Obsessive Compulsive Disorder (OCD)

What Is Obsessive Compulsive Disorder (OCD)?

The main symptom of Obsessive Compulsive Disorder (OCD) is the presence of obsessions or compulsions (or both), so to understand what OCD is, it is first necessary to define what obsessions and compulsions are.

Obsessions

Obsessions are thoughts, images, or impulses that repeatedly come into a person’s mind and are experienced as intrusive and distressing. The following are examples of some common obsessions in OCD:

  • Becoming contaminated with germs
  • Worrying about having done something bad by accident (e.g., accidentally running someone over with a car)
  • Worrying about having forgotten something important (e.g., forgetting to lock a door)
  • Needing to have things in a particular order (e.g., having things arranged symmetrically)
  • Impulses to do terrible or embarrassing things (e.g., harming a child or yelling out profanities in church)
  • Graphic or disturbing images

Obsessions are described as being “ego dystonic” which means that even though the person who experiences them recognizes them as their own thoughts, they feel the obsessions are outside of their control. Someone with OCD also often (but not always) recognizes that their obsessions are unreasonable but feels they cannot put them out of their mind. Obsessions can provoke significant anxiety, leading the person experiencing obsessions to seek ways to counteract them. This attempt to reduce the anxiety of an obsession by counteracting it may lead to the development of compulsions.

Compulsions

Compulsions are repetitive physical or mental actions that a person engages in to reduce anxiety. Often, the compulsion is designed to counteract or undo an obsession. For example, a person who has an obsession about being contaminated with germs might develop a compulsion to wash their hands over and over. The following are examples of some other common compulsions in OCD.

  • Checking (e.g., to make sure doors are locked or to make sure some type of mistake wasn’t made)
  • Counting
  • Repetitive praying

In order to qualify for a diagnosis of Obsessive Compulsive Disorder, someone must have either obsessions or compulsions (or both) and these must interfere with their daily functioning. The person must also recognize, to some degree, that the obsessions and/or compulsions are excessive or unreasonable.

OCD Treatment

OCD can be treated with both therapy and medications and usually responds best when both are combined.

  • Cognitive Behavioral Therapy (CBT): Involves helping the individual suffering from OCD to see the connection between their thoughts, feelings, and behaviors. Once this connection is understood, CBT uses a variety of techniques to change the thoughts, feelings, and behaviors that underlie and perpetuate the OCD. 
  • Medications for OCD: Selective serotonin reuptake inhibitors (SSRIs) are the most frequently used class of medications for OCD. SSRIs work by increasing the amount of serotonin in the space between neurons called a synapse. Psychiatrists generally consider all SSRIs to be equally effective for OCD, but the SSRIs that have an FDA indication for OCD treatment are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox). 
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