Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

• Fear of contamination or dirt
• Doubting and having difficulty tolerating uncertainty
• Needing things orderly and symmetrical
• Aggressive or horrific thoughts about losing control and harming yourself or others
• Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:

• Fear of being contaminated by touching objects others have touched
• Doubts that you've locked the door or turned off the stove
• Intense stress when objects aren't orderly or facing a certain way
• Images of driving your car into a crowd of people
• Thoughts about shouting obscenities or acting inappropriately in public
• Unpleasant sexual images
• Avoidance of situations that can trigger obsessions, such as shaking hands

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.

As with obsessions, compulsions typically have themes, such as:

• Washing and cleaning
• Checking
• Counting
• Orderliness
• Following a strict routine
• Demanding reassurance

Examples of compulsion signs and symptoms include:

• Hand-washing until your skin becomes raw
• Checking doors repeatedly to make sure they're locked
• Checking the stove repeatedly to make sure it's off
• Counting in certain patterns
• Silently repeating a prayer, word or phrase
• Arranging your canned goods to face the same way

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

When to see a doctor

There's a difference between being a perfectionist — someone who requires flawless results or performance, for example — and having OCD. OCD thoughts aren't simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way.

If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health professional.

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

• Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions.
• Genetics. OCD may have a genetic component, but specific genes have yet to be identified.
• Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

• Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.
• Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.
• Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Problems resulting from obsessive-compulsive disorder may include, among others:

• Excessive time spent engaging in ritualistic behaviors
• Health issues, such as contact dermatitis from frequent hand-washing
• Difficulty attending work, school or social activities
• Troubled relationships
• Overall poor quality of life
• Suicidal thoughts and behavior

There's no sure way to prevent obsessive-compulsive disorder. However, getting treatment as soon as possible may help prevent OCD from worsening and disrupting activities and your daily routine.

Steps to help diagnose obsessive-compulsive disorder may include:

• Psychological evaluation. This includes discussing your thoughts, feelings, symptoms and behavior patterns to determine if you have obsessions or compulsive behaviors that interfere with your quality of life. With your permission, this may include talking to your family or friends.
• Diagnostic criteria for OCD. Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
• Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.

Diagnostic challenges

It's sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it's possible to have both OCD and another mental health disorder. Work with your doctor so that you can get the appropriate diagnosis and treatment.

Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don't rule your daily life. Depending on the severity of OCD, some people may need long-term, ongoing or more intensive treatment.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a component of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn ways to resist the urge to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include:

• Clomipramine (Anafranil) for adults and children 10 years and older
• Fluoxetine (Prozac) for adults and children 7 years and older
• Fluvoxamine for adults and children 8 years and older
• Paroxetine (Paxil, Pexeva) for adults only
• Sertraline (Zoloft) for adults and children 6 years and older

However, your doctor may prescribe other antidepressants and psychiatric medications.

Medications: What to consider

Here are some issues to discuss with your doctor about medications for OCD:

• Choosing a medication. In general, the goal is to effectively control symptoms at the lowest possible dosage. It's not unusual to try several drugs before finding one that works well. Your doctor might recommend more than one medication to effectively manage your symptoms. It can take weeks to months after starting a medication to notice an improvement in symptoms.
• Side effects. All psychiatric medications have potential side effects. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric drugs. And let your doctor know if you experience troubling side effects.
• Suicide risk. Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
• Interactions with other substances. When taking an antidepressant, tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you take. Some antidepressants can make some other medications less effective and cause dangerous reactions when combined with certain medications or herbal supplements.
• Stopping antidepressants. Antidepressants aren't considered addictive, but sometimes physical dependence (which is different from addiction) can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, sometimes called discontinuation syndrome. Don't stop taking your medication without talking to your doctor, even if you're feeling better — you may have a relapse of OCD symptoms. Work with your doctor to gradually and safely decrease your dose.

Talk to your doctor about the risks and benefits of using specific medications.

Other treatment

Sometimes, psychotherapy and medications aren't effective enough to control OCD symptoms. In treatment-resistant cases, other options may be offered:

• Intensive outpatient and residential treatment programs. Comprehensive treatment programs that emphasize ERP therapy principles may be helpful for people with OCD who struggle with being able to function because of the severity of their symptoms. These programs typically last several weeks.
• Deep brain stimulation (DBS). DBS is approved by the FDA to treat OCD in adults age 18 years and older who don't respond to traditional treatment approaches. DBS involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that may help regulate abnormal impulses.
• Transcranial magnetic stimulation (TMS). The FDA approved a specific device (BrainsWay Deep Transcranial Magnetic Stimulation) to treat OCD in adults ages 22 to 68 years, when traditional treatment approaches have not been effective. TMS is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of OCD. During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet delivers a magnetic pulse that stimulates nerve cells in your brain.

Talk with your doctor to make sure you understand all the pros and cons and possible health risks of DBS and TMS if you're considering one of these procedures.

Obsessive-compulsive disorder is a chronic condition, which means it may always be part of your life. While OCD warrants treatment by a professional, you can do some things for yourself to build on your treatment plan:

• Practice what you learn. Work with your mental health professional to identify techniques and skills that help manage symptoms, and practice these regularly.
• Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, OCD symptoms are likely to return.
• Pay attention to warning signs. You and your doctor may have identified issues that can trigger your OCD symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
• Check first before taking other medications. Contact the doctor who's treating you for OCD before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, herbal remedies or other supplements to avoid possible interactions.

Coping with obsessive-compulsive disorder can be challenging. Medications can have unwanted side effects, and you may feel embarrassed or angry about having a condition that requires long-term treatment. Here are some ways to help cope with OCD:

• Learn about OCD. Learning about your condition can empower you and motivate you to stick to your treatment plan.
• Stay focused on your goals. Keep your recovery goals in mind and remember that recovery from OCD is an ongoing process.
• Join a support group. Reaching out to others facing similar challenges can provide you with support and help you cope with challenges.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies and recreational activities. Exercise regularly, eat a healthy diet and get adequate sleep.
• Learn relaxation and stress management. In addition to professional treatment, stress management techniques such as meditation, visualization, muscle relaxation, massage, deep breathing, yoga or tai chi may help ease stress and anxiety.
• Stick with your regular activities. Try not to avoid meaningful activities. Go to work or school as you usually would. Spend time with family and friends. Don't let OCD get in the way of your life.

You may start by seeing your primary doctor. Because obsessive-compulsive disorder often requires specialized care, you may be referred to a mental health professional, such as a psychiatrist or psychologist, for evaluation and treatment.

What you can do

To prepare for your appointment, think about your needs and goals for treatment. Make a list of:

• Any symptoms you've noticed, including the types of obsessions and compulsions youꞌve experienced and things that you may be avoiding because of your distress
• Key personal information, including any major stresses, recent life changes and family members with similar symptoms
• All medications, vitamins, herbal remedies or other supplements, as well as the dosages
• Questions to ask your doctor or therapist

Questions to ask might include:

• Do you think I have OCD?
• How do you treat OCD?
• How can treatment help me?
• Are there medications that might help?
• Will exposure and response prevention therapy help?
• How long will treatment take?
• What can I do to help myself?
• Are there any brochures or other printed material that I can have?
• Can you recommend any websites?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• Do certain thoughts go through your mind over and over despite your attempts to ignore them?
• Do you have to have things arranged in a certain way?
• Do you have to wash your hands, count things or check things over and over?
• When did your symptoms start?
• Have symptoms been continuous or occasional?
• What, if anything, seems to improve the symptoms?
• What, if anything, appears to worsen the symptoms?
• How do the symptoms affect your daily life? Do you avoid anything because of your symptoms?
• In a typical day, how much time do you spend on obsessive thoughts and compulsive behavior?
• Have any of your relatives had a mental health disorder?
• Have you experienced any trauma or major stress?

Your doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.