Obsessive Compulsive Disorder: Signs, Symptoms, & Treatments

What Is OCD?

Obsessive compulsive disorder is characterized by the presence of intrusive, unwanted, repetitive thoughts and compulsive behaviors as an attempt to alleviate the stress of the intrusive thoughts. Excessive anxiety is common for people with OCD, which usually rises in response to obsessions (sometimes called an OCD attack) and falls in response to OCD compulsions, causing the OCD cycle of symptoms.

OCD Symptoms

The main two symptoms of OCD are obsessions and compulsions. OCD obsessions could involve any number of fears, including believing you will cause harm to others, having intrusive thoughts that you’re in the wrong relationship, or even constantly “checking” your surroundings because things just don’t feel right. Compulsions are responses to these intrusive thoughts, and could include excessive hand washing, mental review of a situation or memory, or compulsively seeking reassurance from others.

OCD symptoms and characteristics aren’t always all negative, and can sometimes help people reach higher than average levels of success, as evidenced by several famous people with OCD.

Obsessions

Obsessions involve unwanted, repetitive, intrusive thoughts or urges that cause distress. A person with OCD will try to actively suppress, neutralize, or ignore the obsession with some other thought or action (compulsion).

OCD obsessions can vary, but usually have these features:

• Come in the form of words, images, or impulses to act
• Are obsessive in nature, meaning a person gets stuck repeating or ruminating on them
• Cause the person to question whether they are crazy, evil, or that there is something wrong with them
• Are fear-based, and the person is afraid that some aspect of the thought is real/true
• Neutralize in response to specific mental acts or behaviors (compulsions)

Common OCD Obsessions

Common OCD obsessions include:

• Fear of spreading germs or contamination
• Fear of causing harm to oneself or a loved one
• Obsession about ordering or creating symmetry
• Sexual fears, like fear of being a pedophile
• Fear of being in the wrong relationship, constantly “checking” to make sure a partner still loves them/is attracted to them

Compulsions

OCD compulsions are mental acts or behaviors that a person has strong urges to repeat. Compulsions are not typically enjoyable, but instead are repeated because they provide some temporary relief from obsessive thoughts and anxiety. Over time, the compulsions people with OCD experience tend to become disruptive to their lives and routines.

Compulsions are defined as both:

1. Repetitive mental acts (like counting, praying, repeating words) or behaviors that a person feels driven to perform in response to an obsession, urge, or invented rule
2. Behaviors or mental acts are repeated in an attempt to prevent or reduce stress or anxiety but have little or no actual impact on the source of the anxiety

Common OCD Compulsions

Some of the common types of compulsions people with OCD experience include:

• Repeatedly checking
• Cleaning, washing, or sterilizing
• Ordering, organizing, or creating symmetry
• Collecting or hoarding items
• Counting or repeating words or numbers
• Following rigid routines (like hygiene or eating)
• Repeating prayers or mantras
• Avoidance of specific objects, places, or situations
• Doing research online
• Seeking reassurance from others

Other Criteria for OCD

In addition to experiencing obsessions and/or compulsions, the person must also report:

• That the obsessions or compulsions are time-consuming (taking one or more hours per day) or causing significant distress or impairment in functioning
• That the symptoms are not attributable to a different medical issue or effects of a substance
• That the symptoms are not better explained by another mental health disorder

The Severity of OCD Symptoms Can Vary

The symptoms of OCD will always negatively affect a person’s life, but the degree will depend on the severity of symptoms. Mild OCD symptoms can present as inconveniences that add more time or complexity to someone’s daily routine, work, or personal life.

Severe OCD symptoms will completely overwhelm the person’s life, making it difficult for them to do anything other than focus on their symptoms. OCD can deeply impact work, have healthy relationships, and adequately care for oneself.

Is OCD an Anxiety Disorder?

In some ways, OCD symptoms mirror those of anxiety disorders and at one point OCD was even classified as an anxiety disorder. Both people with OCD and those with anxiety commonly describe experiencing excessive anxiety in response to specific triggers, fixation on fear-based thoughts, and reliance on avoidance or control strategies.

In people with OCD, however, the obsessive fears tend to be more intrusive, less realistic, and last longer than in those with other anxiety disorders. In those with OCD, the compulsive behaviors repeated tend to be ones that either are unlikely to prevent the fear from occurring or done even when there is a very low risk of the fear occurring. These behaviors (or mental rituals) often cause a lot of disrupting in routine and functioning.

How Common Is OCD?

According to data from the National Institute of Mental Health and the International OCD Foundation, OCD affected 1.2% of adults in the U.S. in the past year.

Here are a few other stats about the prevalence of OCD:^11,13

• OCD is the 4th most common mental illness
• OCD affected more adult women in the US than men in the past year (1.8% vs 0.5%)
• 2.3% of adults in America will struggle with OCD in their lifetime
• 30% of adults diagnosed with OCD described having symptoms as a child
• The average age of onset for OCD is 19 years old

Outward Signs of OCD

While many symptoms of OCD may be internalized, there may be outward signs that others could start to pick up on, like someone becoming more avoidant of certain activities or situations, someone “checking” their environment excessively, or seeking reassurance from loved ones.

OCD tendencies that may be clues for loved ones include:

• A tendency to ruminate or fixate on specific upsetting thoughts and finding it difficult or impossible to refocus attention away from these thoughts
• Being consistently upset, anxious, or disgusted by the content of thoughts
• Listing or counting—this could be steps they’re taking, food they’re eating, or anything else that could be counted.
• Engaging in certain behaviors that relieve anxiety (ie: hand washing, checking, repeating a certain word)
• Needing a high level of control in any situation or environment
• Needing to follow time-consuming routines or rigid processes to avoid feeling anxious, especially during times of stress
• Giving up activities or tasks that need to be done or are enjoyable to engage in certain routines or ritualistic behaviors that reduce anxiety
• Difficulty tolerating irregularities in a task, situation, or an interruption in a normal routine or process
• Avoiding certain situations, places, people or things because of intense anxiety or intrusive thoughts
• Finding that intrusive thoughts or routines are occurring one or more hours per day

Signs of OCD in Children

Younger children with OCD may:

• Become fixated or anxious on their body or health
• Become fixated on specific irrational fears
• Have difficulty with changes in routines
• Display unusual or overly picky eating habits
• Have tantrums or refuse to participate in certain situations
• Take an unusually long time in parts of their daily routine
• Need frequent reassurance from parents

Signs of OCD in Teens

Teens with OCD may:

• Act out, refuse tasks, or defy authorities to avoid certain situations
• Become preoccupied with certain irrational fears or concerns (ie their health, the planet, etc)
• Seek frequent validation or reassurance from parents
• Request to go to the doctor frequently
• Spend a lot of time online researching things that concern or scare them
• Have difficulty making decisions
• Attempt to hide their symptoms out of embarrassment

Types of OCD

Those with OCD typically fixate on particular fears, which have been categorized into four types of OCD by mental health professionals to better understand the disorder.

Taylor Newendorp, LCPC, an OCD specialist and trainer with NOCD explains, “OCD subtypes represent the experiences that people with OCD describe again and again, both in my practice and in the literature.” In fact, there is evidence for some of these subtypes, with the most research support existing for contamination, symmetry, and checking subtypes.¹

Types of OCD include:

• Harm OCD: A type of OCD where symptoms center around fears of causing harm to self or others. These harm-related thoughts may be violent and graphic in nature, causing some people with OCD to not trust themselves, believing they will act on these thoughts.
• Contamination OCD: A type of OCD where a person’s symptoms center around fears of germs, spreading disease or being contaminated.
• Symmetry OCD: A type of OCD where a person becomes obsessed with patterns and symmetry, needing things to be even or balanced.
• Checking OCD: A type of OCD where the obsessions and compulsions involve checking behaviors, which are often compulsively repeated. A person with checking OCD might repeatedly check locks, their pockets, or even a part of their own body.
• Relationship OCD: This type of OCD usually centers around intimate/romantic relationships and features a preoccupation with some aspect of the relationship. This may include doubts about whether a partner is a good match or on fears of being cheated on or abandoned.
• Pedophilia OCD: A type of OCD where a person has intrusive sexual thoughts about children and becomes panicked that they may be attracted to children or that they may act on these thoughts.
• Emotional Contamination OCD: A relatively rare subtype where obsessions focus around concerns that a person can be negatively affected by certain people or places or energies.
• Existential OCD: A subtype where a person becomes obsessed with certain questions about the meaning of life, an individual’s specific purpose, or doubt about the nature of reality.
• Sexual orientation OCD: A type of OCD where a person has become preoccupied with questions or doubts about their sexual orientation/identity. The person may begin to doubt their attraction to men, women, or both and engage in a variety of compulsions to test themselves or their level of attraction.
• Somatic OCD: A type of OCD where the focus is on some aspect of one’s body or health. Fixations could be on basic activities like breathing or blinking, or on more specific functions of the body like chewing or walking.
• “Just-right” OCD: A type of OCD where a person becomes fixated on needing something to be “just right.” This can show up in a variety of situations and may not have specific details about what would make the situation “right” but tends to feature a lot of anxiety or dread about something not being right.
• Pure-O OCD: While some experts contest whether this type of OCD exists, there are a subset of people who report that they only experience obsessions, without any form of behavioral compulsions (though some categorize this subtype as having mental compulsions). This is called pure-O OCD. Obsessions may take on a variety of themes, but follow the pattern of being intrusive, upsetting, and repetitive.
• Sensorimotor OCD: A type of OCD where a person is overly aware of involuntary bodily processes like breathing, blinking, or swallowing.
• Staring OCD:  A type of OCD where an individual has  obsessions and compulsions focused on staring and feeling unable to control their staring.

What Causes OCD?

There is no singular cause for OCD. A variety of genetic, cognitive, psychological, social, and environmental factors likely play a role in determining the risk for developing OCD. Risk factors do not determine who will develop OCD, but they do increase the risk in susceptible individuals.

Causes of OCD may include:

Perinatal Risk Factors

Some of these risks may begin even before birth, as recent research has suggested that there is a strong link between OCD and children who are born early or who are delivered breech or via cesarean. Research also suggests that smoking during pregnancy increases a child’s risk for OCD, as does having a large birth weight or a low Apgar score.²

Family History

Most mental health disorders have at least some known genetic link. However, in people with OCD, this link is especially strong, with 25% of people diagnosed with OCD having a family member with the disorder. Twin studies (considered to provide some of the strongest evidence) suggests that 45-65% of OCD is determined by genetic factors when symptoms develop in childhood.⁵ When symptoms develop in adulthood, the genetic link to OCD is estimated between 27-47%.⁶

Neurological Abnormalities

Neuroimaging studies have found that there are significant differences in the brains of people with OCD. These include differences in the size and structure of different regions of the brain, differences in the chemical makeup of the brain, and in the way different regions of the brain communicate with one another.⁷

Psychological & Personality Differences

Some research suggests that people with certain personality traits are more likely to develop OCD. Specifically, people with perfectionistic or neurotic tendencies, an inflated sense of responsibility, or who are indecisive or impulsive may be at higher risk.⁸ Also, new research suggests that people with OCD have differences in the way their brains process and send information. Specifically, the research showed that in the brains of people with OCD, the mechanisms for error processing (identifying a wrong thought) and inhibitory control (stopping an unhelpful action) are malfunctioning.⁹

Social & Environmental Learning

There are some studies which have identified factors that place certain children at higher risk for developing OCD. Specifically, children who have a lot of separation anxiety or somatic anxiety (about their body or health) are more likely to develop OCD.⁴ Children from lower socio-economic statuses may also be at higher risk.

Stress

Stressful events are known to be a trigger which can result in an onset of OCD symptoms for people who are already predisposed to the condition. These include things like traumatic events, accidents, or major life transitions. Women may be at higher risk for developing OCD in the postpartum period. While stressful events likely play a part in whether and when OCD symptoms begin, they are not thought to cause OCD on their own.

Childhood Trauma

Childhood trauma can be a catalyst for a lot of changes in a person, including the onset of OCD or exacerbation of existing OCD symptoms. Adverse childhood events such as abuse and neglect are linked with higher rates of OCD symptoms. Specifically, abuse was linked with more depressive OCD symptoms.

Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)

PANDAS occurs when the body attempts to fight off a bacterial infection but also attacks itself. It can be categorized as an autoimmune issue, however the symptoms of this condition can include neurological symptoms, like OCD or tics, and should be discussed to avoid a misdiagnosis. PANDAS symptoms include issues with eating, motor problems, and severe anxiety.

Complications of Obsessive Compulsive Disorder

OCD, especially severe OCD, can begin to negatively affect all elements of a person’s life, including their mental, physical, and social health. It can lead to isolation, social difficulties, other health conditions, and issues with finances if someone is unable to work because of their OCD symptoms.

Possible complications of OCD will vary by the type of OCD, but could include:²

• Poor self-care
• Inability to work or go to school
• Inability to maintain healthy social or family relationships
• Problems with finances, leading to issues with housing and transportation
• Health problems stemming from fears of doctors’ offices or from lesions caused by excessive washing
• Lack of trust or consistency with professional treatments
• Isolation due to avoidance

Conditions Related to OCD

While OCD is its own separate condition, it belongs to a cluster of disorders with similar features. These disorders are grouped within the same chapter of the 5th edition of the Diagnostic and Statistical Manual. While some individuals are diagnosed with OCD and one of the following conditions, it is also possible to have one of these conditions and not have OCD.

Some of the more common disorders that are related to OCD include:

• Excoriation disorder: This disorder is characterized by compulsive skin picking where a person either creates wounds or worsens existing wounds.
• Trichotillomania: This disorder is characterized by compulsive hair pulling, which often is in response to stress or anxiety but can also occur because the person finds it pleasurable.
• Body Dysmorphic Disorder: People with this disorder have a distorted view of some aspect of their own body or appearance and a preoccupation with perceived flaws. This preoccupation causes distress and often leads to compulsive checking, grooming, exercising, comparing or even cosmetic surgeries to correct perceived flaws.
• Tourette Syndrome: This condition features involuntary speech or movements. Tourette syndrome is a type of tic disorder (people who experience involuntary twitches or movements) but is often seen in people with OCD or other anxiety disorders.
• Hoarding disorder: People with hoarding disorder have intense attachments to their belongings and collect belongings to the point where their homes become overcrowded and sometimes virtually unlivable.
• Eating disorders: Those with eating disorders spend a lot of their time fixated on and attempting to control what they eat. This is often a comorbidity with OCD, with obsessions around what, how much, and when eating takes place.

OCD Vs. OCPD

Despite the naming similarities, OCD and OCPD (obsessive-compulsive personality disorder) are quite different. While OCD is marked by obsessions and compulsions, OCPD is characterized by a focus on perfectionism, orderliness, and control in relationships. Someone with OCPD will normally be focused on work and use others to accomplish their goals.²

Can OCD Be Prevented?

OCD cannot be cured or prevented, but if a person works to identify and treat the symptoms of compulsions and obsessions before they begin interfering with routines and happiness, severe symptoms of OCD may be mitigated. Someone may not be able to prevent all symptoms from arising, but early detection and treatment can slow the progress and prevent OCD symptoms from drastically impacting their life.¹⁶

How Is Obsessive Compulsive Disorder Diagnosed?

To properly diagnose OCD, a mental health professional will carefully investigate the presence of obsessions and compulsions. If they are identified, the professional will go on to study the impact of symptoms on the person’s life. If the obsessions and compulsions negatively affect the individual in a way that interferes with their daily life, they could have OCD. Someone looking for an OCD diagnosis should consider finding a mental health professional who specializes in OCD, as it can often be misdiagnosed as anxiety or another condition.

OCD Treatment

Treatment can include therapy (with exposure and response prevention being the gold standard therapy option), medication, or a combination of the two. With treatment, people with OCD are often able to minimize the extent that their symptoms disrupt their lives and routines and learn ways to manage their symptoms.

Common treatments for OCD include:

Exposure and Response Prevention (ERP)

ERP for OCD uses exposure to help desensitize people to anxiety triggers. Over time, exposures result in a long-term reduction in anxiety. The second component of ERP therapy is response prevention, or helping the client resist urges to engage in compulsive behaviors. ERP is considered the most effective form of treatment for people with OCD and can generally be completed in 8-12 sessions with a counselor lasting 60-90 minutes.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of therapy that helps people adjust unhelpful patterns of thinking and make behavior changes that support improved functioning. CBT is considered an evidence-based practice because it has been proven to be effective in treating a variety of mental disorders, including OCD. There is no set time frame for treating OCD with CBT, but generally the therapy is more solution-focused and results can be seen within 12-20 sessions.

Acceptance and Commitment Therapy (ACT)

ACT for OCD can help someone stay present in the here-and-now and allow themself the time and space to come to terms with the feelings and thoughts they have. It is a way to radically accept oneself and these difficult feelings in order to move forward from them.

OCD Medication

Some people with OCD may also benefit from psychiatric medication. These medications are typically prescribed by a psychiatrist or licensed doctor, nurse practitioner, or physician’s assistant with specialized experience in mental health treatment. On occasion, medication may be prescribed by a general practitioner or primary care provider. The most prescribed medications for OCD include SRIs and SSRIs, Antipsychotics, and Benzodiazepines.

Other Treatment Options

• Eye movement desensitization and reprocessing (EMDR): EMDR for OCD uses bilateral stimulation to help an individual process distressing memories and emotions surrounding their intrusive thoughts and compulsions.
• Transcranial magnetic stimulation (TMS): TMS for OCD has shown success in treating obsessions and compulsions. It involves passing magnetic pulses through the brain to stimulate the neurons in the brain. TMS may not work for everyone, but for those who’ve had limited success with therapy and medications, it offers a new opportunity for progress.¹³
• Gamma ventral capsulotomy: Radio-surgical procedure in which gamma rays are precisely directed to target certain parts of the brain to reduce the symptoms associated with OCD.¹⁴
• Deep brain stimulation: DBS is an option for severe OCD that has otherwise been treatment resistant, and the potential benefits of DBS are often felt soon after a treatment session.¹⁵

How to Get Help for OCD

If you suspect you have OCD, you should start by seeking formal treatment from a specialist. Therapy is a first-line treatment covered by most health insurance plans. To find an in-network therapist or to see if therapy is covered by your plan, you can call the number on the back of your insurance card or use your insurance company’s online search tools. You can also use your insurance company to find in-network psychiatrists or other prescribing professionals who can discuss options for medication.

Once you have a list of in-network therapists, the next step would be to call to see if they have experience in treating OCD and if they are accepting new patients. Right now, ERP is the treatment of choice for OCD, because it has the most evidence to support its efficacy—so it’s important to find a professional with experience using ERP.

Other ways to find a therapist are by asking for a referral from your primary care physician or by using an online therapist directory, where you can sort by specialty and insurance coverage. Other online OCD resources can also be helpful for people looking for treatment from home, with options like NOCD offering online treatment options for OCD.

Coping With OCD Symptoms

OCD is a disorder that can cause debilitating impairments for people, and formal treatment is usually needed to improve symptoms. In addition to therapy and/or medications, there may be some steps that people with OCD can take to better manage and cope with symptoms.

Along with formal treatment, here are several ways to cope with OCD symptoms:

• Managing stress levels: Because stress tends to worsen symptoms of OCD, managing stress levels is important in reducing symptoms.
• Being flexible in routines: Because people with OCD tend to more rigidly stick to certain routines when their symptoms progress, making a point to remain flexible and add variation can be helpful.
• Reducing avoidance: Many people with OCD may avoid certain anxiety-producing situations and while this can provide temporary relief, it often leads to a worsening of symptoms in the long-term.
• Mindfulness and meditation: Because people with OCD tend to attribute too much time, energy and attention to specific thoughts, mindfulness and meditation practices for OCD can teach people how to become less involved in their thoughts.
• Social interactions: Social interactions are known to reduce stress and improve health and mental health in several ways. For people with OCD, staying socially active can also help people adapt, compromise, and remain flexible.
• Yoga: Using Yoga for OCD can help manage the anxiety that is at the root of the obsessions and compulsions people with OCD struggle with.

How to Support a Loved One Dealing With OCD

Supporting someone with a mental health condition can be challenging as you work to find the balance between assisting and accidentally making symptoms worse.

Here are some ways to support a loved one dealing with OCD:

• Learn what you can about OCD and related disorders
• Point out to your loved one when symptoms seem to present
• Encourage honesty and openness with your loved one
• Offer to provide transportation to or emotional support at appointments
• Reassure them that their obsessions are likely unfounded fears
• Discuss the irrational connection between their obsessions and compulsions

More than anything, always approach your loved one from a place of love, support, and understanding. Becoming angry or aggressive rarely solves any problems.