Q and A: Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a common and long-lasting disorder. People with OCD have unwanted thoughts that keep coming back (obsessions) and behaviors that keep repeating (compulsions), which they feel they can't control. Rituals, such as handwashing, counting, checking, or cleaning, are often done in hope of preventing obsessive thoughts or making them go away. But these rituals provide only temporary emotional relief. Not doing them greatly increases anxiety. Left untreated, obsessions and the need to do rituals can take over a person's life. OCD is often an illness that occurs over and over again.

People with these symptoms may feel ashamed to talk about them. They also worry that they are crazy. Or they think that nothing could possibly help. Fortunately, effective treatments have been developed to help people with OCD.

How common is OCD?

OCD affects adults and children of all ethnic groups and backgrounds. About 1 in 100 adults have OCD. It may run in families. People with OCD often notice symptoms during childhood, teen years, or early adulthood. OCD is a chronic condition that lasts throughout a person’s life, If the disorder is very bad, the person can face serious limits in their daily life.

What are obsessions?

Obsessions include:

• Thoughts that are often inappropriate and that keep returning. They cause stress or anxiety. This leads to efforts to dismiss those thoughts. 

• Thoughts that are not simply excessive worries about real-life problems

• Recognition that the thoughts come from their own mind

What are compulsions?

Compulsions include:

• Physical behaviors that are done over and over (for example, handwashing) or mental behaviors (for example, counting and repeating words or phrases)

• Behaviors that are aimed at preventing distress. These are not connected in a real way to what they are intended to lessen the effect of. These behaviors usually come before an almost uncontrollable drive to do them.

Other qualifiers

Other reasons that a person would be considered to have OCD:

• The person recognizes the obsessions or compulsions go beyond what is considered normal and reasonable.

• The obsessions or compulsions cause distress, are time-consuming, and interfere with the person’s life.

• The obsession or compulsion is not a specific symptom of some other mental disorder.

• The obsessions and compulsions are not caused by a substance (alcohol, drugs, or medicines).

What causes OCD?

Experts now believe OCD is caused by the brain and nervous system and not by family problems or behaviors learned in childhood. Genes may play a role in OCD.

Brain imaging studies using a method called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. PET scans also show that in people with OCD, both behavioral therapy and medicines result in changes in the brain.

What treatments are available for OCD?

Both medicines and psychotherapy can help most cases of OCD. A combination of both works even better. Support from family and friends is also important.

Several medicines can help people with OCD. These include a tricyclic antidepressant, SSRIs (selective serotonin reuptake inhibitors), and other antidepressants. There are many choices. Talk with your healthcare provider about trying another medicine if one doesn't work well.

Another treatment is a type of cognitive behavioral therapy known as "exposure and response prevention." In this approach, a person is voluntarily exposed to whatever sets off the obsessive thoughts. They are then taught ways to stay away from doing the compulsive rituals and to deal with the anxiety.

Resources to help

Resources are available to help manage OCD, Talk with your healthcare provider or local healthcare organizations. Or visit the following national websites:

• FindTreatment.gov

• National Institute of Mental Health

Can people with OCD also have other physical or emotional illnesses?

A person with OCD may also have depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. OCD often is harder to diagnose and treat when a person also has other disorders. Symptoms of OCD also can coexist and may even be part of a range of nervous system disorders. They include Tourette syndrome. Appropriate diagnosis and treatment of other disorders is important to successful treat OCD. It's important that the person with OCD has an initial evaluation by a psychiatrist or other mental health specialist to make sure of a correct diagnosis.