Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder, also known as OCD, is a mental disorder that involves obsessive thoughts and compulsive acts.

What Is OCD?

Obsessive-compulsive disorder (OCD) is a disorder [mfn] NIMH. (2019, October). NIMH Obsessive-Compulsive Disorder. Www.nimh.nih.gov. Available from: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd [/mfn] wherein a person experiences uncontrollable thoughts (obsessions) and/or the urge to engage in repetitive behavior (compulsions).

OCD can affect multiple facets of your life, including your career, relationships and social life. It can occur in individuals of all ages and backgrounds and is also associated with various functional impairments.

People with obsessive-compulsive disorder are unable to control their thoughts and believe that not engaging in compulsions might lead to something dangerous happening. Hence, they feel compelled to give in to them in order to experience temporary relief.

Case Example

Ashish lost his beloved grandfather at the age of 15.

A year later, he developed the idea that if he always walked by putting his left foot forward first and took an even number of steps, his loved ones would be spared of any harm. Constantly worried about ending his steps in an odd number, Ashish would always walk slowly, counting every step.

If he ever put his right foot forward first by mistake, it would cause him a great deal of stress and discomfort; he would not be able to stop thinking about its probable consequences. As a result of this habit, he was often late to places and sometimes lost track of his surroundings.

Going out with Ashish had become quite the ordeal for his friends and family. They would try to explain to him that walking this way did not make sense but he refused to listen to them. Soon, his friends started distancing themselves from him as they thought he was ‘going crazy’.

Ashish’s concerned parents urged him to visit a psychiatrist. After a lot of reluctance, he finally complied and was prescribed treatment for obsessive-compulsive disorder.

OCD vs. OCPD

Although the two sound quite similar, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD [mfn] Diedrich, A., & Voderholzer, U. (2015). Obsessive-compulsive personality disorder: a current review. Current psychiatry reports, 17(2), 2. https://doi.org/10.1007/s11920-014-0547-8 [/mfn]) are distinct mental disorders.

While OCD involves intrusive and repetitive thoughts and compulsions that are distressing to the individual experiencing them, OCPD involves a need to be orderly and rigid in terms of certain personal rules which can affect people around the individual.

People with OCD suffer from anxiety due to their thoughts and engage in compulsions to relieve themselves from the same. They have insight into their condition and often want to get rid of their obsessions and habits.

On the contrary, people with OCPD are more comfortable with their habits and find that their orderliness and rigidity helps them function effectively without distress.

Symptoms of Obsessive-Compulsive Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, the main symptoms [mfn] Substance Abuse and Mental Health Services Administration. (2016, June). Table 3.13, DSM-IV to DSM-5 Obsessive-Compulsive Disorder Comparison. Nih.gov; Substance Abuse and Mental Health Services Administration (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t13/ [/mfn] of obsessive-compulsive disorder are:

1. Persisting, recurrent, distressing thoughts
2. The urge to suppress or neutralize intrusive thoughts
3. Repetitive physical or mental acts performed in response to the thoughts

It must be noted that the performance of these acts are in no way rationally related to the thoughts and are only perceived to counter them.

Obsessions vs. Compulsions

Obsessive thoughts are not just worries related to day-to-day life; they tend to be more exaggerated and catastrophic. A person with obsessive-compulsive disorder cannot control their obsessions and perceive them as intrusive.

Some examples of intrusive and recurring thoughts [mfn] National Institute of Mental Health. (2020). NIMH» Obsessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over. Www.nimh.nih.gov. Available from: https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over [/mfn] are:

• Fear of being contaminated
• Fear of misplacing things
• Fear of losing control
• Thoughts involving harm to oneself or others
• Other forbidden thoughts [mfn] Clark, D. A., & Radomsky, A. S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 265–268. https://doi.org/10.1016/j.jocrd.2014.02.001 [/mfn] related to sex (eg: incest), homicide, religion, etc.

A person with obsessive-compulsive disorder engages in compulsions to ‘counter’ these thoughts. Examples of compulsive behavior include:

• Excessive amount of cleaning
• Repeatedly washing hands
• Always taking a certain number of steps/ always counting steps
• Checking and rechecking things (eg: if the door is locked, the gas is turned off, etc.)
• Placing everything around them in a certain position, even if they may look absurd
• Engaging in other repetitive rituals that may not make sense to other people

OCD In Children

Obsessive-compulsive disorder can occur in children as young as 4 [mfn] Kulkarni, H., & Sudarshan, C. Y. (2015). Obsessive compulsive disorder in a 4-year-old child. Indian journal of psychological medicine, 37(2), 230–232. https://doi.org/10.4103/0253-7176.155647 [/mfn]. The symptoms are akin to the ones usually experienced by adults. However, OCD in children [mfn] Krebs, G., & Heyman, I. (2015). Obsessive-compulsive disorder in children and adolescents. Archives of disease in childhood, 100(5), 495–499. https://doi.org/10.1136/archdischild-2014-306934 [/mfn] may resemble symptoms of disorders such as autism, as the latter also involves repetitive, stereotypical movements. Differential diagnoses can also include ADHD or tic disorders.

• Read More About Autism
• Read More About ADHD
• Read More About Tic Disorders

An earlier onset of the condition is observed more in males than females [mfn] National Institute of Mental Health. (n.d.). NIMH» Obsessive-Compulsive Disorder (OCD). Www.nimh.nih.gov. Available from: https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd [/mfn].

Types Of OCD

Most symptoms of OCD can be categorized into the following five types:

1. Checking

People with this type of OCD are repeatedly plagued by thoughts of accidents and mishaps involving themselves or their loved ones and thus feel the need to keep rechecking on things such as door locks, switches, pipes, money and other valuables like phone, jewelery, documents etc.

2. Contamination

This is one of the most common types of OCD wherein individuals are constantly afraid of being contaminated by something and are therefore engaged in repeatedly washing themselves and cleaning other things.

A person may also feel “mentally contaminated” after having gone through a traumatic or embarrassing incident and may try to get rid of this ‘dirty’ feeling by bathing and showering excessively.

3. Indecisiveness

This type is usually related to perfectionism and fear of making wrong decisions. People with this OCD often take a long time to complete tasks and tend to plan every aspect of their lives to reduce uncertainty.

4. Hoarding

Although hoarding can be classified as a disorder in itself, it is also a subtype of obsessive-compulsive disorder. It involves collecting and storing a lot of unnecessary things and a feeling of distress or discomfort associated with disposing of them.

5. Ordering and Symmetry

People with this OCD constantly feel the need to place things (eg: cushions, furniture, stationery, etc.) in a certain way for them to be “just-right”. Not doing so can result in them feeling extremely agitated or anxious.

What Causes OCD?

OCD is a multifactorial disorder and researchers suggest several possible reasons for the development of this disorder.

Let’s take a look at some of the most common OCD risk factors:

1. Biological Factors

Several factors related to genetics and physiology have been indicated in the etiology of obsessive-complusive disorder.

Heredity

Genetic factors [mfn] Purty, A., Nestadt, G., Samuels, J. F., & Viswanath, B. (2019). Genetics of obsessive-compulsive disorder. Indian journal of psychiatry, 61(Suppl 1), S37–S42. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_518_18 [/mfn] play a prominent role in development of this condition. Studies show that you are 25% more likely [mfn] NAMI. (2020). Obsessive-compulsive Disorder | NAMI: National Alliance on Mental Illness. Nami.org. Available from: https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Obsessive-compulsive-Disorder [/mfn] to get affected if one of your immediate family members has OCD [mfn] Lenane, M. C., Swedo, S. E., Rapoport, J. L., Leonard, H., Sceery, W., & Guroff, J. J. (1992). Rates of Obsessive Compulsive Disorder in first degree relatives of patients with trichotillomania: a research note. Journal of child psychology and psychiatry, and allied disciplines, 33(5), 925–933. https://doi.org/10.1111/j.1469-7610.1992.tb01966.x [/mfn].

Brain structure & chemistry

Researchers [mfn] Huey, E. D., Zahn, R., Krueger, F., Moll, J., Kapogiannis, D., Wassermann, E. M., & Grafman, J. (2008). A psychological and neuroanatomical model of obsessive-compulsive disorder. The Journal of neuropsychiatry and clinical neurosciences, 20(4), 390–408. https://doi.org/10.1176/jnp.2008.20.4.390 [/mfn] have observed that the frontal cortex and subcortical structures of the brain are different in people with OCD. Chemical imbalances in the brain, especially glutamate and serotonin, can also be contributing factors in the development of this condition.

Traumatic brain injury

Studies [mfn] Grados, M. A., Vasa, R. A., Riddle, M. A., Slomine, B. S., Salorio, C., Christensen, J., & Gerring, J. (2008). New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury. Depression and anxiety, 25(5), 398–407. https://doi.org/10.1002/da.20398 [/mfn] have discovered that around 30% of children between 6-18 years of age developed obsessive-compulsive disorder symptoms within 12 months of a traumatic brain injury.

2. Psychological Factors

Different psychologists have come up with various theories related to the origin of this disorder.

Behavioral theory

According to behavioral theory [mfn] Turner C. M. (2006). Cognitive-behavioural theory and therapy for obsessive-compulsive disorder in children and adolescents: current status and future directions. Clinical psychology review, 26(7), 912–938. https://doi.org/10.1016/j.cpr.2005.10.004 [/mfn], people with OCD believe that engaging in certain behaviors actually “prevent” bad things from happening; this serves as a reinforcement for them to continue their maladaptive cycle of behavior.

Cognitive theory

The cognitive theory [mfn] Rachman S. (2002). A cognitive theory of compulsive checking. Behaviour research and therapy, 40(6), 625–639. https://doi.org/10.1016/s0005-7967(01)00028-6 [/mfn] states that people with obsessive-compulsive disorder tend to focus excessive importance to their intrusive negative thoughts [mfn] Rachman S. (1998). A cognitive theory of obsessions: elaborations. Behaviour research and therapy, 36(4), 385–401. https://doi.org/10.1016/s0005-7967(97)10041-9 [/mfn], perceiving them as a bigger threat than they are, resulting in a cycle of compulsive behavior and obsessive thoughts.

Psychodynamic theory

Psychodynamic theory suggests that OCD is a result of conflicting wishes, drives, and motives in the unconscious “psyche” of a person. Although the conscious mind tries to suppress inappropriate thoughts and desires, they may sometimes rise to the surface causing distress to the person and leading them to engage in compulsive acts.

3. Environmental Factors

Environmental stressors such as trauma exposure [mfn] Kroska, E. B., Miller, M. L., Roche, A. I., Kroska, S. K., & O’Hara, M. W. (2018). Effects of traumatic experiences on obsessive-compulsive and internalizing symptoms: The role of avoidance and mindfulness. Journal of affective disorders, 225, 326–336. https://doi.org/10.1016/j.jad.2017.08.039 [/mfn] in childhood may act as triggers for the development of OCD in some people.

Obsessive-compulsive disorder can also develop due to the influence of other mental conditions [mfn] Murphy, D. L., Timpano, K. R., Wheaton, M. G., Greenberg, B. D., & Miguel, E. C. (2010). Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts. Dialogues in clinical neuroscience, 12(2), 131–148. https://doi.org/10.31887/DCNS.2010.12.2/dmurphy [/mfn] like body dysmorphic disorder (BDD), tourette syndrome, tic disorders, etc.

OCD Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 [mfn] American Psychiatric Association. (2013). DSM-5. Psychiatry.org; American Psychiatric Association. Available from: https://www.psychiatry.org/psychiatrists/practice/dsm [/mfn]), to be diagnosed with obsessive-compulsive disorder, a person must experience obsessions and/or compulsions for at least one hour every day and it must cause significant distress and impairment in daily activities, such as work, study, chores, etc.

A mental health professional usually diagnoses someone with OCD after taking a detailed history of their symptoms, their premorbid life, and their family. They may also recommend some medical tests to ensure that the symptoms are not a result of some other illness or disorder.

Assessments such as the Yale-Brown Obsessive Compulsive Scale [mfn] Woody, S. R., Steketee, G., & Chambless, D. L. (1995). Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale. Behaviour research and therapy, 33(5), 597–605. https://doi.org/10.1016/0005-7967(94)00076-v [/mfn] (Y-BOCS) are commonly used to analyze common obsessions and compulsions and the severity of OCD symptoms.

Treatment For Obsessive-Compulsive Disorder

There are several options when it comes to treatment for an obsessive-compulsive disorder that can enable a person to lead a well-adjusted life. Early intervention is especially recommended for OCD. 60-70% of children [mfn] Kalra, S. K., & Swedo, S. E. (2009). Children with obsessive-compulsive disorder: are they just “little adults”?. The Journal of clinical investigation, 119(4), 737–746. https://doi.org/10.1172/JCI37563 [/mfn] with obsessive-compulsive disorder respond well to therapy and medication.

Let us take a look at some of the treatment options available for obsessive-compulsive disorder:

1. Psychotherapy

Below are the different therapy treatment for obsessive compulsive disorder:

Cognitive Behavioral Therapy

Research [mfn] O’Neill, J., & Feusner, J. D. (2015). Cognitive-behavioral therapy for obsessive-compulsive disorder: access to treatment, prediction of long-term outcome with neuroimaging. Psychology research and behavior management, 8, 211–223. https://doi.org/10.2147/PRBM.S75106 [/mfn] shows that cognitive behavioral therapy (CBT) is an effective treatment method for OCD and also increases the efficacy of medications.

Exposure and response prevention (ERP [mfn] Hezel, D. M., & Simpson, H. B. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian journal of psychiatry, 61(Suppl 1), S85–S92. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_516_18 [/mfn]), a specific CBT technique, is now considered to be the first-line of therapy for both OCD in adults and children suffering from OCD. ERP enables patients to learn to intentionally expose themselves to triggers without engaging in typical compulsive acts related to obsession.

Read More About CBT Here

Group therapy

Interacting with other people suffering from OCD can help you find support and motivation to cope with your condition. Cognitive-behavioral group therapy [mfn] Braga, D. T., Cordioli, A. V., Niederauer, K., & Manfro, G. G. (2005). Cognitive-behavioral group therapy for obsessive-compulsive disorder: a 1-year follow-up. Acta psychiatrica Scandinavica, 112(3), 180–186. https://doi.org/10.1111/j.1600-0447.2005.00559.x [/mfn] (CBGT) has been found to be an effective treatment for obsessive-compulsive disorder.

CBGT can be highly effective in decreasing the impact of exaggerated thoughts and ideas. It can also help to improve the quality of life for OCD patients in a short period of time [mfn] Volpato Cordioli, A., Heldt, E., Braga Bochi, D., Margis, R., Basso de Sousa, M., Fonseca Tonello, J., Gus Manfro, G., & Kapczinski, F. (2003). Cognitive-Behavioral Group Therapy in Obsessive-Compulsive Disorder: A Randomized Clinical Trial. Psychotherapy and Psychosomatics, 72(4), 211–216. https://doi.org/10.1159/000070785 [/mfn] .

Relaxation Techniques

A number of relaxation techniques like breathing exercises, yoga [mfn] Bhat, S., Varambally, S., Karmani, S., Govindaraj, R., & Gangadhar, B. N. (2016). Designing and validation of a yoga-based intervention for obsessive compulsive disorder. International review of psychiatry (Abingdon, England), 28(3), 327–333. https://doi.org/10.3109/09540261.2016.1170001 [/mfn], meditation, mindfulness practices, and even massage can help decrease symptoms of obsessive-compulsive disorder.

‘Kundalini yoga [mfn] Shannahoff-Khalsa, D. S., Ray, L. E., Levine, S., Gallen, C. C., Schwartz, B. J., & Sidorowich, J. J. (1999). Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder. CNS spectrums, 4(12), 34–47. https://doi.org/10.1017/s1092852900006805 [/mfn]’ has been proven to be especially effective in the management of OCD. Mindfulness-based cognitive therapy [mfn] Hertenstein, E., Rose, N., Voderholzer, U., Heidenreich, T., Nissen, C., Thiel, N., Herbst, N., & Külz, A. K. (2012). Mindfulness-based cognitive therapy in obsessive-compulsive disorder – a qualitative study on patients’ experiences. BMC psychiatry, 12, 185. https://doi.org/10.1186/1471-244X-12-185 [/mfn] has also been found to help patients effectively cope with their OCD.

2. Medication

Some common medicines used to treat symptoms of obsessive compulsive disorder are:

Antidepressants

Selective serotonin reuptake inhibitors [mfn] Pittenger, C., & Bloch, M. H. (2014). Pharmacological treatment of obsessive-compulsive disorder. The Psychiatric clinics of North America, 37(3), 375–391. https://doi.org/10.1016/j.psc.2014.05.006 [/mfn] (SSRIs) are the first line of treatment in pharmacotherapy for OCD and have proven to provide relief to about 70% of patients. SSRIs like fluvoxamine [mfn] Hollander, E. (1998). Treatment of obsessive-compulsive spectrum disorders with SSRIs. British Journal of Psychiatry, 173(S35), 7-12. doi:10.1192/S0007125000297845 [/mfn] are especially effective in treating this disorder. However, higher doses of SSRIs prescribed for longer periods of time are necessary for the treatment of obsessive-compulsive disorder.

Read More About Antidepressants Here

Antipsychotics

Antipsychotic medication [mfn] Thamby, A., & Jaisoorya, T. S. (2019). Antipsychotic augmentation in the treatment of obsessive-compulsive disorder. Indian journal of psychiatry, 61(Suppl 1), S51–S57. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_519_18 [/mfn], such as aripiprazole and risperidone can also be recommended by therapists if SSRIs fail to help improve the symptoms. A 2019 study [mfn] Thamby, A., & Jaisoorya, T. S. (2019). Antipsychotic augmentation in the treatment of obsessive-compulsive disorder. Indian journal of psychiatry, 61(Suppl 1), S51–S57. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_519_18 [/mfn] found that around 33% of SSRI-resistant patients respond positively to antipsychotics.

3. Neuromodulation

In rare instances, when psychotherapy and medication prove ineffective, neuromodulation [mfn] Lapidus, K. A., Stern, E. R., Berlin, H. A., & Goodman, W. K. (2014). Neuromodulation for obsessive-compulsive disorder. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 11(3), 485–495. https://doi.org/10.1007/s13311-014-0287-9 [/mfn] may be suggested to treat obsessive-compulsive disorder.

Some techniques [mfn] Bais, M., Figee, M., & Denys, D. (2014). Neuromodulation in obsessive-compulsive disorder. The Psychiatric clinics of North America, 37(3), 393–413. https://doi.org/10.1016/j.psc.2014.06.003 [/mfn] of neuromodulation include:

• Transcranial direct current stimulation (tDCS),
• Electroconvulsive therapy (ECT),
• Deep brain stimulation (DBS) and
• Transcranial magnetic stimulation (TMS [mfn] Shivakumar, V., Dinakaran, D., Narayanaswamy, J. C., & Venkatasubramanian, G. (2019). Noninvasive brain stimulation in obsessive-compulsive disorder. Indian journal of psychiatry, 61(Suppl 1), S66–S76. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_522_18 [/mfn])

Takeaway

OCD can lead to severe stress, depression and even suicidal tendencies, depending on the intensity of the condition and the individual.

If you find yourself experiencing obsessions and compulsions that are starting to affect your relationships and day-to-day functioning, you must seek help from a mental health professional. With effective treatment and support, your symptoms can improve, enabling you to eventually overcome the condition to live a healthier life.

At A Glance

1. OCD is a mental disorder that involves obsessive thoughts and compulsive acts.
2. OCD can occur in individuals of all ages and from different backgrounds.
3. Around 1.2% of Americans are affected by OCD.
4. OCD can lead to severe stress, anxiety, distress, depression and even suicidal tendencies, depending on the intensity of the condition and the individual.
5. OCD is generally managed with therapy, medication or a combination of both.

Frequently Asked Questions (FAQs)