Obsessive-Compulsive Disorder (OCD)

People with obsessive-compulsive disorder (OCD) have obsessions—thoughts, images, or urges that occur over and over even though people do not want them to. These obsessions intrude even when people are thinking about and doing other things. Also, obsessions usually cause great distress or anxiety. The obsessions usually involve thoughts of harm, risk, or danger.

Common obsessions include the following:

Because the obsessions are not pleasurable, people often try to ignore and/or control them.

Compulsions (also called rituals) are one way people respond to their obsessions. For example, they may feel driven to do something—repetitive, purposeful, and intentional—to try to prevent or relieve the anxiety caused by their obsessions.

Common compulsions include the following:

Most rituals, such as excessive handwashing or repeated checking to make sure a door has been locked, can be observed. Other rituals, such as repetitive counting or quietly mumbling statements intended to diminish danger, cannot be observed.

Rituals may have to be done in a precise way according to rigid rules. The rituals may or may not be logically connected to the obsession. When compulsions are logically connected to the obsession (for example, showering to avoid being dirty or checking the stove to prevent fire), they are clearly excessive. For example, people may shower for hours each day or always check the stove 30 times before they leave the house. All obsessions and rituals are time-consuming. People may spend hours each day on them. They may cause so much distress or interfere with functioning so much that people are incapacitated.

Most people with OCD have both obsessions and compulsions.

Most people with OCD are somewhat aware that their obsessive thoughts do not reflect actual risks and that their compulsive behaviors are excessive. However, a few people are convinced that their obsessions are well-founded and that their compulsions are reasonable.

Most people with OCD are aware that their compulsive behaviors are excessive. Thus, they may perform their rituals secretly, even though the rituals may occupy several hours each day.

As a result of OCD symptoms, relationships may deteriorate, and people with OCD may do less well in school, at work, or in other aspects of daily functioning.

Many people with OCD also have other mental health disorders. About 75% of people with OCD also have a lifetime diagnosis of an anxiety disorder Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more , about 40% have major depressive disorder, and 23 to 32% have obsessive-compulsive personality disorder Obsessive-Compulsive Personality Disorder Obsessive-compulsive personality disorder is characterized by a pervasive preoccupation with orderliness, perfectionism, and control (with no room for flexibility or efficiency) that ultimately... read more . About 15 to 20% of people with OCD have major depressive disorder at the time the disorder is diagnosed.

More than one quarter to about two thirds of people with OCD have suicidal thoughts at some point, and 10 to 13 percent attempt suicide Attempted suicide in the United States Suicide is death caused by an intentional act of self-harm that is designed to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation. Suicide usually... read more . Risk of a suicide attempt is increased if people also have major depressive disorder (see Suicidal Behavior Suicidal Behavior Suicide is death caused by an intentional act of self-harm that is designed to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation. Suicide usually... read more ).

Doctors diagnose obsessive-compulsive disorder based on symptoms: the presence of obsessions, compulsions, or both. The obsessions or compulsions must be at least one of the following:

Exposure and ritual (response) prevention therapy, a type of cognitive-behavioral therapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more , is often effective in treating obsessive-compulsive disorder. Exposure therapy involves gradually and repeatedly exposing people to whatever (situations or people) triggers obsessions, rituals, or discomfort while asking them not to perform the compulsive ritual (ritual prevention therapy). Discomfort or anxiety gradually diminishes during repeated exposure as people learn that rituals are unnecessary for decreasing discomfort. The improvement usually persists for years, perhaps because people who have mastered this approach are able to continue to practice it after formal treatment has ended. Cognitive therapy is often added to exposure and ritual prevention therapy.

Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more (such as fluoxetine), a type of antidepressant, and clomipramine, a tricyclic antidepressant, are often effective. Many experts believe that a combination of exposure and ritual prevention therapy and drug therapy is the best treatment.

Psychodynamic psychotherapy (which emphasizes the identification of unconscious patterns in current thoughts, feelings, and behaviors) and psychoanalysis have generally not been effective for people with obsessive-compulsive disorder.