NIMH » Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder Definition Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over. Signs and Symptoms People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships. Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include: Fear of germs or contamination Unwanted forbidden or taboo thoughts involving sex, religion, and harm Aggressive thoughts towards others or self Having things symmetrical or in a perfect order Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include: Excessive cleaning and/or handwashing Ordering and arranging things in a particular, precise way Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off Compulsive counting Not all rituals or habits are compulsions. Everyone double checks things sometimes.

But a person with OCD generally: Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive Spends at least 1 hour a day on these thoughts or behaviors Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause Experiences significant problems in their daily life due to these thoughts or behaviors Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds. Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children. If you think you have OCD, talk to your doctor about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Note for Health Care Providers: There are comprehensive and validated screening instruments for quantifying and tracking signs and symptoms of OCD. One example is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which you can find on the Anxiety and Depression Association of America (ADAA)* website . Another example is the Florida Obsessive-Compulsive Inventory, which is available online at . This listing is not comprehensive and does not constitute an endorsement by NIMH. *ADAA is an NIMH National Partner . Risk Factors OCD is a common disorder that affects adults, adolescents, and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen. For statistics on OCD in adults, please see the NIMH Obsessive Compulsive Disorder Among Adults webpage. The causes of OCD are unknown, but risk factors include: Genetics Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen.

Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment. Brain Structure and Functioning Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway. Understanding the causes will help determine specific, personalized treatments to treat OCD. Environment People who have experienced abuse (physical or sexual) in childhood or other trauma are at an increased risk for developing OCD. In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). For more information, please read this fact sheet on PANDAS. Treatments and Therapies OCD is typically treated with medication, psychotherapy or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms. Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal.

It is important to consider these other disorders when making decisions about treatment. Medication Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms. Examples of medications that have been proven effective in both adults and children with OCD include clomipramine , which is a member of an older class of “tricyclic” antidepressants, and several newer “selective serotonin reuptake inhibitors” (SSRIs), including: sertraline SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement. If symptoms do not improve with these types of medications, research shows that some patients may respond well to an antipsychotic medication (such as risperidone ). Although research shows that an antipsychotic medication may be helpful in managing symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

If you are prescribed a medication, be sure you: Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking. Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible. Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication. Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online at or by phone at 1-800-332-1088. You or your doctor may send a report. Other medications have been used to treat OCD, but more research is needed to show the benefit for these options. For basic information about these medications, you can visit the National Institute of Mental Health (NIMH) Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website . Psychotherapy Psychotherapy can be an effective treatment for adults and children with OCD.

Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication. For many patients EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms. Other Treatment Options NIMH is supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These new approaches include combination and add-on (augmentation) treatments, as well as novel techniques such as deep brain stimulation (DBS). You can learn more about brain stimulation therapies on the NIMH website. Finding Treatment For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator on its website that can be searched by location.

You can also visit the NIMH’s Help for Mental Illnesses page for more information and resources. Join a Study Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including OCD. During clinical trials, investigated treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future. Please Note: Decisions about whether to participate in a clinical trial, and which ones are best suited for a given individual, are best made in collaboration with your licensed health professional. Clinical Trials at NIMH/NIH Scientists at the NIMH campus conduct research on numerous areas of study, including cognition, genetics, epidemiology, brain imaging, and treatment development. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with a clinician.

For more information, visit NIMH Clinical Trials — Participants or Join a Study . How Do I Find a Clinical Trial Near Me? To find a clinical trial near you, visit ClinicalTrials.gov . This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from health professionals. For more information about participating in clinical trials, visit NIH Clinical Trials and You . Learn More Free Booklets and Brochures Obsessive-Compulsive Disorder (OCD) | Mental Health America Home » Obsessive-Compulsive Disorder (OCD) Obsessive-Compulsive Disorder (OCD) People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals, such as handwashing, counting, checking or cleaning, are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them increases anxiety.

Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness. Characteristics Obsessions are thoughts, images or impulses that occur repeatedly. The person does not want to have these ideas, finds them disturbing and intrusive and, usually, recognizes that they really don't make sense. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust or doubt. Common obsessions include contamination fears, imagining having harmed self or others, imagining losing control of aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, or a need to tell, ask or confess. People with OCD typically try to make their obsessions go away by performing compulsions. Compulsions are acts the person repeatedly performs, often according to certain “rules.” These rituals are performed to obtain relief from the discomfort caused by the obsessions. Examples of compulsions are washing, repeating, checking, touching, counting, ordering/arranging, hoarding or saving, and praying. In some instances, a person may suffer from only obsessions or only compulsions.

OCD symptoms cause distress, take up a lot of time (more than an hour a day), or significantly interfere with the person's work, social life or relationships. Most individuals with OCD recognize that their obsessions are not just excessive worries about real problems and that the compulsions they perform are excessive or unreasonable. The extent to which a person with OCD realizes that his or her beliefs and actions are unreasonable is called his or her “insight.” Causes There is growing evidence that OCD has a biological basis. OCD is no longer attributed to family problems or to attitudes learned in childhood. Instead, the search for causes now focuses on the interaction between biological factors and environmental influences. Research suggests that OCD involves problems in communication between parts of the brain. These problems may be caused by insufficient levels of certain brain chemicals, called neurotransmitters. Drugs that increase the brain concentration of these chemicals often help improve OCD symptoms. Treatments The most common treatment for OCD is a combination of cognitive-behavioral psychotherapy (CBT) and medication. A type of behavioral therapy known as “exposure and response prevention” (E/RP) is very useful for treating OCD.

In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts (exposure) and is then taught techniques to avoid performing the compulsive rituals (response prevention). The cognitive portion of CBT is often added to E/RP to help challenge the irrational beliefs associated with OCD. Co-occurring Illnesses OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit/hyperactivity disorder or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD. On average, people with OCD see three to four doctors and spend over nine years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.

OCD: Symptoms & Treatment OCD: Symptoms & Treatment By Elizabeth Palermo, Associate Editor | August 25, 2014 06:36pm ET MORE Credit: caimacanul / Shutterstock.com Obsessive-compulsive disorder, or OCD, is a mental disorder characterized by recurrent, persistent thoughts and images (obsessions) and ritualistic behaviors (compulsions) that interfere with a person's daily life and relationships, according to the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5). People with OCD often realize their compulsive behavior is irrational, but they may feel that they do not have the ability to stop engaging in it, since doing so would only increase their level of anxiety. The International OCD Foundation estimates that about 1 in 100 adults, and 1 in 200 children in the United States has OCD. The condition often appears first during the childhood or teen years, and it tends to occur in men and women in roughly equal numbers. Symptoms of OCD OCD can manifest in many ways, but in general, a person with this disorder has obsessions that result in compulsive behaviors. "Obsessions are automatic and obtrusive.

They come on you whether you like it or not," said Jeff Szymanski, a clinical psychologist and executive director of the International OCD Foundation, a nonprofit organization in Boston. "Compulsions are deliberate, purposeful behaviors that someone does in response to the obsession and anxiety [of OCD] in an effort to make the obsessions and anxiety go away." This is why compulsions often have some connection to the obsession that triggers them. A child who obsesses about germs or contamination, for example, might compulsively wash his or her hands. Other common obsessions and compulsions include the constant need to "check" things, such as whether the front door is locked or the oven is turned off, and an obsession with counting or arranging things in a particular order, according to the International OCD Foundation . While OCD symptoms show up differently in each individual, those with the disorder have at least one thing in common: Their obsessive-compulsive tendencies get in the way of everyday life. This is what separates OCD from day-to-day anxiety and habits that are deemed "normal." A small amount of obsessive thinking or compulsive behavior is not necessarily a symptom of OCD.

Anxiety is a normal response to stress that serves a valuable purpose, Szymanski told Live Science. The ability to foresee, and then worry about, possible dangers allows humans to take precautionary measures and survive difficult situations. But those with OCD may worry and compulsively perform "precautionary" behaviors even after they have determined that no danger exists. Causes of OCD In most cases, there isn't one particular cause of OCD. Many factors likely combine to create the disorder. One of those factors is genetics , as OCD often runs in families. The disorder is also known to coincide with abnormalities in certain brain processes. When exposed to threatening or frustrating situations, most people with OCD experience hyperactivity in the parts of the brain regulating external stimuli. These brain regions include the amygdala, which evaluates and processes danger, and the orbital frontal cortex, which performs cognitive processing and decision-making functions. The neurotransmitter serotonin may also play a part in OCD. (Neurotransmitters are chemicals that relay messages within the brain.) Medication that modifies serotonin levels can reduce OCD symptoms (see Treatments, below). A lesser-known cause of OCD is bacterial infection in children.

Known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), this form of OCD only affects children and is associated with sudden onset of extreme OCD symptoms, including: anxiety (including acute separation anxiety and irrational fears) depression sudden deterioration in school performance sensory or motor abnormalities (particularly trouble with handwriting) physical signs and symptoms While this sudden onset of OCD usually occurs after a strep infection, it can also come after other bacterial infections, according to the International OCD Foundation . Diagnosis of OCD Not all perfectionist or repetitive behaviors are symptomatic of OCD. Washing your hands two times after exiting the subway or triple-checking that the front door is locked before going to bed do not mean that you have OCD, according to Szymanski. "In popular culture, OCD has come to mean 'someone who likes things a particular way,' but it's important to look at the other part of the definition for this disorder, that you're having these obsessions and doing these behaviors, and it's really time-consuming. It's really distressing, and it's getting in the way of you functioning in the world in the way that you would like to," Szymanski said.

It is only when the behaviors become so severe and time-consuming that they interfere with that person's normal daily life that a health care expert might make a diagnosis of OCD. And only a qualified physician or mental-health specialist can make such a diagnosis accurately. The condition is often present with other mental-health disorders, such as depression and anxiety disorders, according to the National Institutes of Health (NIH). Treatment for OCD There are several methods of treating OCD ; most involve some kind of medication, psychotherapy or a combination of both. Cognitive-behavioral therapy (CBT) has been shown to be effective in treating OCD by teaching individuals with the disorder to try a different approach to those situations that trigger their obsessive-compulsive behavior. One type of CBT, known as exposure and response prevention (ERP), can help people with OCD by teaching them healthy ways to respond when exposed to a feared object (dirt or dust, for example). "In [ERP] you ask patients to purposefully make themselves anxious, and then you tell them not to do their compulsive behaviors, and [to then] see what happens," Szymanski said. "And what happens is that their anxiety levels go up.

But when they allow their anxiety to just be, over time, their anxiety levels will come down." Selective serotonin reuptake inhibitor (SSRI) antidepressants are the medications most commonly prescribed for treating OCD, according to the NIH. Anti-anxiety medication may also be prescribed. It may take several weeks for both types of medications to begin working, according to the NIH. In addition to side effects such as headache, nausea and insomnia, antidepressants have been linked to suicidal thoughts and behaviors in some individuals. People taking antidepressants need to be monitored closely, especially when starting their treatments. Follow Elizabeth Palermo @ techEpalermo . Follow Live Science @livescience , Facebook & Google+ .

Additional resources OCD in Children and Adults: Symptoms, Causes, and More Repeatedly bathing, showering, or washing hands Refusing to shake hands or touch doorknobs Repeatedly checking things, such as locks or stoves Constant counting, mentally or aloud, while performing routine tasks Constantly arranging things in a certain way Eating foods in a specific order Being stuck on words, images or thoughts, usually disturbing, that won't go away and can interfere with sleep Repeating specific words, phrases, or prayers Needing to perform tasks a certain number of times Collecting or hoarding items with no apparent value What Causes OCD? Although the exact cause of OCD is not fully understood, studies have shown that a combination of biological and environmental factors may be involved. Biological Factors: The brain is a very complex structure. It contains billions of nerve cells -- called neurons -- that must communicate and work together for the body to function normally. Neurons communicate via chemicals called neurotransmitters that stimulate the flow of information from one nerve cell to the next. At one time, it was thought that low levels of the neurotransmitter serotonin was responsible for the development of OCD.

Now, however, scientists think that OCD arises from problems in the pathways of the brain that link areas dealing with judgment and planning with another area that filters messages involving body movements. Continued In addition, there is evidence that OCD symptoms can sometimes get passed on from parents to children. This means the biological vulnerability to develop OCD may sometimes be inherited. Studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and OCD. This infection, if recurrent and untreated, may lead to the development of OCD and other disorders in children. Environmental Factors: There are environmental stressors that can trigger OCD in people with a tendency toward developing the condition. Certain environmental factors may also cause a worsening of symptoms. These factors include: Abuse Death of a loved one Work- or school-related changes or problems Relationship concerns How Common Is OCD? About 3.3 million adults and about 1 million children and adolescents in the U.S. have OCD. The disorder usually first appears in childhood, adolescence, or early adulthood. It occurs about equally in men and women, and affects people of all races and socioeconomic backgrounds. How Is OCD Diagnosed? There is no lab test to diagnose OCD.

The doctor bases his or her diagnosis on an assessment of the patient's symptoms, including how much time the person spends performing his or her ritual behaviors. How Is OCD Treated? OCD will not go away by itself, so it is important to seek treatment. The most effective approach to treating OCD combines medications with cognitive behavioral therapy. Cognitive behavioral therapy : The goal of cognitive behavioral therapy is to teach people with OCD to confront their fears and reduce anxiety without performing the ritual behaviors (called exposure therapy or exposure and response prevention therapy). Therapy also focuses on reducing the exaggerated or catastrophic thinking that often occurs in people with OCD. Medication therapy : Antidepressants , such as selective serotonin reuptake inhibitors (SSRI) like Luvox , Prozac , and Zoloft , may be helpful in treating OCD. Older drugs -- tricyclic antidepressants like Anafranil -- might also be used. Some atypical antipsychotics, such as Risperdal or Abilify , also have been shown to have value for OCD either when used alone or in combination with an SSRI.

In severe cases of OCD and in people who do not respond to medical and behavioral therapy, electroconvulsive therapy (ECT) or psychosurgery may be used to treat the disorder. During ECT, a small current is passed through electrodes placed on the scalp while the patient is asleep under general anesthesia This causes a brief seizure . Repeated ECT treatments have been found to help improve OCD symptoms in some cases. A newer, surgical form of brain stimulation called deep brain stimulation ( DBS ) involves implanting small electrodes into brain areas that are a part of the brain circuitry associated with OCD symptoms. Continued What Is the Outlook for People With OCD? In most cases, OCD can be successfully treated with medication, cognitive behavioral therapy, or both. With ongoing treatment, most people can achieve long-term relief from symptoms and return to normal or near-normal functioning. Can OCD Be Prevented? OCD cannot be prevented. However, early diagnosis and treatment can help reduce the time a person spends suffering from the condition.

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on February 24, 2016 Sources NAMI: National Alliance on Mental Illness | Obsessive-compulsive Disorder Hand washing due to a fear of germs Counting and recounting money because a person is can't be sure they added correctly Checking to see if a door is locked or the stove is off "Mental checking" that goes with intrusive thoughts is also a form of compulsion Causes The exact cause of obsessive-compulsive disorders is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other. Genetics are thought to be very important. If you, your parent or a sibling, have an obsessive-compulsive disorder, there's close to a 25% chance that another immediate family member will have it. Diagnosis A doctor or mental health care professional will make a diagnosis of OCD. A general physical with blood tests is recommended to make sure the symptoms are not caused by illegal drugs, medications, another mental illness, or by a general medical condition.

The sudden appearance of symptoms in children or older people merits a thorough medical evaluation to ensure that another illness is not causing of these symptoms. To be diagnosed with OCD, a person must have must have: Obsessions, compulsions or both Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day Treatment A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal. Medication , especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions. Psychotherapy is also helpful in relieving obsessions and compulsions. In particular,cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery. Though OCD cannot be cured, it can be treated effectively. Read more on our treatment page. Related Conditions There are related conditions that share some characteristics with OCD but are considered separate conditions. Body Dysmorphic Disorder.

This disorder is characterized by an obsession with physical appearance. Unlike simple vanity, BDD is characterized by obsessing over one's appearance and body image, often for many hours a day. Any perceived flaws cause significant distress and ultimately impede on the person's ability to function. In some extreme cases, BDD can lead to bodily injury either due to infection because of skin picking, excessive exercise, or from having unnecessary surgical procedures to change one’s appearance. Hoarding Disorder. This disorder is defined by the drive to collect a large amount of useless or valueless items, coupled with extreme distress at the idea of throwing anything away. Over time, this situation can render a space unhealthy or dangerous to be in. Hoarding disorder can negatively impact someone emotionally, physically, socially and financially, and often leads to distress and disability. In addition, many hoarders cannot see that their actions are potentially harmful, and so may resist diagnosis or treatment. Trichotillomania. Many people develop unhealthy habits such as nail biting or teeth grinding, especially during periods of high stress. Trichotillomania, however, is the compulsive urge to pull out (and possibly eat) your own hair, including eyelashes and eyebrows.

Some people may consciously pull out their hair, while others may not even be aware that they are doing it. Trichotillomania can create serious injuries, such as repetitive motion injury in the arm or hand, or, if the hair is repeatedly swallowed, the formation of hairballs in the stomach, which can be life threatening if left untreated. A similar illness is excoriation disorder , which is the compulsive urge to scratch or pick at the skin. Find your local NAMI International OCD Foundation – What is OCD? no matter what you did… You don’t want these thoughts — it feels like an avalanche… Along with the thoughts come intense feelings of anxiety… Anxiety is your brain’s alarm system. When you feel anxious, it feels like you are in danger. Anxiety is an emotion that tells you to respond, react, protect yourself, DO SOMETHING! On the one hand, you might recognize that the fear doesn’t make sense, doesn’t seem reasonable, yet it still feels very real, intense, and true… Why would your brain lie? Why would you have these feelings if they weren’t true? Feelings don’t lie… Do they? Unfortunately, if you have OCD, they do lie.

If you have OCD, the warning system in your brain is not working correctly. Your brain is telling you that you are in danger when you are not. When scientists compare pictures of the brains of groups of people with OCD, they can see that some areas of the brain are different than the brains of people who don’t have OCD. Those tortured with OCD are desperately trying to get away from paralyzing, unending anxiety… What exactly are obsessions and compulsions? Obsessions are thoughts, images or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD realize that these thoughts don’t make any sense. Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

Unfortunately, “obsessing” or “being obsessed” are commonly used terms in every day language. These more casual uses of the word means that someone is preoccupied with a topic or an idea or even a person. “Obsessed” in this everyday sense doesn’t involve problems in day-to-day living and even has a pleasurable component to it. You can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession. In fact, individuals with OCD have a hard time hearing this usage of “obsession” as it feels as though it diminishes their struggle with OCD symptoms. Even if the content of the “obsession” is more serious, for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way, that doesn’t mean these obsessions are necessarily symptoms of OCD. While these thoughts look the same as what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on.

In fact, research has shown that most people have unwanted “intrusive thoughts” from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety that gets in the way of day-to-day functioning. Click here for a list of some common obsessions in OCD. Compulsions are the second part of obsessive compulsive disorder. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. Compulsions can also include avoiding situations that trigger obsessions. Compulsions are time consuming and get in the way of important activities the person values. Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions. You have to look at the function and the context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life. Behaviors depend on the context.

Arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. Similarly, you may have “compulsive” behaviors that wouldn’t fall under OCD, if you are just a stickler for details or like to have things neatly arranged. In this case, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like. In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time consuming and many times torturous acts. In OCD, compulsive behavior is done with the intention of trying to escape or reduce anxiety or the presence of obsessions.

Common Obsessions in OCD [1] Contamination Body fluids (examples urine feces) Germs/disease (examples herpes HIV) Environmental contaminants (examples: asbestos radiation) Household chemicals (examples cleaners solvents) Dirt Fear of acting on an impulse to harm oneself Fear of acting on an impulse to harm others Fear of violent or horrific images in one’s mind Fear of blurting out obscenities or insults Fear of stealing things Harm Fear of being responsible for something terrible happening (examples: fire burglary) Fear of harming others because of not being careful enough (example: dropping something on the ground that might cause someone to slip and hurt him/herself) Obsessions Related to Perfectionism Concern about evenness or exactness Concern with a need to know or remember Fear of losing or forgetting important information when throwing something out Inability to decide whether to keep or to discard things Fear of losing things Forbidden or perverse sexual thoughts or images Forbidden or perverse sexual impulses about others Obsessions about homosexuality Sexual obsessions that involve children or incest Obsessions about aggressive sexual behavior towards others Religious Obsessions (Scrupulosity) Concern with offending God, or concern about blasphemy Excessive concern with right/wrong or morality Other Obsessions Symptoms and causes - Obsessive-compulsive disorder (

OCD) - Mayo Clinic Symptoms and causes Print Symptoms 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 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 Needing things orderly and symmetrical Aggressive or horrific thoughts about 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 hurting yourself or someone else that are unwanted and make you uncomfortable Thoughts about shouting obscenities or acting inappropriately that are unwanted and make you uncomfortable Avoidance of situations that can trigger obsessions, such as shaking hands Distress about unpleasant sexual images repeating in your mind Compulsion symptoms OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to prevent or 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 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. Symptoms usually begin gradually and tend to vary in severity throughout life. 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. Causes 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. Environment. Some environmental factors such as infections are suggested as a trigger for OCD, but more research is needed. Risk factors 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. Complications Problems resulting from OCD may include, among others: Health issues, such as contact dermatitis from frequent hand-washing Inability to attend work, school or social activities Troubled relationships Overall poor quality of life Suicidal thoughts and behavior References Cook AJ. Allscript EPSi. Mayo Clinic, Rochester, Minn. April 12, 2016. Obsessive-compulsive disorder.

In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. Accessed July 19, 2016. Hirsch M, et al. Discontinuing antidepressant medications in adults. Accessed May 17, 2016. Obsessive-compulsive disorder. National Alliance on Mental Illness. Accessed July 19, 2016. Moreland CS, et al. Effect of antidepressants on suicide risk in children and adolescents. Accessed May 17, 2016. What is obsessive-compulsive disorder? American Psychiatric Association. Accessed July 19, 2016. Obsessive-compulsive disorder in children and adolescents. American Academy of Child & Adolescent Psychiatry. Accessed July 19, 2016. Obsessive-compulsive disorder. National Institute of Mental Health. Accessed July 19, 2016. Simpson HB. Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis.

Accessed July 19, 2016. Mental health medications. National Institute of Mental Health. Accessed May 16, 2016. AskMayoExpert. Obsessive-compulsive disorder (OCD). Minn.: Mayo Foundation for Medical Education and Research; 2015. 2014-2015 Research report: Psychiatry and psychology. Mayo Clinic. Accessed July 18, 2016. Denys D, et al. Deep brain stimulation for treatment of obsessive-compulsive disorder. Accessed July 19, 2016. Mayo Clinic rankings & ratings. U.S. News & World Report. Accessed July 22, 2016. Whiteside SP (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 16, 2016. Olsen MW (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 17, 2016. Related NIMH » Obsessive-Compulsive Disorder: When Unwanted Thoughts or Irresistible Actions Take Over En Español Introduction Do you constantly have disturbing uncontrollable thoughts?

Do you feel the urge to repeat the same behaviors or rituals over and over? Are these thoughts and behaviors making it hard for you to do things you enjoy? If so, you may have obsessive-compulsive disorder (OCD). The good news is that, with treatment, you can overcome the fears and behaviors that may be putting your life on hold. What is it like to have OCD? “I couldn’t do anything without my rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times because three was a good luck number for me. It took me longer to read because I’d have to count the lines in a paragraph. When I set my alarm at night, I had to set it to a time that wouldn’t add up to a ‘bad’ number.” “Getting dressed in the morning was tough because I had to follow my routine or I would become very anxious and start getting dressed all over again.” I always worried that if I didn’t follow my routine, my parents were going to die. These thoughts triggered more anxiety and more rituals. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.

I couldn’t seem to overcome them until I got treatment.” What is OCD? OCD is a common, chronic (long-lasting) disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over in response to the obsession. While everyone sometimes feels the need to double check things, people with OCD have uncontrollable thoughts that cause them anxiety, urging them to check things repeatedly or perform routines and rituals for at least 1 hour per day. Performing the routines or rituals may bring brief but temporary relief from the anxiety. However, left untreated, these thoughts and rituals cause the person great distress and get in the way of work, school, and personal relationships. What are the signs and symptoms of OCD? People with OCD may have obsessions, compulsions, or both. Some people with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking, facial grimacing, shoulder shrugging, or head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Obsessions may include: Fear of germs or contamination Fear of losing or misplacing something Worries about harm coming towards oneself or others Unwanted and taboo thoughts involving sex, religion, or others Having things symmetrical or in perfect order Compulsions may include: Constantly seeking reassurance What causes OCD? OCD may have a genetic component. It sometimes runs in families, but no one knows for sure why some family members have it while others don’t. OCD usually begins in adolescence or young adulthood, and tends to appear at a younger age in boys than in girls. Researchers have found that several parts of the brain, as well as biological processes, play a key role in obsessive thoughts and compulsive behavior, as well as the fear and anxiety related to them. Researchers also know that people who have suffered physical or sexual trauma are at an increased risk for OCD. Some children may develop a sudden onset or worsening of OCD symptoms after a streptococcal infection; this post-infectious autoimmune syndrome is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS). Learn more about PANDAS at (search term: PANDAS). How is OCD treated?

The first step is to talk with your doctor or health care provider about your symptoms. The clinician should do an exam and ask you about your health history to make sure that a physical problem is not causing your symptoms. Your doctor may refer you to a mental health specialist, such as a psychiatrist, psychologist, social worker, or counselor for further evaluation or treatment. OCD is generally treated with cognitive behavior therapy, medication, or both. Speak with your mental health professional about the best treatment for you. Cognitive behavioral therapy (CBT) In general, CBT teaches you different ways of thinking, behaving, and reacting to the obsessions and compulsions. Exposure and Response Prevention (EX/RP) is a specific form of CBT which has been shown to help many patients recover from OCD. EX/RP involves gradually exposing you to your fears or obsessions and teaching you healthy ways to deal with the anxiety they cause. Other therapies, such as habit reversal training, can also help you overcome compulsions. For children, mental health professionals can also identify strategies to manage stress and increase support to avoid exacerbating OCD symptoms in school and home settings. For more information on CBT and EX/RP, please visit (search term: psychotherapies).

Medication Doctors also may prescribe different types of medications to help treat OCD including selective serotonin reuptake inhibitors (SSRIs) and a type of serotonin reuptake inhibitor (SRI) called clomipramine. SSRIs and SRIs are commonly used to treat depression, but they are also helpful for the symptoms of OCD. SSRIs and SRIs may take 10 – 12 weeks to start working, longer than is required for the treatment of depression. These medications may also cause side effects, such as headaches, nausea, or difficulty sleeping. People taking clomipramine, which is in a different class of medication from the SSRIs, sometimes experience dry mouth, constipation, rapid heartbeat, and dizziness on standing. These side effects are usually not severe for most people and improve as treatment continues, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects that you have. Don't stop taking your medication without talking to your doctor first. Your doctor will work with you to find the best medication and dose for you. For basic information about mental health medications, please visit (search term: medications). Information about medications changes frequently.

Check the Food and Drug Administration’s website ( ) for the latest information on warnings, patient medication guides, or newly approved medications. Don’t give up on treatment too quickly. Both psychotherapy and medication can take some time to work. While there is no cure for OCD, current treatments enable most people with this disorder to control their symptoms and lead full, productive lives. A healthy lifestyle that involves relaxation and managing stress can also help combat OCD. Make sure to also get enough sleep and exercise, eat a healthy diet, and turn to family and friends whom you trust for support. Finding Help Mental Health Treatment Program Locator The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at . For additional resources, visit . Questions to Ask Your Doctor Asking questions and providing information to your doctorealth care provider can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at .

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If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Resource Center at 1-866-615-6464 or email nimhinfo@nih.gov . For More Information To learn more information about OCD, visit: Medline Plus (National Library of Medicine) Obsessive Compulsive Disorder (OCD) - Canadian Mental Health AssociationCanadian Mental Health Association Find Your Local CMHA Obsessive Compulsive Disorder (OCD) Many of us have small habits that make us feel better, but we can also live without them. For example, we might think of something as ‘lucky’ or have a routine that feels comforting. But for people who experience obsessive-compulsive disorder (OCD), these behaviours are much more intense and disruptive and are fuelled by unwanted thoughts that don’t go away. Obsessive-compulsive disorder is not always easy to understand, but it’s a real illness that causes difficulties in a person’s life. Shop CMHA Download What is OCD? Obsessive-compulsive disorder is a mental illness. It’s made up of two parts: obsessions and compulsions.

People may experience obsessions, compulsions, or both, and they cause a lot of distress. Obsessions are unwanted and repetitive thoughts, urges, or images that don’t go away. They cause a lot of anxiety. For example, someone might worry about making people they love sick by bringing in germs. Obsessions can focus on anything. These obsessive thoughts can be uncomfortable. Obsessions aren’t thoughts that a person would normally focus on, and they are not about a person’s character. They are symptoms of an illness. Compulsions are actions meant to reduce anxiety caused by obsessions. Compulsions may be behaviours like washing, cleaning, or ordering things in a certain way. Other actions are not obvious to others. For example, some people may count things or repeat phrases in their mind. Some people describe it as feeling like they have to do something until it feels ‘right.’ It’s important to understand that compulsions are a way to cope with obsessions. Someone who experiences OCD may experience distress if they can’t complete the compulsion. People who experience OCD usually know that obsessions and compulsions don’t make sense, but they still feel like they can’t control them. Obsessions and compulsions can also change over time.

Who does it affect? OCD can affect anyone. Researchers don’t know exactly what causes OCD, but there are likely many different factors involved, such as family history, biology, and life experiences. What can I do about it? Obsessive-compulsive disorder can be very challenging and hard to explain to other people. You may feel embarrassed, ashamed, or guilty about your experiences. These feelings can make it hard to seek help. Because obsessions and compulsions take a lot of time, it can be hard to go about your daily life. Many people describe OCD as something that takes over their life, and this is not easy to deal with. But the good news is that OCD is treatable. It’s important to talk to a health professional. Counselling and support A type of therapy called cognitive-behavioural therapy (or ‘CBT’) is shown to be effective for helping people with OCD. It teaches you how your thoughts, feelings, and behaviours work together, and teaches skills like solving problems, managing stress, realistic thinking and relaxation. For OCD, therapy may also include a strategy called exposure and response prevention, which helps you learn new ways to look at obsessions and compulsions. Support groups can also be very helpful.

They are a good place to share your experiences, learn from others, and connect with people who understand what you’re going through. OCD can make people feel very isolated and alone, so support groups can be a good way to build a support network. There are many self-help strategies to try at home. Small steps like eating well, exercising regularly, and practicing healthy sleep habits can really help. You can practice many CBT skills, like problem-solving and challenging anxious thoughts, on your own. Ask your support team about community organizations, websites, or books that teach CBT skills. And it’s always important to spend time on activities you enjoy and connect with loved ones. Medication Antidepressants are the most common medication for OCD. Antianxiety medications (benzodiazepines) may be less effective for OCD, so they are not usually the first option to try. How can I help a loved one? Supporting a loved one who experiences OCD can be challenging. Many people feel like they have to follow along with a loved one’s compulsions. Some people who experience OCD avoid certain things or activities, and other people may feel like they have to do everyday things for a loved one. You may have many different complicated feelings.

You may feel upset when a loved one is experiencing distressing symptoms of OCD, but you may not see why a normal task could be a problem. You may want a loved one to be more independent, but see how challenging certain things can seem. If a loved one’s experiences with OCD affects others, especially young people, it’s a good idea to seek counselling for everyone. Family counselling is a good option for the entire family. Here are more tips to help you support someone you love: A loved one who experiences OCD usually understands that their experiences don’t make sense. Trying to argue with obsessions or compulsions doesn’t help anyone. Avoid ‘helping’ behaviours around OCD—for example, helping a loved one avoid things that cause anxiety. This can make it harder to practice healthy coping skills in the long run. Instead, it may be more helpful to focus on the feelings behind the behaviours. Signs of OCD can be more difficult to manage during times of stress—and even happy occasions can be stressful. Recognize that a loved one may need extra supports, and try to plan ahead. Every small step towards managing OCD behaviour can take a lot of courage and hard work, so celebrate every victory. Set your own boundaries, and seek extra support when you need it.

Support groups for loved ones can be very helpful. Do you need more help? Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area. Founded in 1918, The Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.

Question: What is the mental disorder OCD?
Answer: Obsessive-Compulsive Disorder