An introduction to obsessive-compulsive disorder (OCD)
What is it like to have OCD?
“My obsessive thoughts irrationally promised me that I was dangerous, or in danger, or some combination. I felt that if I can’t trust my thoughts anymore, I can still trust my actions, and I can trust that I’m touching this doorknob 64 times. I initially settled on 8 as the acceptable quantity of touch that would absolve me from guilt over something I’d never done, or prove to me that I wasn’t destined for some catastrophic fate. Then 8 started to feel too easy, so I moved to 64 (8×8). Inevitably, something would go wrong on the 63rd touch of a faucet or tug of an earring. And so I’d start over again. Meanwhile, disturbing images and sounds played across my mind—people I love dying, my own death, my body riddled with disease—all somehow my fault.”
– Lived experience of a woman with OCD, age 24
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition that occurs when a person is overwhelmed by intrusive thoughts or feelings that cause anxiety or distress, compelling them to engage in certain repeated behaviors or routines. These ritualistic actions briefly relieve the anxiety—until the unwanted thoughts return, and the cycle begins again.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a comprehensive guide that mental health professionals use to understand and diagnose mental health conditions, people with OCD spend at least one hour per day engaging in these repetitive behaviors. The considerable amount of time a person with OCD spends on these routines—in additional to the psychological burden of living with intrusive, distressing thoughts—can take a significant toll on a person’s health, happiness, and overall quality of life.
What isn’t OCD?
In recent years, phrases like “I’m so OCD!” have become a trendy way to describe a personal preference for tidiness, cleanliness, or organization. And while some individuals with OCD do experience thoughts and routines related to cleaning or organizing, these behaviors aren’t a personality quirk—they are part of a maladaptive behavior pattern, and they typically interfere with daily life. Clinicians and OCD sufferers alike implore the general public not to make light of the condition, urging them to consider the very real, devastating impact of OCD on the millions of Americans who live with the disorder.
Why is it called “obsessive-compulsive disorder”?
OCD is named for the two primary components of the disorder: obsessions and compulsions.
Obsessions refer to the intrusive, relentless thoughts, feelings, impulses, or mental images that cause emotional distress or discomfort. While most people experience the occasional unpleasant thought or feeling, those who have OCD fixate on these constant obsessions and may be unable to control or suppress them. Even if a person with OCD recognizes that their obsessions are excessive or irrational, they still might feel powerless to control these persistent, unwanted thoughts. In some cases, this internal conflict amplifies the anxiety associated with their obsessions.
Compulsions are the repeated actions that temporarily alleviate the distress caused by obsessions. These behaviors are often rigid and routine, and they must be performed in a certain sequence or a certain number of times in order to soothe the anxiety associated with obsessive thoughts. Many people are familiar with the relatively common, visible compulsions that a person with OCD might repeat, including hand-washing, neatly arranging objects, or checking (such as ensuring that the door is locked). Other compulsions may be entirely mental, such as silently counting or internally repeating certain words or phrases. Unfortunately, compulsions typically provide a brief reprieve from anxiety before the obsession returns, causing an endless cycle of obsessive-compulsive behavior.
To an outside observer, a person’s obsessions and compulsions may be invisible or may appear to be normal, innocuous behaviors. Yet to a person living with OCD, obsessions and compulsions can be all-consuming and may prevent healthy participation in school, employment, hobbies, and relationships.
What are the signs and symptoms of OCD?
Although every person’s OCD is different, the most common types of obsessions and compulsions can be grouped into broad categories. Understanding how a person’s OCD corresponds to these categories may help health care professionals and people with OCD to identify, understand, and address obsession and compulsions when they occur.
- Losing control. A person with OCD may have intrusive thoughts about acting on an impulse to harm oneself or others, about engaging in socially inappropriate acts (such as using profanity), or about stealing.
- Perhaps the most stereotyped form of OCD, a person with contamination obsessions may be excessively afraid of coming in contact with substances they perceive to be unclean, including dirt, germs, and body fluids.
- A person with harm-related obsessions may fear that harm will occur as a result of their actions; for example, they might fear that leaving the stove on will cause a fatal house fire.
- A person with perfectionistic OCD may fixate on exactness or symmetry. They may be afraid to forget information or memories, to throw away objects that will be needed later (which may lead to hoarding behaviors), or to lose important objects.
- Unwanted sexual or taboo thoughts. Sexual OCD may cause intrusive, perverse sexual thoughts, images, or impulses, often related to others around them. Many people with unwanted sexual obsessions fear acting on these impulses or engaging in sexually harmful behavior, including pedophilia, incest, or assault. An estimated 1 in 10 people with OCD may experience obsessions related to their sexual orientation.
- Religion (also called scrupulosity). A person with scrupulosity OCD may experience obsessions about committing sins, offending God or other sacred figures, or committing blasphemy. They may be excessively concerned with “perfect” moral behavior.
- A person with cleanliness compulsions may excessively or repetitively bathe, groom, wash their hands, or clean items in an effort to remove contaminants.
- A person may repeat tasks, activities, or body movements (such as blinking or tapping) to relieve their anxiety, often in multiples of a preferred number.
- A person may repetitively check on real or imagined conditions, such as excessively checking that loved ones are safe, checking that certain tasks were completed (such as locking the door), or checking the body (often to look for signs of illness or disfiguration).
- Mental compulsions. A person with OCD may internally count in multiples of a preferred number, excessively pray to oneself, or review past events (often to ensure that tasks were completed properly to prevent a perceived harm to oneself or others).
How is OCD diagnosed?
The DSM-5 provides guidelines for determining that a person has OCD. To be diagnosed with OCD, a person’s behaviors must meet the following criteria:
Behaviors qualify as obsessions when a person…
- Experiences recurrent, persistent, intrusive thoughts that cause anxiety or distress.
- Attempts to suppress these thoughts by engaging in a compulsive behavior.
Behaviors qualify as compulsions when a person…
- Feels driven to repetitively, excessively, or rigidly perform a task in response to an obsession.
- Engages in these behaviors to relieve distress, even though the actions are not rationally connected with the events they are intended to prevent (e.g., hand-washing does not actually prevent a loved one from having a car accident).
- Spends at least one hour per day engaging in compulsive behaviors, or experiences significant impairments in important areas of their life as a result of compulsive behaviors.
How many people have OCD?
Millions of people in the United States live with OCD. Researchers estimate that:
- About 1 in 40 adults in the United States will meet the diagnostic criteria for OCD at some point in their lives.
- About 1 in 80 adults in the United States had OCD in the last 12 months.
- About 1 in 100 children in the United States have OCD.
- More than 1 in 4 adults have experienced obsession-like or compulsive-like behaviors at some point in their lives, even though they did not meet the DSM-5 clinical criteria for an OCD diagnosis.
- The World Health Organization estimates that OCD is one of the top 10 disabling illnesses among adults, and the fifth leading cause of illness-related health problems and disabilities among women aged 15 to 44 years.
Who’s at risk for OCD?
Any person can develop OCD at any point in their lifetime. However, certain groups of people are more likely to develop OCD than others.
- Adults are more likely to develop OCD than children. The average age of OCD symptom onset is 19 years old, and it is most common among older teens and young adults.
- Women have a slightly higher lifetime risk for OCD than men. Additionally, women (1.8%) are significantly more likely to have experienced OCD in the last year than men (0.5%).
- People who have experienced stressful or traumatic situations are more likely to develop OCD. Research indicates that up to 30% of people with PTSD will develop OCD within a year of their PTSD diagnosis.
- Traumatic brain injury (TBI) may trigger OCD in some people.
- Genetics play a role. People who have family members with OCD are also more likely to develop OCD, and researchers are working to identify the specific genes that are involved in OCD.
How does OCD affect a person’s life?
Most people with OCD are either severely (50.6% of sufferers) or moderately (34.8%) impacted by their illness. For those with moderate to severe OCD, the hours they spend engaging in compulsions can significantly interfere with their ability to work, study, sleep, maintain social relationships, and enjoy leisure activities. Many people with OCD experience additional emotional distress because they are aware that their behavior is irrational and detrimental to their quality of life, but they feel powerless to stop.
Individuals with OCD are also more likely to develop other mental disorders. While some people may be generally predisposed to experiencing mental illness, the distress of living OCD can directly cause other debilitating conditions that can further reduce quality of life. An estimated 40-80% of people with OCD also experience major depressive disorder. Additionally, more than 1 in 4 people with OCD meet criteria for a substance use disorder, often using drugs or alcohol to cope with the anxiety and distress of OCD. When seeking treatment for OCD, it is critical to address any other co-occurring mental health concerns to ensure that OCD recovery is not complicated or inhibited by the presence of other disorders.
What’s happening in the brain?
Neuroscientists have used brain imaging techniques to determine that people with OCD may have structural differences in certain areas of the brain, such as the prefrontal cortex, which is responsible for decision making, personality, impulse control, and planning. Some scientists suspect that OCD symptoms are the result of communication errors between multiple areas of the brain called the cortico-striatal-thalamic-cortical (CTSC) circuit, which works together to regulate cognition, reward seeking and motivation, behavior, sensation, motor function, and other important brain functions. When these specific areas of the brain fail to properly send certain signals among each other, a person may experience OCD symptoms.
Scientists also know that neurotransmitters, or brain chemicals that perform important functions, are involved in OCD. Specifically, they have found that people with OCD may release too much or too little of four specific neurotransmitters (serotonin, dopamine, glutamate, and GABA), all of which are found in the CTSC circuit. The resulting chemical imbalance may cause OCD.
Despite these observations, scientists have not discovered a predictable pattern of brain structure or behavior that can definitively indicate that a person has OCD. Researchers are still working to advance our understanding of the neuroscience basis for this disorder.
How is OCD treated?
Many treatment options are available to people seeking relief from OCD. Treatment usually involves a combination of medication and therapy, but other cutting-edge options may offer a solution for the 30% of individuals who do not respond to traditional treatment.
Selective serotonin reuptake inhibitors (SSRIs), which are considered a first-line treatment for OCD, help the brain regulate and create a healthy balance of neurotransmitters. These medications can also help to treat other mental disorders (especially depression), making them an desirable option for people who suffer from certain co-occurring conditions in addition to OCD.
Many clinicians recommend that people with OCD should seek psychotherapy, which can be effective alone or in combination with medication. One popular therapeutic approach, called cognitive behavioral therapy (CBT), may help people reduce their OCD symptoms by providing them with coping skills that can help them unlearn patterns of harmful behavior.
Although medication and therapy generally are considered successful treatments for OCD, research suggests that only 7 in 10 people with OCD will benefit from these treatments, and they typically only see a partial reduction in their symptoms, rather than full remission.
Fortunately, innovative techniques may offer relief where traditional treatments fail. Transcranial magnetic stimulation (TMS), a non-invasive therapy that uses small electrical impulses to stimulate areas of the brain, received FDA approval in 2018 as a safe, effective treatment for OCD. Research indicates that 38.1% of people with treatment-resistant OCD showed at least a 30% reduction in their OCD symptoms after receiving TMS, indicating that the technique is a promising way to alleviate stubborn OCD and offer a renewed quality of life to those who live with the condition.
We are happy to offer this evidence based, cutting-edge OCD treatment, TMS Therapy, at our clinic, TMS Program. Please give us a call at 856.350.5555 to schedule a free consultation.