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Common conditions

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD)

What is OCD?

What is OCD?

Obsessive-compulsive disorder (OCD) is often misunderstood, portrayed in TV or film as causing people to be “really clean” or develop type A personalities. But OCD is more complicated. It’s a disorder characterized by unwanted thoughts known as obsessions. Obsessions are recurring and can cause uncomfortable feelings, like fear, anxiety, or disgust. Everyone has intrusive thoughts from time to time, but people with OCD have a harder time ignoring the thoughts and uncomfortable feelings and respond to them with compulsions—repetitive or ritualized actions that often feel hard to stop or control. Compulsions only provide temporary relief, and people with OCD can end up in a frustrating cycle that makes everyday life more difficult.

Remember, if you’re struggling with OCD, your intrusive thoughts are just that—thoughts—and are not reflective of who you are. OCD can be frustrating, but getting effective treatment is possible.

Symptoms of OCD

Symptoms

If you have OCD, you may notice obsessions, compulsions, or a mixture of both. Obsessions usually involve a fear or “What if?” question that you can never fully satisfy. Sometimes, an obsession is a superstitious belief or fear that something bad may happen, and other times, it is nonsensical or disturbing in nature. Compulsions, on the other hand, are things that we do. They aren’t always easy to spot, especially if they are not overt, physical actions like turning off switches or cleaning. Sometimes, compulsions are covert, meaning they can happen in your head or show up in interactions with other people. For instance, you may replay a memory in your head many times a day, or repeatedly ask a friend to reassure you.

Types of obsessions

  • Contamination/germs
  • Intrusive thoughts about harm or losing control
  • Thoughts about morality or religion
  • Intrusive thoughts about sexual or inappropriate content that you don’t want to have

Types of compulsions

  • Seeking constant reassurance from people around you (“Did you see me turn off the stove?” “Am I a nice person?")
  • Checking (repeatedly checking door locks, closing a faucet multiple times)
  • Counting rituals (counting down from 10 before getting in an elevator)
  • Repeated cleaning (over-washing hands, polishing the same surface multiple times)

What causes OCD?

Causes

The exact cause of OCD is still unclear to experts, but family history, brain structure, and even learned behavior may play a role.

  • The brain: Research suggests that OCD involves circuits in our brain related to behavioral control, reward, and emotions. Other research shows that OCD also involves an imbalance of serotonin in the brain, which is a chemical that helps balance your mood.
  • Genetics: People who have one or more family members with OCD are more likely to have it themselves
  • Learned behavior: Watching a family member react to fears can cause a negative association with certain situations, leading to a strong “fear response” even when there’s no real danger

Risk factors

Risk factors
  • Other mental health conditions – OCD can be related to or happen alongside other mental health conditions such as depression, substance abuse, anxiety, eating disorders, and more
  • Stressful events – A traumatic or high-stress experience can trigger OCD in some people
  • Illness in childhood – Some experts have traced the sudden onset of OCD symptoms in children to an infection response. This type of OCD is known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).

How is OCD diagnosed?

Diagnosis

There are no blood or imaging tests that can diagnose OCD. Your doctor may do lab work to check for any underlying physical conditions tied to your symptoms, but this is not necessary to make a diagnosis of OCD. OCD is diagnosed through a psychological evaluation, during which your provider will ask about your overall mental health, family history, and symptoms. 
Questions may include:

  • Do you struggle with repetitive and distressing thoughts, and if so, how often and for how long?
  • Do you take any actions to try to stop the thoughts or soothe your fears?
  • Do you repeat these behaviors over and over?
  • Do you seek constant reassurance from others about your fears?
  • Do the actions or behaviors feel difficult to resist?
  • Do you worry about what might happen if you don’t perform the behavior?
  • Have your symptoms and actions affected your relationships, school, or work?
  • Do you actively avoid situations that might trigger your distressing thoughts?

How is OCD treated?

Treatment

Therapy, medication, or a combination of both can be extremely effective in treating OCD. Committing to treatment can feel overwhelming, but giving yourself a chance to feel better is worth it.

Therapy

Finding a therapist who has experience working with OCD patients is important, as OCD is often treated with a specific therapy approach called exposure and response prevention therapy (ERP). Other types of talk therapy—while helpful for conditions like depression or anxiety—can even be counterproductive for someone dealing with OCD. During ERP, a trained therapist will help you learn to tolerate troubling thoughts by gradually exposing you to your fears. You’ll also practice resisting compulsions as a response to these thoughts. Learn more about exposure and response prevention therapy.

Medication

While medication is not a fix-all solution, it may help ease your anxiety and make everyday tasks—including exposure therapy sessions—feel easier to tackle. The type of medicine you’re prescribed can depend on a few factors, like your age or the intensity of OCD. Many common antidepressants work well for those struggling with OCD, including:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft) 
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Venlafaxine (Effexor)

OCD can be challenging—you might feel like you’re stuck in a hamster wheel of your own thoughts and fears. But getting better is possible. If you’re struggling with OCD or any other mental health symptoms, don’t hesitate to ask for help.

The Center for Youth Mental Health at NewYork-Presbyterian

Get Care

The Center for Youth Mental Health is a rich resource, bringing together doctors from Columbia University Vagelos College of Physicians and Surgeons and Weill Cornell Medicine to lead research and treatment programs that give young people the care they need. Learn more.