What Is OCD? Symptoms, Treatment And More

When someone is suffering from obsessive-compulsive disorder, they often have repetitive and unwanted thoughts—called obsessions—of a disturbing nature. These obsessions are often unrealistic or irrational and are recognizable as such to the individual, but still trigger intense feelings of anxiety or distress. Obsessions are often, but not always, accompanied by strong, uncomfortable urges to perform certain behaviors, called compulsions. These behaviors can temporarily relieve the distressing feelings but over time, can begin to take over the person’s day, as some of these compulsions are repetitive and involve elaborate rituals that can take a long time and cut into their ability to tend to their responsibilities or engage socially.

At the heart of these obsessions and compulsions is doubt. “Doubt is a hallmark of OCD and it overrides any sense of logic or intelligence an individual might have,” says Holly Schiff, Psy.D., a licensed clinical psychologist based in Greenwich, Connecticut. “The cause for this doubt comes from the fact that OCD makes you obsess over certain thoughts—in this case doubting if you did something or not, and therefore, in order to get safety, security and certainty, you will obsessively repeat the action.”

Symptoms of OCD

The chief symptom associated with OCD is a person experiencing obsessions and/or compulsions. People with OCD find it difficult to manage their obsessive thinking which can wreak havoc on their ability to manage other tasks effectively. Those who experience the compulsion symptoms will have great difficulty resisting the urge to perform these compulsions. These symptoms can ultimately impact their work, education or relationships with others.

Below, we’ve listed some of the more common obsessive thoughts and compulsive actions, according to the Mental Health Foundation.

Common obsessions in OCD:

• Fear of dirt
• Fear of germs
• Fear of harm (such as what might happen if the stove is left turned on or door left unlocked)
• Placing items in an exact order, facing the same way or matching in some other fashion
• Excessive need for orderliness
• Anxiety over unwelcome thoughts including anger or sexual or religious content
• Anxiety over unwelcome thoughts relating to harming oneself or others
• Anxiety over unwelcome thoughts relating to inappropriate behavior

Common compulsions in OCD:

• Ritualized and extensive cleaning
• Repetitive acts (like checking stoves or locked doors)
• Ordering and arranging
• Repeating mantras or phrases
• Mental rituals
• Repeating words, phrases or prayers

“OCD symptoms can be similar to those of other mental illnesses, like obsessive-compulsive personality disorder, anxiety disorders, depression, autism spectrum disorders or schizophrenia,” says Dr. Schiff. Each person suffering from OCD may have a unique mix of symptoms that stems from personal experience, stressful events and even trauma.

While the repetitive thoughts associated with OCD can be about pretty much anything, there are a few categories of obsessions that tend to occur frequently, according to the International OCD Foundation.

Sexual or Violent Obsessions

This includes obsessive thoughts that are either violent and/or sexual in nature. Thoughts may focus on one’s own sexual tendencies, including an unusual level of concern that one may currently be or will become a pedophile.

Contamination Obsessions

Here, thoughts revolve around some aspect of contamination. Fears can be about many things outside of dirt and/or germs, and can include bodily fluids, diseases, garbage, spoiled food and even soap. Contamination obsessions can lead to excessive cleaning, throwing away personal belongings or avoiding certain places or touching things.

Sexual Orientation Obsessions

This subtype occurs when someone’s doubts extend to their own sexual orientation. This includes questioning their sexual orientation, fears of becoming homosexual (or heterosexual), or fears that others might think one is homosexual (or heterosexual).

Relationship Obsessions

Relationships are hard enough as it is, but someone suffering from relationship obsessions may find themselves constantly second-guessing every aspect of their relationship. Those with OCD may constantly wonder whether they’re with the right person, whether their opinion of their partner is correct or whether they should stay with their partner or find someone new.

While the cause of OCD is unknown, it does appear to be familial in many cases.“Family history is a risk factor when it comes to OCD, since having parents or other family members with the disorder can increase your risk of developing it,” says Dr. Schiff.

OCD can also develop in response to stress or trauma, and while research is still underway, the National Institute of Mental Health notes that structural differences in the brain have been observed in patients with OCD.

OCD is a condition that can cause extensive interruption to the lives of those who suffer from this disorder. Below, Dr. Schiff outlines just a few of the risks associated with OCD:

• Problems that result from the obsessions and compulsions, since one may spend an excessive amount of time engaging in ritualistic behaviors (this could include raw, chapped skin on hands from excessive washing, for example, or having to spend extra money on items that have been repeatedly thrown away)
• Difficulty attending work or school or participating in social activities
• Difficulty maintaining friendships and/or relationships
• Suicidal thoughts and behaviors

OCD usually begins before an individual reaches their 20s, with symptom onset in childhood and adolescence being quite common. Many people are diagnosed with OCD by the age of 19, but onset after age 35 does occur, notes the National Institute of Mental Health. There is also the possibility of a delayed diagnosis, as the individual with OCD often experiences significant shame about their symptoms, which can delay treatment seeking and accurate diagnoses. An estimated 1.2% of U.S. adults had OCD in the past year, according to the institute ^[1]Obsessive-Compulsive Disorder. National Institute of Mental Health. Accessed 5/10/2022. .

If you’re experiencing any of the thoughts or actions discussed above, it’s important to seek the help of a qualified therapist or other mental health professional. They will likely start by doing a complete psychological evaluation or assessment that looks at your thoughts, feelings, symptoms and behavior in order to determine if your obsessions and compulsions interfere with your quality of life, says Dr. Schiff.

The latest version of the Diagnostic and Statistical Manual of Mental Health Disorders, the DSM-5, which is the American Psychological Association’s official manual for diagnosing mental disorders, has established new criteria for diagnosing OCD. According to the manual, the actions and thoughts associated with OCD must be present for more than one hour a day or cause clinically significant distress or impairment in functioning. Additionally, these disturbances must not be attributed to another mental disorder, substance abuse or physical trauma (such as a head injury).

There are other diagnostic criteria as well in addition to these, and a diagnosis requires clinician judgment on whether and how these criteria apply to you. It’s crucial that you seek the help of a professional to make this diagnosis, rather than trying to diagnose yourself.

Treatment for OCD focuses on symptom management, primarily through medication, psychotherapy or a combination of both.

In a therapeutic setting, a therapist may use cognitive behavioral therapy (CBT), since this is aimed at changing the way the patient thinks—the goal is to trade negative thought patterns for healthier, more affirming thoughts. CBT can help manage and reduce obsessive thinking, and also help to reduce the frequency of compulsions by learning other more effective and healthy coping strategies to combat the emotional symptoms of OCD.

“There is a form of CBT called ERP (exposure and response prevention) where the individual is exposed to situations that provoke their obsessions and the resulting distress while preventing them from engaging in their compulsive responses,” says Dr. Schiff. The goal of this specific type of therapy is for the patient to become desensitized to the fears and impulses they experience. In addition to CBT and ERP, there are a number of psychiatric medications (such as serotonin reuptake inhibitors or selective serotonin reuptake inhibitors) that can also help control obsessions and compulsions, says Dr. Schiff.

If you or a loved one suffers from OCD symptoms, reach out to a mental health professional to determine which course of treatment might be best for you.

You May Also Be Interested In Online Therapy Services From Our Featured Partners

Talkspace

Learn More

On Talkspace's Website

4.9

Our ratings take into account a product's rewards, fees, rates and other category-specific attributes. All ratings are determined solely by our editorial team.

Price per session

$65

Choose your own therapist?

Yes

Cerebral

Learn More

On Cerebral's Website

4.5

Our ratings take into account a product's rewards, fees, rates and other category-specific attributes. All ratings are determined solely by our editorial team.

Price per session

$64.75

Choose your own therapist?

Yes

BetterHelp Online Therapy

Learn More

On BetterHelp's Website

4.2

Our ratings take into account a product's rewards, fees, rates and other category-specific attributes. All ratings are determined solely by our editorial team.

Price per session

$60 to $90

Choose your own therapist?

No

(Note: Product details and pricing are accurate as of the publication date.)