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What is Obsessive Compulsive Disorder (OCD)?

According to Laura Schuster Effland, Managing Director of Clinical Operations for Eating Recovery Center Washington, the psychiatric textbook definition of OCD requires the presentation of both uncontrollable, obsessive, recurrent thoughts (obsessions) and compulsive behaviors that must be repeated over and over again (compulsions).

Patients will often feel that the intrusive thoughts are the problem, and their compulsions are the solution. For example, if someone is experiencing intrusive thoughts about cleanliness or germs, their reaction can be to wash their hands, clothes and surroundings to an extent that it disrupts their usual way of living.

Dr. Charles Brady notes that when patients perform their compulsions, they’re trying to gain a sense of certainty and avoid or prevent the “what if” questions and feelings of uncertainty introduced by intrusive thinking. What if I drop and hurt this baby? What if I’m not as devoted to my religion as I ought to be? What if I just ran over a person while driving but I can’t tell?

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Types of OCD

It’s important to remember that OCD can look different in different people, and this list won’t cover every possible manifestation of the disorder. However, some of most commonly occuring forms are identified as:

Harm obsession

This form of OCD is characterized by intrusive thoughts involving violent acts against another person, or fearing they could cause someone else harm. Compulsions often involve avoiding the risk of causing harm to others, like hiding/avoiding knives and sharp objects.

Perfection / Symmetry

Also known as “Just Right” OCD, this subset involves the need for things to be correctly aligned or symmetrical. Compulsions can include aligning, ordering, touching and tapping.

Checking Compulsions

As the name suggestions, this form of OCD presents with checking-based compulsive behavior. People with this OCD often believe that they could cause something bad to happen to themselves or others, creating anxiety. Compulsive checking is used to gain a sense of certainty that they did lock the door, turn off the oven, tuck their children in, etc.

Contamination / Cleanliness

Contamination OCD is characterized by a patient becoming concerned by illness or germs, or in some cases “clean eating.” Compulsions can include excessive washing or avoiding areas where it's more likely to come in contact with germs, like crowded public places.

Sexual OCD

Sexual obsession OCD, often under-diagnosed according to “Psychology Today,” involves unwanted thoughts of a sexual nature that those experiencing them find disturbing.

What Causes OCD (Obsessive Compulsive Disorder)?

There are several theories about the origins of obsessive compulsive disorder, but it’s impossible to know for sure how and why it develops. However, we do know genetics, brain chemistry and external factors can all play a role. Importantly, the treatment an individual receives won’t depend on the cause of the condition, but it will depend on understanding the nature of the obsessions and compulsions.
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Genetic & Inherited Factors

There is a notable genetic component to OCD, and it is not uncommon for family members to also have it.

Potential Genetic Component

The rate of heritability of OCD is reported to be between 35-50%, and the risk of developing OCD is greater in first-degree relatives, such as siblings or children, than compared to the general population.

Learning & Observed Behaviors

There is a theory that OCD compulsions and behaviors are learned over time.

Watching Family Members

Through watching family members avoid their fears or perform compulsive behaviors, it’s thought that others can pick up those habits and begin to perform them themselves.

Biology

Research suggests that OCD can take place in a brain that has chemical imbalances or in a brain that functions differently than other brains.

Chemical Imbalance

There is correlation between patients who experience OCD and those that have lower levels of serotonin. Serotonin is a chemical that acts as a neurotransmitter, and is involved in modulation of mood, cognition, memory and more.

Brain Functions

Studies have shown that certain areas of the brain — including the orbitofrontal cortex and anterior cingulate cortex — may be in higher use with people who experience OCD than those who don’t.

PANDAS

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) can be diagnosed when a child develops OCD or a tic disorder (sometimes both) after a strep infection. It is thought that the cause of the OCD occurs when autoimmune antibodies mistakenly attack part of the brain, the basal ganglia, rather than the infection.

Other Risk Factors

OCD can be related to a family history of having the disorder, or can be caused by specific events in your life.

Family History

Studies have shown that OCD is more commonly occurring among relatives of someone who experiences OCD than in relatives of people who don’t.

Stressful Life Events

A traumatic or stressful event can increase the risk of developing OCD. The event may trigger intrusive thoughts, compulsions or emotional distress.

OCD Symptoms & Signs

Obsessive compulsive disorder includes both obsessions and compulsions that take up a great deal of time. Signs and symptoms vary by age and individual, but treatment is possible.

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OCD Obsession and Compulsion

Each subset of OCD can have its own symptoms, signs and triggers, but some of the most commonly occurring include:

Harm Obsession

Obsession

  • Fear you will cause harm to others
  • Fear of acting upon a violent urge

Compulsion

  • Avoiding sharp objects
  • Compulsively checking to ensure you haven’t caused anyone harm
  • Asking others if you’ve hurt them

Perfection/Symmetry

Obsession

  • Fixating on the feeling that something is “off”
  • Ensuring symmetry in actions or their surroundings

Compulsion

  • Repeating an action, such a flipping a light switch, until they have the feeling of “just right”
  • Ordering, aligning and organizing that which is out of order

Checking Compulsions

Obsession

  • Fear or doubt that lights were turned off, doors were closed, etc

Compulsion

  • Repeated “checking” to make sure things are as you thought
  • Seeking assurance from others

Contamination/ Cleanliness

Obsession

  • Fear of germs, fluids, or touching certain items that may be contaminated
  • Fear of spreading contaminants

Compulsion

  • Repeated washing of hands
  • Extensive bathing routines
  • Avoiding public places and touching people

Sexual OCD

Obsession

  • Fear around intrusive thoughts inconsistent with your sexual identity
  • Thoughts about forcing someone else do perform a sexual act

Compulsion

  • Avoiding interactions with people
  • Self-punishing thinking

Obsession Symptoms

Obsessions are thoughts, images or impulses that occur over and over again and feel outside of a person’s control. Typically, people do not want these thoughts and even realize they don’t make sense. Obsessions often bring fear, doubt, and a consuming need to do things the “right way.” Common obsession symptoms include:

Fear of Contamination

When a person is overly concerned by illness or germs, they may be struggling with contamination OCD. Worry over touching items that may be contaminated, as well as a fear of spreading contamination, are prevalent with this fear. Concern over cleanliness may lead to avoiding social situations that could trigger anxiety.

Unwanted and Intrusive Thoughts

Thoughts take many forms. In the case of OCD, thoughts are distressing and usually follow a theme, such as doubt that tasks were done correctly, such as turning off the oven or locking doors. Other examples include:

  • Needing things to be orderly or symmetrical, and feeling intense stress when objects are not a certain way
  • Aggressive or horrific thoughts about losing control and harming themself or others
  • Unwanted thoughts about aggression, sexual or religious subjects

Compulsion Symptoms

To neutralize the intensity of ruminations, people with OCD use compulsive, repetitive behaviors or thoughts as a temporary solution. Important to note is that they would rather not have to do these time-consuming tasks but feel driven to engage in compulsive behavior. Typical compulsions include:

Excessive Hand-washing

Intrusive thoughts create uncertainty, thus causing the need to perform a stress-reducing action. For those afraid of contamination, this often means excessive washing and cleaning of both themselves and objects around them. The repetitive washing of body and hands goes well beyond cleanliness and can cause skin to become chapped, raw or bleed.

“Checking” of Locks, Stove, etc.

Individuals with OCD often worry that harm will come to themselves or others. To ease these feelings, as well as ease the fear that they have forgotten to complete a task in order to keep everyone safe, they may compulsively perform many actions, including:

  • Checking stove, doors repeatedly
  • Counting in patterns
  • Arranging items until it “feels right”
  • Mental review of events/praying to prevent harm
  • Repeating routine activities

OCD Signs in Children and Teens

The signs and symptoms of OCD in children and teens mimic those of adults, but often children and teens do not realize their obsessions and compulsions are out of the ordinary. Symptoms appear gradually over time, but there are signs to watch for:

Early-age Rituals

Rituals are important for child development, such as having an established eating or sleeping schedule. However, rituals can be problematic when children or adolescents become obsessed with doing them the “right way” and cannot complete tasks or move on until they’ve repeated the ritual to perceived perfection.

Counting

Like adults, children and adolescents with OCD often have the compulsive need to count. Homework may take hours as they rewrite the same number or word to get it “just right.” Similarly, they may be consumed by patterns and ordering objects a certain way.

Intense Need for Reassurance

As thoughts become distressing, children and adolescents may reach out to parents for reassurance — checking if doors are locked, windows closed, etc. — and keep asking until discomfort is relieved, and they feel confident nothing bad will happen. Though harmless once in a while, this need for reassurance is often not satiated and questions are repeated over and over.

Health Risks of OCD

When a person doesn’t know they have obsessive compulsive disorder (OCD) or they don’t know about methods of managing it — like forms of therapy and medication — there can be both emotional and physical OCD health risks. If left untreated, these complications can impact life in the long term.

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Changes in Mental Health and Mood

With much time and energy focused on ritualistic behaviors, mental health and moods may suffer. Individuals living with OCD may experience significant emotional distress, difficulty developing and maintaining relationships, difficulty attending school and work, and an overall poorer quality of life due to the time it takes to perform rituals.

Depression

According to the International OCD Foundation, one quarter to one half of people with OCD also meet diagnostic criteria for a major depressive episode. OCD steals time from relationships, hobbies, school or work, and general life activities. When coping with OCD and depression, it can be increasingly difficult for patients to find the courage to seek treatment.

Anxiety

According to a 2020 peer-reviewed article, about 90% of people with OCD will also have anxiety disorders, mood disorders, impulse disorders, substance use disorders or other psychiatric conditions. Persistent, distressing thoughts and urges from OCD cause nerves to rise. As a person fights to control their mind and actions, anxiety increases.

Physical and Behavioral Effects

Beyond the mental health effects, those with OCD are at risk for behavioral effects, such as substance abuse and loss of sleep. These can lead to troubled relationships and an overall lessened quality of life.

Risk of Substance Abuse

With OCD and substance use alike, a person frequently completes an action (compulsion or using a substance) to temporarily find release. Unfortunately, once the effects wear off, the desire to do the action again intensifies. In addition to the similarities between OCD and substance use, social isolation and mental health effects from OCD can lead to seeking an escape in the form of alcohol or drugs.

Exhaustion and Loss of Sleep

Physical harm can occur as a result of compulsions, including contact dermatitis, repetitive strain injury, physical exhaustion; or from self-soothing behaviors, including biting nails, picking skin or pulling hair. The obsessions and compulsions may make it difficult to fall asleep until all rituals are completed, causing a lack of sleep and further exhaustion.

Long-Term Impacts of Untreated OCD

If OCD is left untreated, triggers may increase and make life difficult to manage. Due to time spent avoiding these triggers, isolation from friends and family is increasingly likely.

Disruptive Avoidance of Triggers

Without therapy and/or medication, obsessive thoughts and compulsions can make it extremely difficult to concentrate. Hours spent on compulsions, or avoiding triggers, can lead to missing out on life’s joys with loved ones. People who struggle with OCD commonly avoid:

  • Going outside
  • Social gatherings or celebrations
  • Seeing family and friends
  • Work or school
  • Hobbies

Isolation From Friends and Family

With hours spent ruminating and acting to avoid fears, a person may become isolated from friends and family. To cope with this, compulsions to avoid further hurt or fear increase, taking up more time. Unfortunately, this can lead to sufferers feeling that they are alone.

At Pathlight Mood & Anxiety Center (Pathlight), our goal is to walk with patients every step of the way, so they know they are never on their own as they pursue recovery.

OCD Treatment

Obsessive compulsive disorder (OCD) can be managed with a combination of therapy and medication. Treatment helps ease emotional and physical complications of the disorder, so individuals can get back to living a fulfilling life.

sitting in chair

Therapy

While medication is helpful for managing symptoms, therapy is often an essential component for recovery from OCD. The following are proven methods to manage OCD so it does not control a person’s life:

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is rooted in the idea that our thoughts, feelings, and behaviors are interrelated. In other words, our thoughts can influence behaviors, our behaviors can influence emotions, emotions can influence thoughts, and so on. There are two main components of CBT: cognitive change methods (exploring how thoughts and beliefs influence our emotions) and behavior change methods (looking at how our behaviors in situations can trigger or perpetuate symptoms).

CBT provides patients with the awareness and skills to identify and modify dysfunctional thoughts, emotions and behaviors that are causing them pain or interfering with their quality of life. Once unhelpful or distressing thoughts and behaviors are identified, patients can begin to make changes to their previous assumptions, thinking styles and behavioral responses.

Exposure & Response Prevention (ERP)

Exposure & Response Prevention is an evidence-based therapeutic intervention designed to help people safely confront their fears and interrupt patterns of avoidance and anxiety. Patients are supported by trained therapists throughout the exposures. Exposure work has been found to reduce emotional distress and improve overall functioning.

OCD Treatment Options with Pathlight

Treatments for OCD vary, but patients seeking help through Pathlight Mood & Anxiety Center (Pathlight) can find hope in recovery in our Residential and Partial Hospitalization Programs.

The OCD track is focused on supporting patients in managing triggers and experiencing success. It utilizes a specific form of Cognitive Behavioral Therapy called Exposure & Response Prevention (ERP) — an evidence-based treatment for OCD and other anxiety disorders. The specialty track includes OCD individual and group therapy, family therapy for ongoing support and education, and psychiatric assessments to modify OCD treatment plans.

With guidance from Pathlight's highly experienced therapists, patients learn and practice CBT skills, making gradual, systematic and sustained progress towards recovery from mood and anxiety concerns.

Frequently Asked Questions About OCD

What is OCD?

OCD requires the presentation of both uncontrollable, obsessive, recurrent thoughts (obsessions) and compulsive behaviors that must be repeated over and over again (compulsions). It’s important to remember that OCD can look different in different people, but beneficial treatment is available.

What are the Causes of OCD?

The causes of OCD are not entirely clear, but research suggests the following can be contributing factors: genetics, brain chemistry or abnormalities, and life events or external stressors.

What are the Health Risks of OCD?

When a person doesn’t know they have obsessive compulsive disorder (OCD) or they don’t know about methods of managing it, there can be health risks, such as changes in mental and physical health.

OCD Treatment Options

Managing obsessive compulsive disorder (OCD) is possible with a combination of therapy and medication that ease complications of the disorder. Patients seeking help through Pathlight Mood & Anxiety Center can find relief in the Residential and Partial Hospitalization Programs.

OCD Facts and Statistics

Obsessive compulsive disorder affects an estimated 3 million people in the United States annually (nami.org). For more statistics on OCD and other mood disorders, please visit our facts and statistics page.

Do I have OCD? Take our OCD Test

If left untreated, OCD may become chronic and interfere with normal routines, schoolwork, employment and family or social activities. To identify if the symptoms you are experiencing might be OCD, answer a few short questions with our OCD quiz.

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