatedly. These can include:

Fears about germs and dirt
Worries about causing harm to themselves or others
Fixations on having items in a specific order or being perfectly symmetrical
Upsetting or inappropriate thoughts about violence, religion, or other taboo topics
Anxieties about losing control and acting out in ways they don’t want to

Common Compulsions

To ease the stress from these obsessions, people may engage in repetitive actions called compulsions. Examples include:

Washing hands or cleaning surfaces many times a day
Checking and rechecking things, like door locks or appliances
Counting or touching items in a specific way
Arranging items until they "feel right" or are perfectly ordered

These behaviours can be time-consuming and interfere with everyday life, such as getting to work or finishing tasks on time. If OCD symptoms make daily life difficult, speaking to a healthcare provider can help.

OCD Causes

The exact cause of obsessive-compulsive disorder (OCD) isn’t fully understood, but experts believe a mix of genetics, brain chemistry, and environment may play a role. OCD often begins in the teenage years or early adulthood, though some people may experience symptoms in childhood. Here are some key factors thought to be involved:

Genetics: OCD can run in families, which suggests that genetics may play a role. If a close family member has OCD, you may be more likely to develop it as well. Scientists haven’t found specific genes linked to OCD yet, but it’s likely that genes can increase the risk.
Brain Chemistry: Some people with OCD have differences in how certain areas of their brain work or in their brain chemistry, especially involving a chemical called serotonin. Serotonin affects mood, behaviour, and anxiety, so changes in its levels may contribute to OCD symptoms.
Life Experiences: Stressful or traumatic events, such as being bullied or losing a loved one, may trigger OCD in people who are already at risk. Major life changes, like becoming a parent, can also bring out symptoms for the first time.
Personality: People who are naturally very detail-oriented, anxious, or feel a strong sense of responsibility may be more likely to develop OCD.

While the exact cause isn’t clear, understanding these possible factors helps find effective treatments and support.

OCD Diagnosis

Diagnosing obsessive-compulsive disorder (OCD) involves several steps to ensure that the symptoms are related to OCD and not another condition. The first step is visiting a healthcare provider, who will ask questions about your symptoms and medical history. This helps to rule out any physical issues that might be causing similar symptoms.

After the initial check-up, if OCD is suspected, you may be referred to a mental health specialist, like a psychologist or psychiatrist, for further assessment. The specialist will look for key signs that are common in OCD, such as:

Spending at least one hour each day on obsessive thoughts or compulsive behaviours
Finding that these thoughts or actions cause significant stress or anxiety
Feeling like you cannot control these thoughts or behaviours, even if you know they do not make sense
Not finding absolute pleasure in these actions (though they might bring temporary relief from anxiety)
Noticing that these thoughts and actions interfere with daily life, such as school, work, or relationships
Since OCD shares some symptoms with other mental health conditions, like anxiety disorders, the diagnosis can sometimes be challenging. It’s possible to have OCD along with another condition, so the specialist may perform additional tests or evaluations to create an accurate diagnosis.

Getting a proper diagnosis is important because it can lead to effective treatments that help manage symptoms and improve daily life.

OCD Treatment

While OCD cannot be cured, treatment can help manage symptoms and make life easier. The main treatments are therapy (talk therapy) and medication, and often, a combination of both is most effective. Here’s a look at each:

Therapy

Cognitive Behavioural Therapy (CBT): This type of therapy helps people change the way they think and behave. A specific form of CBT called Exposure and Response Prevention (ERP) is very effective for OCD. ERP involves:
- Gradually exposing people to situations that trigger their obsessive thoughts, like touching something they think is dirty
- Guiding them to resist the urge to perform their usual actions, such as washing their hands over and over
- Over time, ERP helps people see that their fears do not come true, which can lower their anxiety

Other therapies: Acceptance and Commitment Therapy (ACT) helps people recognise obsessive thoughts as just thoughts, which can make them feel less powerful. Mindfulness practices, such as meditation, can also help manage stress.

Medication

Doctors often prescribe medications called SSRIs (selective serotonin reuptake inhibitors) to help with OCD. SSRIs are a type of antidepressant that can reduce obsessive thoughts and compulsive actions. Common SSRIs include:

Fluoxetine (Prozac)
Sertraline (Zoloft)

These medications may take a few weeks to start working and might be used in higher doses than for other conditions like anxiety or depression.

Other Treatments for Severe Cases

For people who do not find relief with therapy and medication, other options are available, such as:

Transcranial Magnetic Stimulation (TMS): TMS uses magnetic pulses to stimulate specific brain parts to help with OCD symptoms.
Deep Brain Stimulation (DBS): DBS is a more involved treatment where electrodes are implanted in the brain to help control OCD-related brain activity.

With the proper support and a treatment plan, many people with OCD can manage their symptoms and improve their everyday lives.

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Medically Reviewed

Chrysoula I. Liakou

What Is Obsessive Compulsive Disorder?