Obsessive-Compulsive Disorder (OCD) is an anxiety disorder that consists of a cycle of obsessions and compulsions. OCD can be time-consuming, debilitating, and can hinder day-to-day functioning for those who live with it. OCD is not about germaphobia or perfectionism, nor is it a choice.
Obsessions are intrusive thoughts, images, or urges that create uncomfortable and distressing feelings.
Compulsions are behaviors that the person exhibits in order to eliminate or decrease those obsessive thoughts and feelings.
OCD is a disorder that can significantly impact ones’ quality of life and sense of well-being. OCD is one of those terms that get thrown around a lot in every day conversations. Language is important when it comes to mental health disorders, and a true diagnosis of OCD only occurs in about 2% of the US population. 1
Checking to make sure that you’ve turned off the stove 2 or 3 times is not OCD. Rearranging your bookshelf twice in one week is not OCD. Organizing your closets so that all of your shirts are facing the same direction is not OCD.
Using “OCD” as a way to describe these occasional bouts of perfectionism can be potentially damaging to those who experience real OCD. It minimizes the severity and disruptiveness of the disorder and can make those who live with it feel like OCD is being diminished, or laughed off.
OCD presents with symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, including school, work, social life, and relationships. 2
In order to receive a diagnosis of OCD these symptoms must be time-consuming (at least an hour a day), cause significant distress, and impair work or social functioning. 3
Obsessions are repetitive and persistent thoughts that cause distressing emotions, such as anxiety, anger, or disgust.
A person with OCD may understand cognitively that these obsessions are irrational and unreasonable, but OCD cannot be controlled or diminished through reasoning and logic. Most people try to ignore the obsessive thoughts, distract themselves with other activities, or ease them with compulsions.
People with OCD don’t want to have these thoughts and usually find them disturbing or disruptive. These obsessions are often accompanied with feelings of fear, disgust, or doubt. Knowing that these obsessions are unreasonable or illogical does not make them go away.
Compulsions are repetitive behaviors that the person with OCD uses in hopes of neutralizing their obsessions. Acting out these compulsions offer only temporary relief; they are a coping mechanism for relieving some of the anxiety that stems from the obsessive thoughts.
These behaviors are a reaction to obsessive thoughts, and take up a lot of time and energy. We’ve all double-checked our locks and ovens, but a person with OCD will spend so much time doing these things that it becomes nearly impossible to maintain a normal routine. It’s disruptive, potentially debilitating, and can lead to depression, and even suicidal thoughts.
Most people experience obsessive thoughts occasionally, and sometimes compulsions as well. Take the onset of Covid-19. We’ve all been washing our hands with more frequency than usual, wearing masks in public places, and have been extra careful about not touching our faces.
Does this mean we’ve all developed temporary OCD? Absolutely not. There is a rational reason for all that hand-washing, and it’s potentially beneficial to our health. For a person living with OCD, excessive hand-washing isn’t necessarily for health reasons, but an attempt to relieve anxiety as a result of obsessive thoughts that may have nothing to do with actual cleanliness or hygiene.
As the vaccine rolls out, we are collectively feeling a little less anxious, wearing our masks less often, and don’t feel panic every time we unwittingly scratch our noses. For the person with OCD, no amount of hand washing will truly relieve their symptoms of anxiety.
Experts are still studying the exact causes of OCD, but there are several working theories. Genetic, neurological, behavioral, and environmental factors are all thought to contribute to the onset of OCD.
Genetics may be a factor, since OCD tends to run in families. Imaging studies show that people with OCD do have characteristic differences in their brain activity. Genetics play a role in how the brain responds to certain neurotransmitters such as dopamine and serotonin, which may be a factor in causing the disorder.
Autoimmune-related causes may also play a part in OCD, since symptoms sometimes appear in children after certain infections such as strep throat, Lyme Disease, and the H1N1 flu virus.
This is sometimes referred to as PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome. With PANS, the symptoms will start suddenly, reach full intensity in 24-72 hours, then disappear, sometimes returning at a later date.
Behavioral causes of OCD may result from a period of intense stress, or a traumatic event. A car wreck for example, may lead to someone avoiding driving in cars, or performing certain rituals before getting into a car in order to reduce the perceived risk.
This avoidance, or ritualization of getting into a car may evolve to include other characteristics of OCD. This is likely more common in people who already have a genetic predisposition towards OCD.
Cognitive causes may be an issue when people misinterpret their own thoughts. We all have annoying or intrusive thoughts once in a while, but for a person with OCD these thoughts aren’t fleeting, and they become extreme.
Taking care of a baby for example; you may experience an unwelcome thought or two of accidentally hurting the baby, but a person with OCD will put heavy significance on those thoughts, and then take excessive, continual, unwarranted actions in order to prevent this threat of danger.
Environmental causes may trigger OCD, such as complication during childbirth, serious illness, a traumatic brain injury, or a severe conflict with a colleague or family member.
Stressful life events can trigger OCD in people with a predisposition towards OCD, genetic or otherwise. OCD may also develop alongside post-traumatic stress disorder, or PTSD.1
Like many other mental and psychological illnesses, OCD is complicated and presents in different people for different reasons. There’s no exact science as to whether or not a person will develop OCD in their lifetime. In general, people are diagnosed by age 19, but some are diagnosed much earlier or much later.
OCD is an anxiety disorder, and people who live with it are constantly haunted by fear. Fear of death, fear of illness, fear of fire, fear of people, fear of not being good enough, smart enough, capable enough. These fears become obsessions because they’re relentless. They can’t be brushed off. Awareness of the fact that the obsessions are irrational doesn’t make them less scary, and it doesn’t make them go away.
When you hear “OCD” you may picture someone repeatedly washing their hands, or switching a light on and off dozens of times. This may be the case for some people, but really, these are stereotypical assumptions we make about what OCD looks like.
Many people with OCD only struggle internally. This can make it very difficult to seek out help or treatment, because all of the symptoms are hidden. There can be shame and embarrassment in admitting to having thoughts and fears you know don’t make any logical sense.
We all occasionally have intrusive thoughts about something that causes fear, such as being in a plane crash. Most of us can talk ourselves out of that fear well enough to get on the plane and get to where we need to go. We may even laugh about it later.
For people with OCD, trying not to think about the plane crash is next to impossible. The more they try not to think about it, the more they feel “stuck” thinking about it.
This becomes distressing, and that’s where the compulsions come in. Sometimes the compulsions are an attempt to stop the thoughts, and sometimes it’s about preventing the feared event from occurring.
“The plane might crash” becomes an obsession – a person with OCD can’t simply dismiss the idea and move onto something else. It becomes unbearable, so they decide “If I walk up and down the stairs 18 times the plane won’t crash”. This is irrational, but that’s the nature of the disorder. This is how the cycle goes.
OCD takes up a lot of time and energy. It is disruptive to daily life, and can be extremely isolating and frustrating. Knowing that the fears are unlikely to come true doesn’t help. Knowing that the compulsions aren’t likely to change the course of anything doesn’t help.
Many of us experience occasional obsessive thoughts and compulsions, but it may be time to reach out for help if your symptoms of OCD:
Treatment for OCD varies person to person. Certain treatment modalities work well for people with compulsions, but not as well for people whose symptoms are strictly internal. Some people take medication in tandem with therapy, while others focus on therapy and behavioral approaches.
Cognitive-behavioral therapy (CBT) is about training your brain to react differently to thoughts, feelings, and situations that cause distress. CBT is a means of coming to understand that there are “glitches” in your brain, recognizing the glitches when they occur, and finding new ways to solve problems and overcome anxiety.
CBT teaches you strategies to do this, such as deep-breathing, journaling, and self-talk. There are 2 types of CBT that are effective at treating OCD; Exposure and Ritual Prevention (ERP) and Acceptance and Commitment Therapy (ACT).
ERP consists of taking inventory of your obsessions and compulsions and purposely replacing them with different thoughts and behaviors. You begin with the least troubling ones, and work your way up to the more problematic ones.
For example, if you’re obsessed with straightening your collar before walking out your front door, the therapist will work with you on making it all the way to your car before checking your collar. Once that has been mastered, your goal would be to make it down the street. As time goes on, this exposure and delayed response will help you to react differently to your obsessions, and your anxiety and need to check your collar (or whatever the compulsion may be) will lessen.
ACT works with the premise that our thoughts aren’t necessarily problematic; our interpretation of those thoughts are. When we focus on trying not to think about something troubling (especially with OCD), our brain gets even more entangled with the thing we’re trying not to think about.
With ACT you don’t try to change or fight your thoughts, but instead focus on how you respond and react to them, and how those responses affect your behavior.
ACT is about mindfulness; learning to accept your thoughts and feelings rather than hiding from them. It teaches you that your thoughts and feelings aren’t “bad” or troublesome, but rather just a part of who you are. And situations aren’t “bad” or troublesome either, but just a part of life.
Antidepressants are usually the first medication specialists try for treating OCD, specifically SSRIs (selective serotonin reuptake inhibitors).
Medications work differently for everyone, so it’s really important to take them as prescribed and keep your doctor informed of any side effects. It’s also important to take the medication for at least 3 months in order to see if they will work.
Many people stop taking their medication because of undesirable side effects, so stay in touch with your doctor, and don’t give up if the first or second medication doesn’t work as you’d hoped. Everyone’s brain chemistry is a little bit different, and it often takes a few tries to find the correct medication and dosage.
Medication alongside therapy is often the most effective treatment for OCD. If you are living with OCD, or think you may have undiagnosed OCD, contact your doctor or therapist as soon as possible. OCD can be managed, and life doesn’t need to remain so difficult. With the proper tools and support, you can begin to live a brighter and freer life.
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Jamie Mantel is a Licensed Marriage and Family Therapist, with a Psy.D. in psychology. Jamie has worked for non-profits for over 20 years working with agencies, as well as her private practice in Huntington Beach, California.
