Obsessive-compulsive disorder (OCD) is characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). It's also possible to have only obsessions or only compulsions and still have OCD.

With OCD, you may or may not realize that your obsessions aren't reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings.

OCD often centers around themes, such as a fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped. Despite efforts to ignore or get rid of bothersome thoughts, the thoughts or urges keep coming back. This leads to more ritualistic behavior — and a vicious cycle that's characteristic of OCD.

Obsessive-compulsive disorder symptoms usually include both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. About one-third of people with OCD also have a disorder that includes sudden, brief, intermittent movements or sounds (tics).

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted urges or images that cause distress or anxiety. You might try to get rid of them by performing a compulsion or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

  • Fear of contamination or dirt
  • Having things orderly and symmetrical
  • Aggressive or horrific thoughts about 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 shaking hands or 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 hurting yourself or someone else
  • Thoughts about shouting obscenities or acting inappropriately
  • Avoidance of situations that can trigger obsessions, such as shaking hands
  • Distress about unpleasant sexual images repeating in your mind

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors are meant to prevent or 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 also make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are often not rationally connected to preventing the feared event.

As with obsessions, compulsions typically have themes, such as:

  • Washing and cleaning
  • Counting
  • Checking
  • Demanding reassurances
  • Following a strict routine
  • Orderliness

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

Symptoms usually begin gradually and tend to vary in severity throughout your life. Symptoms generally worsen when you're experiencing more stress. OCD, considered a lifelong disorder, can be so severe and time-consuming that it becomes disabling.

Most adults recognize that their obsessions and compulsions don't make sense, but that's not always the case. Children may not understand what's wrong.

When to see a doctor

There's a difference between being a perfectionist and having OCD. OCD thoughts aren't simply excessive worries about real problems in your life. Perhaps you keep the floors in your house so clean that you could eat off them. Or you like your knickknacks arranged just so. That doesn't necessarily mean that you have OCD.

If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health provider. People with OCD may be ashamed and embarrassed about the condition, but treatment can help.

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

  • Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions. OCD may also have a genetic component, but specific genes have yet to be identified.
  • Environment. Some environmental factors such as infections are suggested as a trigger for OCD, but more research is needed to be sure.

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

  • Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.
  • Stressful life events. If you've experienced traumatic or stressful events or you tend to react strongly to stress, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.

Individuals with obsessive-compulsive disorder may have additional problems. Some of the problems below may be associated with OCD — others may exist in addition to OCD but not be caused by it.

  • Inability to attend work, school or social activities
  • Troubled relationships
  • Overall poor quality of life
  • Anxiety disorders
  • Depression
  • Eating disorders
  • Suicidal thoughts and behavior
  • Alcohol or other substance abuse
  • Contact dermatitis from frequent hand-washing

You may start by seeing your primary doctor. Because obsessive-compulsive disorder often requires specialized care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment.

What you can do

To prepare for your appointment, think about your needs and goals for treatment.

  • Make a list of any symptoms you've noticed, including any that may seem unrelated to the reason for the appointment.
  • Make a note of key personal information, including any major stresses or recent life changes.
  • Take a list of all medications, vitamins, herbal remedies or other supplements, as well as the dosages.
  • Make a list of questions you'd like to ask to make the most of your appointment time.

For OCD, basic questions to ask may include:

  • Do you think I have OCD?
  • How do you treat OCD?
  • How can treatment help me?
  • Are there medications that might help?
  • Will talk therapy (psychotherapy) help?
  • How long will treatment take?
  • What can I do to help myself?
  • Are there any brochures or other printed material that I can have? Can you recommend websites?

Don't hesitate to ask questions anytime you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • Do certain thoughts go through your mind over and over despite your attempts to ignore them?
  • Do you have to have things arranged in a certain way?
  • Do you have to wash your hands, count things or check things over and over?
  • When did your symptoms start?
  • Have symptoms been continuous or occasional?
  • What, if anything, seems to improve the symptoms?
  • What, if anything, appears to worsen the symptoms?
  • How do the symptoms affect your daily life?
  • In a typical day, how much time do you spend on obsessive thoughts and compulsive behavior?
  • Have any of your relatives had a mental illness?
  • Have you experienced any trauma or major stress?

To help diagnose OCD, your doctor or mental health provider may do exams and tests, including:

  • Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications.
  • Lab tests. These may include, for example, a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
  • Psychological evaluation. A doctor or mental health provider asks about your thoughts, feelings, symptoms and behavior patterns. Your doctor may also want to talk to your family or friends, with your permission.

Diagnostic criteria for OCD

To be diagnosed with OCD, you must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This manual is used by mental health professionals to diagnose mental illnesses and by insurance companies to reimburse for treatment.

General criteria required for a diagnosis of OCD include:

  • You must have either obsessions or compulsions or both.
  • You may or may not realize that your obsessions and compulsions are excessive or unreasonable.
  • Obsessions and compulsions are significantly time-consuming and interfere with your daily routine and social or work functioning.

Your obsessions must meet these criteria:

  • Recurrent, persistent and unwelcome thoughts, impulses or images are intrusive and cause distress.
  • You try to ignore these thoughts, images or impulses or to suppress them with compulsive behaviors.

Compulsions must meet these criteria:

  • Repetitive behavior that you feel driven to perform, such as hand-washing, or repetitive mental acts, such as counting silently.
  • You try to neutralize obsessions with another thought or action.
  • These behaviors or mental acts are meant to prevent or reduce distress, but they are excessive or not realistically related to the problem they're intended to fix.

Diagnostic challenges

It's sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental illnesses. Someone with true obsessions and compulsions has OCD, although it's possible to have both OCD and obsessive-compulsive personality disorder. Be sure to stick with the diagnostic process so you can get appropriate diagnosis and treatment.

Obsessive-compulsive disorder treatment may not result in a cure, but it can help you bring symptoms under control so they don't rule your daily life. Some people need treatment for the rest of their lives.

The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these.

Psychotherapy

A type of therapy called exposure and response prevention (ERP) is the most effective treatment. This therapy involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn healthy ways to cope with your anxiety. Exposure therapy takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Therapy may take place in individual, family or group sessions.

Medications

Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants that have been approved by the Food and Drug Administration (FDA) to treat OCD include:

  • Clomipramine (Anafranil)
  • Fluvoxamine (Luvox CR)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)

However, other antidepressants and psychiatric medications used for other conditions may be prescribed off label to treat OCD.

Choosing a medication

With OCD, it's not unusual to have to try several medications before finding one that works well to control your symptoms. It can take weeks to months after starting a medication to notice an improvement in your symptoms. Your doctor also might recommend combining medications, such as antidepressants and antipsychotic medications, to make them more effective in controlling your symptoms.

Don't stop taking your medication without talking to your doctor, even if you're feeling better — you may have a relapse of OCD symptoms. Antidepressants aren't considered addictive, but sometimes physical dependence, which is different from addiction, can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Medication side effects and risks

In general, the goal of OCD treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Here are some things to consider:

  • Side effects. All psychiatric medications have potential side effects, which may include stomach upset, sleep disturbance, sweating and reduced interest in sexual activity. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric medications. And let your doctor know if you experience troubling side effects.
  • Suicide risk. Most antidepressants are generally safe, but the FDA requires that all carry the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur when taking an antidepressant, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
  • Interactions with other substances. Some medications can have dangerous interactions with other medications, foods, alcohol or other substances. Tell your doctors about all medications and over-the-counter substances you take, including vitamins, minerals and herbal supplements.

Other treatment

Sometimes, medications and psychotherapy aren't effective enough to control OCD symptoms. Research continues on the potential effectiveness of deep brain stimulation (DBS) for treating OCD that doesn't respond to traditional treatment approaches.

Because DBS hasn't been thoroughly tested for use in treating OCD, make sure you understand all the pros and cons and possible health risks.

Obsessive-compulsive disorder is a chronic condition, which means it may always be part of your life. While you can't treat OCD on your own, you can do some things for yourself that will build on your treatment plan:

  • Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, OCD symptoms are likely to return.
  • Pay attention to warning signs. You and your doctors may have identified issues that can trigger your OCD symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
  • Check first before taking other medications. Contact the doctor who's treating you for OCD before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals or herbal supplements. These may interact with your OCD medications.

Coping with obsessive-compulsive disorder can be challenging. Medications can have unwanted side effects, and you might feel embarrassed or angry about having a condition that requires long-term treatment. Here are some ways to help cope with OCD:

  • Learn about OCD. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Join a support group. Support groups for people with OCD can help you reach out to others facing similar challenges.
  • Stay focused on your goals. Recovery from OCD is an ongoing process. Stay motivated by keeping your recovery goals in mind.
  • Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies and recreational activities. Regular exercise, eating a healthy diet and getting adequate sleep can have a positive effect on your treatment.
  • Learn relaxation and stress management. Try stress management techniques such as meditation, muscle relaxation, deep breathing, yoga or tai chi.
  • Stick with your regular activities. Go to work or school as you usually would. Spend time with family and friends. Don't let OCD get in the way of your life. If OCD disrupts activities or your daily routine, work with an experienced therapist on doing exposures to reduce this disruption.

There's no sure way to prevent obsessive-compulsive disorder. However, getting treatment as soon as possible may help prevent OCD from worsening.

Aug. 09, 2013