Obsessive-compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or sensations (obsessions) or the urge to do something over and over again (compulsions). Some people can have both obsessions as well as compulsions.
OCD isn’t about habits like biting your nails or thinking negative thoughts. An obsessive thought might be that certain numbers or colours are “good” or “bad.” A compulsive habit might be to wash your hands seven times after touching something that could be “dirty.” Although you may not want to think or do these things, you feel powerless to stop.
Everyone has habits or thoughts that do repeat sometimes.
People with OCD have thoughts or actions that:
- Take up at least an hour a day
- Are beyond your control
- Aren’t enjoyable
- Interfere with work, your social life, or another part of life
OCD Types and Symptoms
OCD comes in many forms, but most cases fall into at least one of the four general categories:
- Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a medical condition like pregnancy or schizophrenia
- Contamination, a fear of things that might be dirty or a compulsion to clean. Mental contamination involves feeling like you’ve been treated like dirt
- Symmetry and ordering, the need to have things lined up in a certain way
- Ruminations and intrusive thoughts, an obsession with a line of thought. Some of these thoughts might be even violent or disturbing
It’s a bit more common in women than in men. Symptoms often appear in teens or young adults.
OCD risk factors include:
- A parent, sibling, or child with OCD
- Physical differences in certain parts of your brain
- Depression, anxiety, or tics
- Experience with trauma
- A history of physical or sexual abuse as a child
- Sometimes, a child might have OCD after a streptococcal infection. This is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.
Your doctor may do a physical exam and blood tests to make sure something else isn’t causing your symptoms. They will also talk with you about your feelings, thoughts, and habits.
There’s no cure for OCD. But you may be able to manage how your symptoms affect your life.
Treatments can include:
Cognitive behavioural therapy can help change your thinking patterns. In a form called exposure and response prevention, your doctor will put you in a situation designed to create anxiety or set off compulsions. You’ll learn to lessen and then stop your OCD thoughts or actions.
Simple things like meditation, yoga, and massage can help with stressful OCD symptoms.
Psychiatric drugs called selective serotonin reuptake inhibitors help many people control obsessions and compulsions. They might take 2 to 4 months to start working.
In rare cases, when therapy and medication aren’t making enough of a difference, your doctor might talk to you about devices that change the electrical activity in a certain area of your brain. One kind, transcranial magnetic stimulation, is FDA-approved for OCD treatment. It uses magnetic fields to stimulate nerve cells. A more complicated procedure, deep brain stimulation, uses electrodes that are implanted in your head.
OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behaviour or ritual. These obsessions typically intrude when you’re trying to think of or do other things. OCD usually begins in the teen or young adult years, but it can start in childhood.
Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD is usually considered a lifelong disorder can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.
Obsessions often have themes to them, such as:
- Fear of contamination or dirt
- Doubting and having difficulty tolerating uncertainty
- Needing things orderly and symmetrical
- Aggressive or horrific thoughts about losing control and harming yourself or others
- Unwanted thoughts, including aggression, or sexual or religious subjects
Examples of obsession signs and symptoms include:
- Fear of being contaminated by touching objects others have touched
- Doubts that you’ve locked the door or turned off the stove
- Intense stress when objects aren’t orderly or facing a certain way
- Images of driving your car into a crowd of people
- Thoughts about shouting obscenities or acting inappropriately in public
- Unpleasant sexual images
- Avoidance of situations that can trigger obsessions, such as shaking hands
OCD compulsions are repetitive behaviours that you feel driven to perform. These repetitive behaviours or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.
You may make up rules or rituals to follow that help control your anxiety when you’re having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they’re intended to fix.
Compulsions typically have themes, such as:
- Washing and cleaning
- Following a strict routine
- Demanding reassurance
Examples of compulsion signs and symptoms include:
- Hand-washing until your skin becomes raw
- Checking doors repeatedly to make sure they’re locked
- Checking the stove repeatedly to make sure it’s off
- Counting in certain patterns
- Silently repeating a prayer, word or phrase
- Arranging your canned goods to face the same way
When to see a doctor
There’s a difference between being a perfectionist — someone who requires flawless results or performance and having OCD. OCD thoughts aren’t simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way. If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health professional.
Problems resulting from obsessive-compulsive disorder may include, among others:
- Excessive time spent engaging in ritualistic behaviours.
- Health issues, such as contact dermatitis from frequent hand-washing.
- Difficulty attending work, school or social activities.
- Troubled relationships/ Impact on your relationships.
- Disruption to your day-to-day life.
- Overall poor quality of life.
- Suicidal thoughts and behaviour.
- Feeling ashamed or lonely.
- Feeling anxious.
People with OCD frequently also experience another form of mental illness. An estimated three quarters of adults with OCD are diagnosed, at some point in their lives, with an anxiety disorder (such as generalized anxiety disorder or panic disorder); more than half are diagnosed with a depressive or bipolar disorder; and up to 30 percent have a tic disorder, according to DSM-5. Those with OCD may also experience a range of other conditions, including related disorders such as body dysmorphic disorder, trichotillomania, and excoriation disorder.
Self-help tips for people living with OCD
There are many ways that you can help yourself in addition to seeking therapy.
Some suggestions are:
Refocus your attention (like doing some exercise or playing a computer game). Being able to delay the urge to perform a compulsive behaviour is a positive step.
Write down obsessive thoughts or worries. This can help identify how repetitive your obsessions are.
Anticipate urges to help ease them.
For instance, if you compulsively check that the doors are locked, try and lock the door with extra attention the first time. When the urge to check arises later, it will be easier to re-label that urge as ‘just an obsessive thought’.
Set aside time for a daily worry period.
Instead of trying to suppress obsessions or compulsions, set aside a period for obsessing, leaving the rest of the day free of obsessions and compulsions. When thoughts or urges appear in your head during the day, write them down and postpone them to your worry period – save them for later and continue to go about your day.
Take care of yourself.
Although stress doesn’t cause OCD, it can trigger the onset of obsessive and compulsive behaviour or make it worse. Try to practice relaxation (such as mindfulness meditation or deep breathing) techniques for at least 30 minutes a day.