What You Should Know About Obsessive Compulsive Disorder (OCD)

• OCD affects approximately 2% of the world’s general population.¹

• Around two to three million adults in the US have OCD.²

• One in 100 adults in the US has OCD.²

• One in 200 children has OCD in the US.²

• 25% of OCD cases occur before the age of 14, but the average age of onset is 19.³

• Women are three times more likely to develop OCD than men.³

OCD affects everyone differently but generally causes a particular pattern of thoughts and behaviors.

OCD may cause you to have the following obsessive thoughts:

• Fear of germs, disease, and infection

• Thoughts about violence or sex that repulse or scare you

• Thoughts about harming yourself or others, deliberately or by mistake

• A desire for everything to be symmetrical and orderly

These obsessive thoughts may make you feel anxious or distressed. To ease your anxiety, you may feel the urge to act compulsively. Common compulsions in people with OCD include:

• Excessively cleaning the environment or yourself (excessive hand washing is a common OCD compulsion)

• Saying words in your head repeatedly

• Counting

• Arranging objects in a particular order

• Checking things (you might check the door to ensure it’s locked or the cooker to ensure the gas is off)

• Hoarding objects for their real or imagined value

Experts still don’t know what causes OCD behaviors, but several factors are linked to an increased risk of developing the condition.¹ These include:

Genetics

Studies suggest a link between genetics and OCD,² but environmental factors may also contribute.

People with a first-degree relative (a parent, sibling, or child) living with OCD are thought to have a higher risk. This risk is often higher if the relative displayed signs of OCD as a child or teenager. 

Additionally, several studies have demonstrated an 80% or higher chance of twins sharing OCD symptoms, strongly implying a genetic link.²

Research still hasn’t shown which genes or gene sets cause the condition.

Stress

Evidence suggests stress and OCD are linked.

25–67% of OCD patients link the onset of their OCD to a significant life event.³ Most said this event was stressful. Reports suggest stressful life events typically occur around six to 12 months before signs of OCD appear. 

Whether stress directly causes OCD or if stressful experiences worsen the disorder remains unclear.

Stressful events can also cause OCD symptoms to emerge suddenly. However, a family history of the condition is less likely in these cases.

Biology

A person with OCD may have brain abnormalities that cause symptoms.⁴

The prefrontal cortex area of the brain is associated with OCD. It is responsible for cognitive processes like attention and impulse control. However, subcortical (deeper) brain structures that affect mood, thought, and social functions can also play a role in obsessive-compulsive traits.

Imaging has revealed people with OCD often have differences in these areas of the brain. More research is underway about this link.

Traumatic brain injury

In some cases, a traumatic brain injury (TBI) can cause complications like OCD.

An external force causes a traumatic brain injury (TBI). The most common causes are car accidents, falls, hitting the head on an object, being hit by an object, and assault.⁵ A TBI may be caused by an object entering the skull and injuring the brain. It can also occur when the body is shaken so hard the brain hits the skull.

OCD symptoms may appear soon or months after a traumatic brain injury. In most cases, people who develop OCD months after a traumatic brain injury do so after a major depressive episode.⁶

History of abuse

Early research points to a higher risk of OCD if a child experienced neglect or physical, emotional, or sexual abuse early in life.⁷ However, more research is needed to understand this link.

Infection

OCD may develop from a childhood streptococcal infection in some cases.¹

Children who develop OCD after this infection may be diagnosed with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Personality

Personality or temperament are not established causes of OCD. However, different personality types have been associated with this disorder and linked to traits like hoarding and indecisiveness. 

People that strive for perfection have been known to fit the profile for obsessive traits.

Other mental health conditions associated with OCD

Some mental health conditions are associated with OCD, including:

Body dysmorphic disorder

Body dysmorphic disorder (BDD) is an obsessive preoccupation with flaws in your appearance. This fixation is often enough to cause distress and disrupt your daily life. 

BDD is often categorized as a type of obsessive condition, so it’s linked to OCD.

BDD and OCD symptoms commonly start early in life, usually during adolescence. Both conditions involve repetitive behaviors like continuously checking the mirror to critique your features.

The two conditions differ. OCD causes any number of obsessions, while people with BDD focus solely on perceived shortcomings in their physical appearance.

Depression

OCD and depression can occur together, with symptoms like trouble feeling pleasure, sadness, low sex drive, and appetite and sleep disturbance. Research suggests 25–50% of people with OCD meet the criteria for depression.⁸

Depression develops after the onset of OCD in most cases. More rarely, both conditions start at the same time.

Treating OCD typically involves cognitive behavior therapy (CBT), but this treatment may not be so successful if you also have depression.

Autism spectrum disorder

OCD and autism spectrum disorder have common overlapping features. For example, both conditions can involve compulsive or obsessive behaviors, which are often repetitive and form part of your daily routine.

People with autism often carry out repetitive behaviors to soothe themselves or cope with overwhelming environmental stimuli. In contrast, OCD-compulsive traits are usually distressing and unwanted.

Generalized anxiety disorder

Generalized anxiety disorder (GAD) and OCD involve excessive concern about various situations. However, the nature of these worries is different in each condition.

GAD often involves worries about everyday issues, like paying bills and responsibilities at work or school. OCD usually involves specific concerns about contact with germs, losing something valuable, or religious impurity.

People with GAD don’t display compulsive behaviors like handwashing or praying, which is typical of OCD.

Diagnosis

Your doctor may diagnose you with OCD if you meet certain criteria.

They will determine if your obsessions and compulsions cause extreme discomfort and difficulties that affect your quality of life. This avoids confusing every unwanted thought or repetitive behavior as an OCD symptom.

Generally, the following criteria will help your doctor determine if your symptoms are indicative of OCD:⁹

• You have obsessions:

  • Persistent, recurring thoughts, impulses, or images that are intrusive, unwanted, and cause you distress.

  • You try to ignore or suppress these thoughts, impulses, or images. You might try to do this with another thought or action (a compulsion).

• You have compulsions:

  • You feel driven to perform repetitive behaviors or mental acts in response to an obsession. These might include washing your hands, counting, praying, checking, or saying words in your head over and over.

  • You carry out these behaviors or mental acts to prevent or reduce distress and anxiety caused by your obsessions. Your behavior is excessive and is not realistically linked to your obsession.

• Your obsessions and compulsions take up at least one hour per day.

• Your obsessions and compulsions are not caused by another mental health condition, like generalized anxiety disorder, body dysmorphic disorder, or an eating disorder.

• Your obsessive and compulsive behaviors are not caused by other medical conditions or substances (for example, medication or drug abuse).

Your doctor will assess to what degree:

• You believe your OCD beliefs are definitely or probably not true, or they may or may not be true.

• You believe your OCD beliefs are probably true.

• You are completely convinced your OCD beliefs are true

They will also establish if you have a current or past history of tic disorder.

People with OCD can learn to manage and control their obsessive-compulsive thoughts and behaviors. Your doctor may recommend a combination of education, medication, or even surgery. Alternative medicine may provide positive results for treating OCD in some cases.

Psychoeducation

You might find it helpful to learn more about your condition through psychoeducation. This will provide information about the causes, effects, and available treatments. You may also learn about societal stigmas and prejudices.

This can also extend to your friends or family members whenever possible — those who observe your traits and behaviors. This is particularly important for children and teenagers, but equally crucial for adults where loved ones could be facilitating OCD traits.

Medication

Doctors often recommend selective serotonin reuptake inhibitors (SSRIs) as a first-line OCD treatment. This will be a likely recommendation if you have severe OCD or other mental health conditions that SSRIs could treat, like depression.

Clomipramine, a tricyclic antidepressant, is a second-line treatment option for OCD in children aged ten and older.¹ The Food and Drug Administration (the FDA) also approved clomipramine for use in adults with OCD.

Other FDA-approved medications for OCD include:

• Fluoxetine (Prozac): An SSRI for adults and children aged seven years and older

• Fluvoxamine: An SSRI for adults and children aged eight years and older

• Paroxetine (Paxil, Pexeva): An SSRI for adults only

• Sertraline (Zoloft): An SSRI for adults and children aged six years and older

Psychotherapy

Cognitive behavior therapy is a first-line OCD treatment. This form of psychotherapy has the most supporting evidence for its success.² It helps pinpoint negative, obsessive thoughts that contribute to compulsive, repetitive reactions.

Exposure and response prevention (ERP) is a type of CBT. Through exposure to OCD stimuli, ERP teaches you to embrace your obsessive thoughts without giving in to compulsions.

This form of therapy is done in a safe environment. It also involves teaching the skills needed to control obsessive-compulsive traits.

Non-conventional approaches to OCD

Other, non-conventional OCD treatments include:

Deep brain stimulation (DBS)

DBS is commonly used to manage movement disorders like Parkinson’s disease. It’s a type of brain surgery that may be recommended as a last resort in cases where OCD does not ease with treatment. It has been shown to improve severe OCD symptoms.

A surgeon will place a pulse generator underneath your skin in your stomach or chest area. The device is a bit like a pacemaker. It connects to your brain using thin wires and delivers high-frequency stimulation. The aim is to alter the brain’s electrical signals and improve the circuitry to ease your symptoms.

It is a minimally invasive procedure.³

Transcranial magnetic stimulation (TMS)

This procedure is a non-invasive treatment for managing obsessive symptoms. It’s an established major depressive disorder treatment and the FDA approved it for OCD in 2018.

TMS introduces magnetic fields to portions of the brain responsible for OCD symptoms. It is believed that targeting these sections isolates the specific OCD symptoms, giving the brain a chance to reorient its response to obsessive thoughts.

Transcranial magnetic stimulation can complement established treatment options like medicine and psychotherapy.

Coping with OCD

Managing your obsessions and compulsions on a daily basis can be tiring and stressful. It can take up a significant portion of your day and interrupt your work and social life.

Your doctor will recommend an individual treatment plan to help you manage your OCD symptoms. While your treatment is ongoing, you can try these different measures to help you cope with OCD symptoms:

Learn about OCD

To help tackle the condition head-on, try researching OCD and learning as much as you can about it. For example, reading about the different causes, symptoms, and treatment options may be useful.

Education could make it easier for you to talk to friends and family about your experiences. You might also like to learn about OCD with loved ones to help them understand what you’re going through and how they can help you.

Join a support group

An OCD support group is a judgment-free setting to discuss challenges, concerns, and progress.

Around 2% of people worldwide have OCD,⁴ so you may benefit from hearing about other people’s experiences and discussing your own. You might simply feel relieved to know you’re not alone and other people can empathize with your experiences.

Maintain a healthy lifestyle

During OCD treatment, your doctor may recommend taking steps to improve your lifestyle. For example, you might try doing more exercise, eating a healthy diet, and improving your sleep quality. These things could positively affect your quality of life and treatment outcomes.

It’s possible to prevent OCD symptoms from worsening or emerging at all in some cases.¹

Identifying OCD signs early can lead to timely symptom management and prevention. Furthermore, people at high risk of this disorder may go through psychoeducation to understand their obsessive traits.

Family members and friends can also play an important role in preventing OCD from worsening. This is through reducing family accommodation, which occurs when loved ones enable symptoms.

OCD is a serious mental health condition that can greatly affect your day-to-day life, work, and relationships. Making an appointment to see a doctor is the first step in getting a diagnosis and starting an OCD treatment plan.

Some people put off speaking to a doctor about their OCD symptoms, perhaps because they feel embarrassed, they don’t know enough about the condition, or their obsessions and compulsions prevent them from doing so. However, seeing a medical professional can put you on the path to improved quality of life.

If you think you might have OCD, see a doctor as soon as possible. They will ask you questions about your symptoms and experiences and discuss potential treatment options with you.