What is OCD? Symptoms, causes, and treatment for obsessive compulsive disorder

• Obsessive compulsive disorder (OCD) is a mental health disorder that is made up of intrusive, unwanted thoughts that become obsessions, and repetitive compulsions that impact daily life.
• Obsessions and compulsions are often related to irrational fears about contamination, perfectionism, making mistakes, superstition, and sexual or religious thoughts.
• OCD can be treated effectively with therapy and medication, though it is first important for the patient to recognize their obsessions and compulsions.
• This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John's Health Center.
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Obsessive compulsive disorder (OCD) is a mental illness that affects about 1% of the US population.

OCD is made up of two distinct symptoms: obsession and compulsions. Although rare, someone can be diagnosed with OCD if they only have one of these symptoms, says Gregory Sayer, MD, board-certified psychiatrist and faculty psychiatrist at NYU Langone Health.

Here's what you need to know about obsessions and compulsions, what causes OCD, and how to treat it effectively.

OCD symptoms

For someone with OCD, obsessions are thoughts, feelings, or impulses that are experienced again and again. The obsessions are intrusive — they severely impact daily life — and the person often feels disgusted by them.

"A person with OCD may realize their obsessive intrusive thoughts don't make sense, but they can't seem to stop them," says Roseann Capanna-Hodge, a psychologist.

To try to avoid these obsessions, patients develop compulsions, which are overly repetitive behaviors that they believe will help them counteract or overcome the obsessive thoughts.

"Compulsions are behaviors that individuals with OCD feel compelled to do repeatedly," says Capanna-Hodge. "OCD causes a person to feel they have to do rituals to do things in a certain way to make them feel less anxious… but in reality [compulsions] heighten anxiety."

Common types of obsessions and compulsions include:

• Contamination: Being overly concerned about dirt, germs, or other perceived contaminants. People with OCD might wash their hands and then still think they're dirty, Sayer says. Sometimes, they wash so much that their hands become cracked or bleed.
• Perfectionism: Fears about being exact, balanced, or perfect. "Feeling something isn't exactly aligned or ordered would lead to ordering, measuring, rearranging," says Sayer. This can include repetitively cleaning your living space or constantly reordering your daily schedule, even when it isn't necessary.
• Causing harm or making mistakes: Fear of danger, or hurting oneself or someone else, can lead to repetitive safety measures. For example, people with this obsession might constantly check to make sure they've locked the door or turned off the oven.
• Superstition and prevention: Some people with OCD obsess over the idea that a negative consequence will occur if they do something wrong. "They will compulsively engage in a behaviour that they think will undo the bad luck such as arranging items in a perfect symmetry or counting every window they see," Sayer says.
• Sexual or religious thoughts: People with these obsessions might constantly fixate on prayer, deprive themselves of sex, or have unwanted sexual thoughts.

What causes OCD?

Scientists believe that OCD originates in the brain, and potentially has to do with abnormal function of neurotransmitters like serotonin.

"While the exact cause of OCD is still not known, there are clear contributors to the development of OCD," says Gail Saltz, MD, associate professor of psychiatry at the New York Presbyterian Hospital Weill-Cornell School of Medicine.

For example, people with a first-degree relative (parent or sibling) with OCD are more likely to have the condition themselves — both due to genetics and the environment they're raised in.

A 2019 twin study published in the journal European Psychiatry found that stressful life events increased the risk of experiencing obsessive-compulsive symptoms. The study found that 48% of obsessive-compulsive symptoms were influenced by genetics, while 52% were influenced by environmental factors.

Prenatal development may also play a role in the development of OCD: a 2016 study of siblings found premature births, those with low or high birth weights, and those whose mother smoked during pregnancy had a higher risk of developing OCD.

In addition, people with autism are twice as likely as the general population to develop OCD, according to a 2015 study, although scientists are still working to understand the relationship between the two disorders.

OCD treatment

The first step in treating OCD is recognizing that you have a problem and getting a diagnosis from a psychiatrist, says Patricia Celan, MD, a psychiatry resident at Dalhousie University in Canada.

Although some worry is normal, spending an hour or more worrying each day could signal a bigger problem. "If your symptoms are impeding your ability to have a normal social life or perform well at school or work, then you may have OCD," Celan says.

The most effective treatment for OCD is a combination of medication and cognitive-behavioral behavioral therapy. About 70% of people who try this combination will see improvement, according to the International OCD Foundation. However, before you can start a treatment plan you need to acknowledge that your obsessions or compulsions are problematic.

"A person who is in denial may be unwilling to take the medication or engage in the therapy needed for recovery, and therapy definitely will be ineffective if you're not able to recognize when an obsession or compulsion is irrational," Celan says.

Exposure and Response Prevention (ERP) is the most common form of cognitive behavioral therapy used to treat OCD. It involves people with OCD triggering their obsessive thoughts, then challenging themselves not to compulsively respond to the obsession. Two-thirds of people who go through ERP will experience some relief for their symptoms.

In addition, medication can reduce OCD symptoms by about 40 to 60%. The class of antidepressants called serotonin reuptake inhibitors (SRIs) can increase serotonin in the brain. Scientists aren't sure why, but this helps with symptoms of OCD. Many of these medications take 6-8 weeks to take full effect, although many people see some effect in 1-2 weeks.

Treatment for OCD might not get rid of all obsessions and compulsions, but it should reduce their severity, giving the person more freedom to go about their daily life unhindered.

"We know an OCD treatment is effective when it significantly reduces obsessions and compulsions and the person can function at home, school, and work," Capanna-Hodge says. "They are able to participate in their daily activities and have normal relationships."

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