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 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 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)
- Repetitive praying
Often, compulsions can be clearly associated with a specific obsession, such as repeatedly checking to make sure a door is locked to reduce the anxiety of an obsession about forgetting to lock the door. However, many people with OCD develop compulsions that have no logical connection to the thing they are intended to prevent. For example, a person with an obsession involving thoughts about something bad happening may have a compulsion to touch each shoulder three times that they feel somehow makes the bad event less likely to happen. People with OCD often recognize that their compulsions are unrealistic but find it very difficult not to engage in them.
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. This recognition is called “insight” and it varies widely among people with OCD. Some people with OCD have good insight and usually understand that their obsessions and/or compulsions are excessive and unlikely to be true, while others have poor insight and do not often question whether their obsessions and/or compulsions are true. The amount of insight someone has into the symptoms of their OCD can also change quite a bit depending on the situation, and even someone with very good insight most of the time may find it difficult not to believe in their obsessions and/or compulsions when they are stressed or anxious.
OCD can be treated with both therapy and medications and usually responds best when both are combined. The type of therapy with the most evidence supporting its efficacy for OCD is Cognitive Behavioral Therapy.
- Cognitive Behavioral Therapy for OCD
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. The doctors of Anxiety.org have created a CBT-based self-help program called the ABCtracker™ that can be used for free on this website. Anxiety.org also has a directory of mental health care providers that can be searched for therapists who specialize in the treatment of OCD.
- Medications for OCD
Medications are used very frequently in OCD treatment. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently used class of medications for OCD. These are the same medications that are used to treat depression, but they are usually prescribed at higher doses 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).