Obsessive Compulsive Disorder: Causes, Symptoms, and Treatment

About 1.2% of the world’s population, or 84 million people, deals with obsessive compulsive disorder (OCD). It is a mental health condition that involves repeated, uncontrollable thoughts (obsessions) or repeated, uncontrollable actions (compulsions). Like many other mental health disorders, OCD is a treatable condition.1

In this article:

What is Obsessive Compulsive Disorder?

Obsessive compulsive disorder involves thoughts or actions that the person has extreme difficulty controlling.1

Thoughts can include worries that the person’s fears will become a reality. The person does not want these thoughts and experiences them as intrusive, causing the person extreme anxiety or distress. Because the person does not welcome these thoughts, they may try to ignore or curb them with actions, which are compulsions.1For a diagnosis of OCD, the person experiences obsessions, compulsions, or both. Most people with the disorder experience both.1

A common example of an obsession is a fear of germs. Worrying about contracting germs takes up a lot of their time and causes them great distress. To deal with the fear and temporarily ease their anxiety, they wash their hands constantly, which also takes up a lot of their time.1

One main characteristic of OCD is that the obsessions and compulsions occur in a cycle. For example, if someone has an extreme fear of catching germs, they may excessively wash their hands right after using a public restroom. After the person returns home, they constantly worry that they have contracted germs by spending the extra time in the public restroom washing their hands. As a result, the person washes their hands again at home for a very long time.

How is OCD Different from Everyday Obsessions and Compulsions?

Obsessions and compulsions in OCD are different from regular habits in that they take up an excessive amount of time or cause a significant amount of psychological distress.1 These repetitive thoughts or actions can get in the way of normal life and are difficult or impossible to ignore.

For example, if you have a job interview or an important work meeting the following day, you might spend more time than usual making sure that you have set your alarm. You might even spend another 10 or 15 minutes checking and rechecking that the alarm is, in fact, on and set to the right time.

For someone with OCD, the worry about not getting up in time and the time spent checking alarms is excessive and happens frequently, not just in certain circumstances. It might take them a few hours to set and check their alarms. The added time also contributes to the person’s worries that they accidentally turned an alarm off while checking it. This causes a cycle of worrying the alarm is not on, checking it, worrying that they accidentally turned it off, rechecking it, and so on.2

Many people with OCD know that their obsessions and compulsions do not make sense. However, they cannot help them and have trouble controlling their impulses, such as washing their hands or checking the alarm.1

What Causes Obsessive Compulsive Disorder?

Scientists do not know with certainty what causes obsessive compulsive disorder (OCD). However, they have identified some risk factors for it.3

Brain Characteristics

One risk factor is brain functioning.3 Because of this, some researchers consider OCD a neuropsychiatric disorder.4

Scientists have found less gray matter and white matter in the brains of those diagnosed with OCD. This reduction in the matter has been found in parts of the brain involved in impulse control and compulsive checking. However, the exact connection between these parts of the brain and OCD symptoms is not yet clear, and research is ongoing.3,5,6

Is OCD Genetic?

OCD does have a strong genetic component. Those who have a parent or sibling with the disorder are at a high risk of developing it.3

A recent study of more than 7,000 people diagnosed with OCD also found that maternal factors are a significant part of the overall genetic risk factor. Research about genetics and OCD is ongoing as well.7

Environmental Factors

Some research has found a link between childhood trauma and OCD symptoms. Children may reportedly develop OCD or obsessive compulsive symptoms after a streptococcal infection, such as strep throat or scarlet fever.3,8

Obsessive Compulsive Disorder Symptoms and Signs

It is important to note that having obsessive compulsive disorder should not define a person. OCD is a mental health disorder, just like depression, anxiety, or schizophrenia. A person diagnosed with OCD can have varying degrees of severity when it comes to their obsessions, compulsions, or both. Symptoms can also worsen under increased stress.11

A person with OCD deals with:1,3

  • A lack of control over obsessions and compulsions
  • A great deal of anxiety and distress due to the obsessions and compulsions
  • Panic attacks
  • Feelings of agitation or apprehension
  • The symptoms interfering in a few different parts of their life, such as work and relationships

Obsessions

Obsessions are thoughts or mental images that cause significant anxiety and distress. People with OCD experience these thoughts as intrusive and unwanted. Some common obsessions include:3

  • Needing to have things in a neat or symmetrical order
  • Aggressive thoughts toward self or others
  • Fear of germs
  • Thoughts involving sex or religion

Compulsions

Compulsions are repetitive acts that a person with OCD feels a strong impulse to do. Many times the urge is in reaction to an obsession. Some common compulsions include:3

  • Excessive handwashing
  • Arranging things in a particular way
  • Repeatedly checking things, such as constantly checking that the oven is turned off.
  • Repeated counting

Treatment for OCD

The first-line treatments for OCD are the antidepressant medications selective serotonin reuptake inhibitors (SSRIs) and clomipramine. About half of those who try these medications experience a reduction in OCD symptoms.9

For those who do not respond to SSRIs or clomipramine, providers prescribe atypical antipsychotic medication to enhance the effects of the other medications. After three months from starting the other medication, they typically do this after observing how the person responds.9 Overall, researchers have found that augmenting antidepressant medication with atypical antipsychotics, such as haloperidol and risperidone, is effective.10

Providers also use cognitive behavioral therapy (CBT) in addition to or in place of pharmacological treatments.9 Researchers have thus far found CBT to be very effective in treating OCD. It involves examining how your thoughts, feelings, and actions are related to each other. Altering unrealistic thoughts can lead to relief in anxiety, distress, and compulsive behavior.11

Another psychological treatment for OCD is exposure and response prevention (ERP). By being in a situation that a person fears, they learn that their fear does not become a reality. For example, if someone has intrusive thoughts of harming loved ones with a knife, therapy may involve having the person hold a knife in the presence of their therapist and loved ones to see that they do not actually harm people.12

In some studies, ERP was found to be the most effective treatment for patients with OCD. At the same time, some with OCD may not respond well. Factors for poor outcomes can include the severity of OCD, co-occurring depression, and attendance rate for treatment. Stopping treatment prematurely is likely due to ERP being time-consuming, and some people may also find it too anxiety-provoking.12

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Who Can Develop Obsessive Compulsive Disorder?

Research has found some differences in how obsessive compulsive disorder looks between different ethnic groups in the U.S.1

In one study of Asian Americans diagnosed with OCD, a strong ethnic identity was associated with worse symptoms than Americans of European descent. Researchers speculate that identifying as Asian American could be related to trying to offset racist historical stereotypes.13

Another study found that Asian Americans and African Americans were more likely to have more contamination-related OCD symptoms when compared to those of European descent.14 Researchers speculate that for African Americans, the symptoms are to offset racist negative stereotypes and societal pressures.13

What Mental Health Conditions Are Associated with OCD?

One study of more than 1500 Spanish children ages 8-12 found that those with an obsessive compulsive disorder diagnosis also likely dealt with separation anxiety and physical symptoms of anxiety.15

Researchers found that other disorders likely to occur alongside OCD in U.S. adults include anxiety, mood, substance use, and impulse control disorders.16

When Can Obsessive Compulsive Disorder Start?

About 25% of people with OCD begin to have symptoms at age 14. The average age for the start of the disorder is about 19 years of age. In rarer cases, the disorder can manifest after 35 years of age.1

Men tend to experience the symptoms of OCD earlier than women. Obsessive compulsive disorder starts at age 10 for about 25% of men. While the acute onset of OCD is possible, most of the time, the symptoms develop gradually.1

Most children and adults diagnosed with OCD have both obsessions and compulsions. However, in children, compulsions can be diagnosed much more easily than obsessions because they are observable. Adults are more easily able to hide their compulsions, such as counting in their minds rather than out loud.1

Who Diagnoses Obsessive Compulsive Disorder?

Only professionals trained in mental health disorders can diagnose obsessive compulsive disorder. Professionals legally able to make a formal diagnosis can depend on the jurisdiction but usually include:17

  • Psychologists—those with a Ph.D. in psychology
  • Psychiatrists—those with an MD specializing in psychiatric disorders
  • Licensed mental health counselors—those with a master’s degree in psychology
  • Primary care providers—general practitioners with an MD

Primary care providers will often refer a person to a professional specializing in mental health.

How Do I Get an OCD Test?

To get an OCD test for yourself or your child, you can start by talking with your primary care provider. They will ask you some initial questions based on the diagnostic criteria for OCD, such as:1,17

  • Do you find yourself having unwanted thoughts over and over again?
  • Do you have difficulty controlling your thoughts?
  • Do you do some behaviors repeatedly that you can’t control?
  • Do these symptoms cause you distress?
  • Do these symptoms get in the way of living any parts of your life?

Your primary care physician might also do a physical exam or blood tests to rule out any physical reasons or medications that might cause your symptoms.17

If your primary care provider refers you to a mental health professional for further assessment, you will do a longer of an assessment where the mental health professional interviews you to better understand your experience. They may also conduct a more formal OCD screen or test with more questions than those asked by a primary care doctor. There is nothing you need to do to prepare for an OCD test.17,18

How to Find Obsessive Compulsive Disorder Treatment

Early treatment is important to reduce the risk of ongoing obsessive compulsive disorder  symptoms. Those who do not receive treatment are much less likely to achieve remission of the disorder.1

Medication tends to be the first-line treatment for OCD. Providers might also recommend therapy.9 Typically, you would work with a psychiatrist for pharmacological treatment and a psychologist or licensed professional counselor for therapy.

For assistance with locating treatment providers, please call 800-598-5053 (Who Answers?) 24/7 for help from one of our specialists.

Resources

  1. American Psychiatric Association. (2022). Obsessive-Compulsive and Related Disorders. In Diagnostic and Statistical Manual of Mental Disorders 5: Text Revision. 263-294. American Psychiatric Publishing.
  2. Knapton, O. (2015). Dynamic conceptualizations of threat in obsessive-compulsive disorder (OCD). Language and Cognition, 8(1), 1-31.
  3. National Institutes of Health. (2019). Obsessive-compulsive disorder.
  4. Stein, D.J., Costa, D.L.C., Lochner, C., Miguel, E.C., Reddy, Y.C.J., Shavitt, R.G., van den Heuvel, O.A., & Simpson, H.B. (2019). Obsessive compulsive disorder. Nature Reviews Disease Primers, 5.
  5. Goncalves, O.F., Sousa, S., Carvalho, S., Leite, J., Ganho, A., Fernandes-Goncalves, A., Pocinho, F., Carracedo, A., & Sampaio, A. (2017). Alterations of gray and white matter morphology in obsessive compulsive disorder. Psicothema, 29(1), 35-42.
  6. Wang, H. (2020). Research on the causes and treatment of OCD. CAIH2020: Proceedings of the 2020 Conference on Artificial Intelligence and Healthcare, 188-193.
  7. Mahjani, B., Klei, L., Hultman, C.M., Larsson, H., Devlin, B., Buxbaum, J.D., Sandin, S., & Grice, D.E. (2020). Maternal effects as cause of risk for obsessive-compulsive disorder. Biological Psychiatry, 12(15), 1045-1051.
  8. National Institutes of Health. (2019). PANDAS – Questions and answers.
  9. Kellner, M. (2022). Drug treatment of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 187-197.
  10. Bloch, M.H., Landeros-Weisenberger, A., Kelmendi, B., Coric, V., Bracken, M.B., & Leckman, J.F. (2006). A systematic review: Antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Molecular Psychiatry, 11, 622-632.
  11. Ost, L., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156-169.
  12. Hezel, D.M., & Simpson, H.B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian Journal of Psychiatry, 61(Suppl 1), S85-S92.
  13. Ching, T.H.W., & Williams, M.T. (2019). The role of ethnic identity in OC symptom dimensions among Asian Americans. Journal of Obsessive Compulsive Related Disorders, 21, 112-120.
  14. Wheaton, M.G., Berman, N.C., Fabricant, L.E., & Abramowitz, J.S. (2013). Differences in obsessive-compulsive symptoms and obsessive beliefs: A comparison between African Americans, Asian Americans, Latino Americans, and European Americans. Cognitive Behavioral Therapy, 42(1), 9-20.
  15. Moreso, N.V., Hernandez-Martinez, C., Val, V.A., & Sans, J.C. (2013). Socio-demographic and psychopathological risk factors in obsessive-compulsive disorder: Epidemiologic study of school population. International Journal of Clinical and Health Psychology, 13(2), 1818-126.
  16. Ruscio, A.M., Stein, D.J., Chiu. W.T., & Kessler, R.C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey replication. Molecular Psychiatry, 15, 53-63.
  17. National Institutes of Health. (2021). Obsessive compulsive disorder (OCD) test.
  18. Rough, H.E., Hanna, B.S., Gillett, C.B., Rosenberg, D.R., Gehring, W.J., Arnold, P.D., & Hanna, G.L. (2020). Screening for pediatric obsessive-compulsive disorder using the Obsessive-Compulsive Inventory-Child Version. Child Psychiatry and Human Development, 51, 888-899.

Resources

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