Obsessive Compulsive Disorder (OCD)

What is OCD?

Obsessive-compulsive disorder is a condition in which you have recurrent obsessions (thoughts, urges, or mental images) that you can’t control, or compulsions (behaviors) that you feel compelled to repeat over and over, according to the National Institute of Mental Health (NIMH).  These obsessions and compulsions can have a disruptive effect on your daily life, including work, school, and personal relationships.

However, having OCD doesn’t mean that your brain is beyond help, says Jonathan Abramowitz, PhD, a professor of psychology at the University of North Carolina in Chapel Hill and the editor in chief of the Journal of Obsessive-Compulsive and Related Disorders.

"Actually, everyone has unwanted thoughts, and everyone has anxiety sometimes,” he explains. “The whole idea of really overcoming OCD is learning that you can tolerate these experiences, and they don’t have to stop you from doing what’s important in your life. When you stop fighting anxiety and obsessions, that’s ironically when the anxiety and obsessions stop bullying you." 

Signs and Symptoms of OCD

People who have obsessive-compulsive disorder may have obsessions, compulsions, or both, according to the NIMH. Symptoms can be mild, moderate, or severe, and usually get worse during times of stress.  

Common obsessions include:

Excessive fear of germs or contamination
Unwanted, forbidden, or taboo thoughts about sex, religion, or harm
Aggressive thoughts about yourself or others
A need to have things in perfect order or symmetry
Common compulsions include:

Excessively cleaning or washing your hands
Ordering or arranging items in a specific way
Repeatedly checking on certain things, such as making sure the oven is turned off
Compulsively counting

A person who has OCD typically:

Can't control their thoughts or behaviors
Spends at least one hour each day on these uncontrollable thoughts or behaviors
Doesn’t get pleasure from the behaviors or rituals, but may feel a fleeting sense of relief from the anxiety the thoughts cause
Experiences significant problems in their daily life due to their obsessive or compulsive thoughts or behaviors

Causes and Risk Factors of OCD

     Explanation of risk factors that may contribute to the development of Obsessive-Compulsive Disorder (OCD), based on findings from the National Institute of Mental Health (NIMH):

Genetics

• Family History: OCD has a hereditary component, meaning it can run in families. If a person has a parent, sibling, or child with OCD, their risk of developing the disorder is higher. The risk is particularly elevated if a close family member developed OCD during childhood or adolescence.
• Genetic Studies: Ongoing genetic research aims to identify specific genes that may contribute to OCD. However, no single gene has been pinpointed as the cause. Instead, it’s believed that multiple genes may work together, combined with environmental factors, to increase the likelihood of developing OCD.

Brain Structure and Function

• Brain Imaging Findings: Imaging studies, such as MRI scans, have shown differences in certain brain areas, particularly in the frontal cortex and subcortical structures, in people with OCD. These brain regions are involved in processing information and decision-making, which could play a role in the development of obsessive thoughts and compulsive behaviors.
• Neurotransmitter Imbalance: Imbalances in neurotransmitters, such as serotonin, are also thought to be related to OCD symptoms. Medications that adjust serotonin levels (such as SSRIs) can help reduce OCD symptoms, which suggests that neurotransmitter function may be an important factor.

Early Childhood Trauma

• Trauma and OCD: Certain studies have shown a link between early childhood trauma and the onset of OCD symptoms. Trauma, such as abuse, neglect, or loss of a loved one, can increase a person's vulnerability to developing OCD or other mental health conditions. Trauma can contribute to changes in brain function and stress responses, which may make someone more susceptible to obsessive thoughts and compulsions as coping mechanisms.

Childhood Streptococcal Infections (PANDAS)

• Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Some children who experience streptococcal (strep) infections may develop OCD or OCD-like symptoms. This condition is thought to occur when the immune response to a strep infection mistakenly targets brain cells, resulting in sudden OCD symptoms, tics, or other neuropsychiatric symptoms. Although relatively rare, PANDAS highlights the potential role of immune responses and infections in triggering or exacerbating OCD symptoms in children.
• Further Research: Researchers continue to study the PANDAS hypothesis to better understand how infections and autoimmune responses may contribute to the sudden onset of OCD and similar symptoms in children.

Summary

While the exact causes of OCD remain unknown, a combination of genetic, neurobiological, and environmental factors likely influences the development of the disorder. Genetic predispositions, changes in brain structure and neurotransmitter function, early traumatic experiences, and specific infections all contribute to a more comprehensive understanding of OCD and may help inform future treatment and prevention efforts.

Treatment and Medication Options for Obsessive Compulsive Disorder

OCD is typically treated with medication, psychotherapy, or both, according to the National Institute of Mental Health (NIMH).

     Psychotherapy
Research shows that a type of cognitive behavior therapy (CBT) called Exposure and Response Prevention (EX-RP), or spending time in the situation that triggers your compulsions (such as touching dirty objects) but then not performing the usual resulting compulsion (such as hand-washing), effectively reduces compulsive behaviors in OCD. Other related therapies, like habit reversal training, can also be effective.

When patients confront situations that cause them distress, and they stay in the situation for long enough without escaping or doing rituals, they'll learn several things. They'll learn that the anxiety does not last forever. In fact, it decreases even without escaping, avoiding, or ritualizing. Also, they'll find out that as their anxiety decreases, their urge to ritualize and to escape from the situation also decreases.

     Medication Options
Although therapy is the treatment of choice for OCD, some people who have a severe form, or do not respond to therapy, may use medications to help with the disorder. Per the NIMH, medications used to treat OCD include:

Serotonin Reuptake Inhibitors (SRIs) Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms.
     Antipsychotic Medication

If your symptoms don’t improve with SRIs, research shows that some people who have OCD may find some relief with an antipsychotic medication.
However, research suggests that medications for OCD are only partially effective. "Cognitive behavioral therapy, using the techniques of Exposure and Response Prevention, have the best and most consistent research support for OCD," says Dr. Abramowitz.

     Alternative and Complementary Therapies
The FDA approved transcranial magnetic stimulation (TMS) in 2018 as a supplementary treatment for OCD in adults. TMS is a noninvasive procedure in which an electromagnetic coil is placed against your scalp near your forehead. The electromagnet uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of OCD. The FDA approved a device, BrainsWay Deep Transcranial Magnetic Stimulation, to treat OCD in adults when traditional treatments have not been effective.

Deep brain stimulation (DBS) may also help the 10 percent of people who have treatment-resistant OCD, according to a July 2017 study published in the journal Medicine. DBS is approved by the FDA to treat OCD in adults who don't respond to traditional treatment methods. With DBS, electrodes are implanted within certain areas of the brain. These electrodes produce electrical impulses that may help regulate abnormal impulses.

Complications of OCD

Obsessive-Compulsive Disorder (OCD) can lead to various complications that impact an individual's physical, emotional, and social well-being. When left untreated or inadequately managed, OCD can become chronic and lead to the following complications:

• Severe Anxiety and Depression

Many people with OCD also experience intense anxiety and depression due to the distressing nature of obsessive thoughts and the time-consuming, repetitive behaviors. Depression is common in OCD sufferers, particularly when they feel overwhelmed or unable to control their symptoms.

• Difficulty with Daily Functioning

OCD can interfere significantly with daily routines. People may spend hours each day on compulsions, leading to exhaustion and difficulty managing daily responsibilities. Simple tasks, like leaving the house or completing work assignments, can become challenging and contribute to further stress and frustration.

• Social Isolation

Individuals with OCD may avoid social situations to prevent exposure to triggers or out of embarrassment about their behaviors. This isolation can lead to loneliness, strain relationships, and even increase symptoms of depression. Additionally, friends and family may not understand the disorder, which can exacerbate feelings of isolation.

• Academic and Occupational Impairment

OCD symptoms can lead to poor performance at school or work. Compulsions may take up large portions of the day, causing tardiness, decreased productivity, or even job loss. For students, OCD symptoms may interfere with completing assignments or participating in classes, impacting academic performance and future opportunities.

• Health Risks from Physical Compulsions

Some physical compulsions, such as excessive handwashing, skin picking, or checking behaviors, can cause physical harm. For example:

Skin Issues: Repeated handwashing or cleaning can lead to skin irritation, sores, or infections.

Injury from Checking: Repeated checking behaviors (such as checking locks or appliances) can lead to physical injuries, particularly if checking involves unsafe actions.

• Substance Abuse

Some individuals with OCD turn to drugs or alcohol to self-medicate or cope with the distressing symptoms of the disorder. This can lead to substance abuse or dependency, adding an additional layer of complexity and risk to their mental and physical health.

• Strained Relationships

OCD can cause significant stress within relationships. Family members, friends, or romantic partners may feel frustrated, overwhelmed, or burdened by the individual’s rituals or need for reassurance. This strain can lead to conflict, emotional distance, or even the breakdown of relationships.

• Financial Issues

People with OCD may face financial difficulties due to reduced work productivity, medical expenses for treatment, and other costs associated with managing their symptoms. In severe cases, individuals may be unable to maintain employment, adding to financial stress.

• Suicidal Thoughts and Behaviors

OCD, especially when coupled with depression, can increase the risk of suicidal thoughts and behaviors. The intense distress, hopelessness, and frustration stemming from severe OCD symptoms can lead some individuals to experience suicidal ideation.

• Impact on Physical Health

The chronic stress associated with OCD can lead to physical health issues, such as headaches, gastrointestinal problems, sleep disturbances, and high blood pressure. The strain on the body from ongoing stress responses may also impact immune function over time.

• Reduced Quality of Life

The combination of these complications can significantly reduce overall quality of life. Everyday activities may become challenging, relationships may deteriorate, and personal goals can feel out of reach, leading to a cycle of worsening symptoms and quality of life.

Coping and Prevention of Complications

• Early Intervention: Seeking early treatment for OCD can help prevent many of these complications.
• Effective Treatment: Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), and medications (such as SSRIs) are effective at reducing symptoms.
• Support Systems: Family and community support can help reduce the risk of social isolation and strained relationships.
• Self-Care: Practicing stress management techniques, getting regular exercise, maintaining a balanced diet, and ensuring adequate sleep can help reduce the impact of OCD.

Obsessive Compulsive Disorder  FAQ