Background Information

Have you ever left your house, but stopped the car and went back inside because you couldn’t remember if you turned off the stove? A natural reaction to a potentially dangerous situation, right? Sure – we’ve all done it. Ever obsessively thought about whether you turned the stove off for hours on end. Or engaged in the repetitive checking and re-checking that you turned it off? Do you have no control over stopping these obsessive thoughts and compulsive behaviors? Then, you might be suffering from obsessive compulsive disorder (OCD). This condition is chronic and affects approximately 2% of the general population over the course of a lifetime. On any given day, 1.5% of people across the globe are suffering from OCD.

If you are suffering from obsessive-compulsive disorder, it is likely negatively affecting your life to some degree. You might engage in excessive hand washing that disrupts your lifestyle – spending over an hour a day washing your hands repeatedly to the point they become raw and blistered. Or, you might develop a counting ritual such that you can’t leave a room without turning the light on and off a certain number of times. If you are suffering from OCD, you likely know that your thoughts and behaviors are irrational. But, you still, uncontrollably, engage in the ritualistic behavior or can’t stop thinking about something obsessively. In addition, if you suffer from obsessive-compulsive disorder, you are more likely to also be coping with other mental health disorders, including eating disorders and depression; and your risk of developing anxiety, tics, and contemplating suicide are increased.

The typical onset of obsessive-compulsive disorder is before the age of twenty. It is very uncommon for obsessive-compulsive behavior to begin after the age of thirty-five, though it can occur. Obsessions and compulsions are prevalent among children and occur about equally in men and women. Often, obsessions and compulsions develop among some type of theme. For example, if you are suffering from this condition, you might be fearful of germs. You obsessively think about getting sick from these germs, so you engage in the compulsive act of excessive hand washing. Despite your best efforts to ward off these thoughts, you have no control over them, so you engage in more and more hand washing because of your fear of germs. Because the obsessive thoughts about germs never go away, your compulsions get worse, and the cycle goes on and on with no relief. This cyclical nature of obsession and compulsion is classic of obsessive-compulsive disorder.

So What are the Symptoms?

We’ve talked a lot about hand washing rituals. But this is only touching the tip of the iceberg when it comes to OCD. What exactly are obsessions and compulsions? What other types of behaviors represent this disorder? Read on to find out.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety in an individual. Some of the more common themes of obsessions include:

  • Fear of germs
  • The need to have things in perfect, symmetrical order
  • Taboo thoughts or other unwanted thoughts are things such as sex, religion, or harm
  • Aggressive thoughts toward yourself or toward others

Some of the more common obsession signs and symptoms include:

  • Fear of being contaminated with germs or dirt by shaking hands with another person or touching objects that are not yours
  • Feeling intensely stressed out when certain belonging are not facing in the same direction (need for order and symmetry)
  • Avoiding situations that could cause obsessive thoughts (e.g., avoiding shaking another person’s hand for fear of getting germs or dirt on your own hands)
  • Constant doubt that you locked the door to your house/car and/or turned your stove off
  • Thoughts about horrifically hurting yourself or hurting others
  • Obsessive thoughts about shouting inappropriate things or obscenities
  • Feeling stressed out when you replay unwanted sexual images in your head repeatedly
  • Fear of being embarrassed
  • Excessive doubt and need for reassurance

Compulsions are the direct result of obsessions. When you suffer from obsessive-compulsive disorder, your obsessive thoughts lead to repetitive behaviors (compulsions) you feel are necessary to perform. You perform these behaviors to reduce the anxiety produced from obsessive thoughts and to prevent something bad from happening. If you are coping with obsessive-compulsive disorder, you likely know that these compulsions only provide temporary relief and bring no pleasure.

Common themes surrounding compulsions include:

  • Counting
  • Checking
  • Washing/cleaning
  • Maintaining strict routines
  • Orderliness
  • Need for reassurance

Common compulsion signs and symptoms include:

  • Excessive hand washing, often causing your hands to become raw and sometimes bleed
  • Patterned counting behaviors
  • Repeated checking that the stove is turned off
  • Repeated checking of door locks
  • Refusing to shake hands or touch door knobs
  • Eating foods in a specific order and/or not allowing foods to touch
  • Collecting or hoarding items
  • Repeating a prayer or phrase to yourself
  • Ordering and arranging things in a precise, symmetrical way

If you are suffering from obsessive-compulsive disorder, your symptoms may come and go over time and also vary in intensity.

How Is OCD Diagnosed and What Causes It?

What causes obsessive-compulsive disorder? Doctors and mental health professionals cannot pinpoint an exact cause but believe both genetics and environmental factors play a role in the occurrence of OCD. Twin and family studies reveal a higher likelihood of developing OCD if first-degree relatives also suffer from the disorder. Research has shown that the likelihood also increases if the first-degree relative developed OCD at an early age.

Individuals suffering from obsessive-compulsive disorder also have varying brain structures from those of a population without OCD. Studies indicate abnormalities in the frontal cortex and subcortical structures of the brain in OCD patients; however, more extensive research is needed to more definitively understand this biological occurrence.

Environmental factors that are thought to increase your chances of developing OCD include experiencing physical or sexual abuse during childhood or other types of trauma.

When obsessions and compulsions are negatively affecting your everyday life, it is wise to see a doctor or mental health professional.  Adults who are suffering from OCD are likely aware of their thoughts and behaviors; however, children are usually unaware that something’s amiss. Oftentimes, parents or teachers are the ones who first notice OCD symptoms occurring in youth or adolescents.  Its negative impact can affect your social, interpersonal, work, and school life, interrupting daily routines by spending excessive amounts of time on obsessive thoughts and compulsive actions.

Your mental health provider will perform a mental health assessment to confirm an OCD diagnosis and your physician will perform an exam and blood work to rule out other underlying causes. A number of comprehensive obsessive-compulsive disorder screenings exist to determine the occurrence of OCD and the severity of it.  Once diagnosed, you and your mental health provider will work together to determine the best treatment options and coping mechanisms.

OCD Treatment

The most common treatment options for obsessive-compulsive disorder are medication and psychotherapy. Or, a combination of both.

If you are suffering from OCD, you may be prescribed serotonin reuptake inhibitors (SRIs) or selective serotonin reuptake inhibitors (SSRIs) to control symptoms. Antidepressants are normally tried first to control OCD symptoms. The most commonly prescribed medications include:

  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Clomipramine (Anafranil)
  • Fluvoxamine (Luvox, CR)
  • Paroxetine (Paxil, Pexeva)

In some cases, antipsychotics are prescribed to treat OCD, or a combination of antidepressants and antipsychotics. If you have been prescribed a medication for treatment of OCD, it is important to note that many of these medications may take a number of weeks or months to have a full effect on your symptoms.

Your doctor might also suggest psychotherapy as a treatment option for obsessive-compulsive disorder. Psychotherapy is meant to change your negative thought patterns to related to obsessions and resultant compulsions. With OCD, exposure and response prevention (ERP) has been found to be the most effective treatment option. A form of cognitive behavioral therapy, this method of exposure therapy gradually exposes you to your obsession (e.g., dirt) to allow you to cope with your anxiety in a healthier way. Many times, doctors will prescribe ERP therapy in conjunction with medications when SRIs and SSRIs are not effective enough on their own. Individual, family, and group sessions of exposure therapy are available.

Obsessive-compulsive disorder is a chronic condition, meaning if you are suffering from this disorder, you may cope with it for your entire life. However, as our understanding of this condition grows, our treatment options and success rates of treatment evolve. Educate yourself about your condition, follow your doctor’s advice, and learn the warning signs and symptoms. Doing so keeps you proactive and informed of your disorder and enables you to live a healthy and productive life.

Last Updated: Oct 5, 2017