What is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent and intrusive thoughts, images, urges, or impulses (obsessions) that cause anxiety or distress, and repetitive mental or physical behaviors (compulsions) to reduce this anxiety. The obsessions and associated compulsions significantly interfere with the individual’s daily functioning, including their ability to succeed at work, manage relationships, and enjoy leisurely activities. About 3% of the U.S population will meet criteria for OCD at some point in their lives, and a larger percentage will experience subclinical symptoms that may still warrant attention and respond to intervention.

 

Obsessive-Compulsive Disorder Symptoms

Worrying is not necessarily abnormal, nor is having “odd” or “repetitive” thoughts. Individuals who meet diagnostic criteria for OCD, however, significantly worry about things like:

  • Contracting germs and disease
  • Offending religious beings
  • Vomiting
  • Having sexual thoughts
  • Having thoughts of harming others

In response, individuals with OCD perform compulsive behaviors to reduce their anxiety or distress. For example, individuals struggling with obsessions may:

  • Excessively wash their hands or shower to rid themselves of germs and disease
  • Say a prayer each time they feel they may have offended a religious being
  • Avoid eating (or eat significantly less) to ensure they don’t vomit
  • Say something mean in their mind about the person they had sexual thoughts about
  • Avoid the people they have had harming thoughts about

When the individual performs a compulsion in response to their obsession, their anxiety typically diminishes. However, this pattern of negative reinforcement maintains and can even worsen OCD.

 

How Obsessive-Compulsive Disorder is Diagnosed

An OCD diagnosis is typically based on a clinical interview with a psychologist or other mental health provider, and may be augmented by one or more assessment measures (such as the Yale-Brown Obsessive Compulsive Scale [Y-BOCS]). These assessment procedures help determine whether OCD is present, how severe it may be, and whether any other conditions (e.g., another anxiety disorder, depression) may be contributing to the individual’s distress. A formal diagnosis is assigned by comparing the results of the assessment to the diagnostic criteria for OCD (see below). A valid diagnosis always involves the clinical judgment of a qualified mental health provider and cannot be determined by testing alone.

 

Impact of Obsessive-Compulsive Disorder on Daily Life

OCD always impairs one or more important areas of an individual’s life. For example, an individual with OCD may avoid leaving their home, avoid certain places or certain people, spend too much time performing compulsions to the point where they cannot get to other important responsibilities, have trouble focusing at home or at work, and find it difficult to relax. These symptoms, when left untreated, also put the individual at risk for other problems, such as another anxiety disorder, depression, and drug or alcohol abuse.

 

Obsessive-Compulsive Disorder is Treatable

The most effective treatment option for OCD is cognitive behavioral therapy (CBT).

While effective OCD treatment should incorporate cognitive approaches to change patterns of maladaptive thinking (e.g., challenge inaccurate or irrational thoughts, cope with distressing thoughts rather than avoid them), the focus of OCD treatment should always be exposure and response prevention (ERP) because it produces the greatest and longest-lasting treatment gains.

With ERP, the individual with OCD is progressively exposed to the thoughts, images, and urges that cause anxiety and is guided to resist performing the associated compulsion. Over time, the individual observes how the situations they were anxious about did not occur as expected; consequently, their anxiety declines.

In addition to ERP and cognitive approaches, relaxation and mindfulness procedures can be used to help the individual with OCD cope with their treatment.

Medication is generally not considered to be a first-line treatment for OCD.

 

What to do Next

If you think you may meet criteria for Obsessive-Compulsive Disorder:

 

Obsessive-Compulsive Disorder Diagnostic Criteria

DSM-5 Code: 300.3

ICD-10 Code: F42

A: Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2): 

1. Recurrent and persistent thoughts, urges, or impulses that are experiences, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2)

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

B: The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C: The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D: The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Specify if:

With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.

With poor insight: The individual thinks obsessive-compulsive disorder beliefs are probably true.

With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.

Specify if:

Tic-related: The individual has a current or past history of a tic disorder.