Q and A: Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) have recurrent, unwanted thoughts (obsessions) and repetitive behaviors (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 a chronic, relapsing illness.

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

How common is OCD?

About 2.2 million American adults may be affected by OCD during their lives. This is split between men and women. People with OCD often notice symptoms during childhood. Early onset OCD has been reported in children as young as 2 years old. Some evidence suggests OCD may run in families. 

What are obsessions?

Obsessions include:

• Recurrent and persistent, intrusive, inappropriate thoughts that 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 are a product of their own mind

What are compulsions?

Compulsions include:

• Repetitive behaviors (for example, handwashing) or mental behaviors (for example, counting and repeating words or phrases)

• Behaviors that are aimed at preventing distress. These are not realistically connected with 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 are excessive and unreasonable.

• The obsessions or compulsions cause marked 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 due to a substance (alcohol, drugs, or medicines).

What causes OCD?

There is growing evidence that the major basis of OCD is in the brain and nervous system. Family problems or attitudes learned in childhood—for example, an unreasonable emphasis on cleanliness or a belief that certain thoughts are dangerous or unacceptable—are no longer considered primary and may not be involved at all. A genetic link is currently being studied as a possible cause of OCD.

Brain imaging studies using a technique 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. In addition, PET scans show that in people with OCD, both behavioral therapy and medicines produce changes in the brain.

What treatments are available for OCD?

Both medicines and psychotherapy have proven to be effective in most cases of OCD, and a combination of both is even more effective.

Several medicines are effective in helping people with OCD. These include a tricyclic antidepressant, SSRIs (selective serotonin reuptake inhibitors), and other antidepressants. There are many options. If one doesn't work well, talk with your healthcare provider about trying another.

A type of behavioral therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is voluntarily exposed to whatever triggers the obsessive thoughts. They are then taught ways to avoid doing the compulsive rituals and to deal with the anxiety. Cognitive psychotherapy also can be effective.

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

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