Mental 

What is OCD? The Basics of Obsessive-Compulsive Disorder

October 10, 2020 7 min read

Person washing their hands at a sink with soap and water

Obsessive-compulsive disorder (OCD) is a mental disorder that affects nearly 2.2 million men and women in America. The condition occurs when a person becomes caught in a cycle of obsessions and compulsions. Those obsessions mostly revolve around unwanted or intrusive thoughts that consistently trigger intensely difficult feelings(1)

OCD isn’t a common disorder but it does affect some populations more than others, such as postpartum women and children. While researchers say experiencing occasional intrusive or disturbing thoughts is normal, OCD causes significant disruptions to a person’s everyday life(2).

What are OCD obsessions?

Obsessions include thoughts, images or impulses that occur continuously and feel that they’re happening outside of a person’s control. People with OCD do not want these thoughts and attempt to avoid them as they find them bothersome and irrational. These obsessions often create feelings of fear, doubt and disgust. The thoughts are usually time-consuming and prevent the person from completing daily activities in their professional and personal lives(1).

Common obsessions associated with OCD include: 

  • Contaminationor the fear of coming in contact with germs, diseases or bodily fluids. Contamination may also include environmental contaminants and household chemicals such as cleaning products.
  • Losing controlor the fear of exhibiting impulsive or violent behavior. This includes a fear of blurting out obscenities or insults or being potentially stealing from others.
  • Harmor fear of being responsible for something terrible happening, such as a fire or a burglary. This also includes a fear of harming others through lack of care.
  • Obsessions related to perfectionisminclude concerns about evenness or exactness of objects. This can also include the fear of forgetting important information or an inability to decide which items to keep or discard.
  • Unwanted sexual thoughtsor fear of experiencing forbidden or perverse sexual thoughts/impulses about others.
  • Religious obsessions (Scrupulosity)include concerns with offending a higher power. This can also include obsession with morality and continuous thoughts about what is right or wrong.
  • Other obsessionscould include concerns of getting physically ill or suffering an incurable disease and superstition about lucky and unlucky numbers or colors(1).

What are OCD compulsions? 

Compulsions are the behaviors or “rituals” a person engages in as an attempt to eliminate or limit the distress brought on by their obsessions. Those with OCD attempt to counteract obsessive thoughts with compulsive behaviors to neutralize or control the distressed feelings the thoughts create. This coping mechanism offers a temporary escape for those with OCD as they are typically unaware of a permanent solution to end their obsessive thoughts. Those with OCD also tend to avoid situations that trigger obsessions and therefore avoid compulsive behaviors(1).

Common compulsions associated with OCD include: 

  • Washing and cleaninghands or items excessively or in a specific way. This could also include excessive showering or extensive grooming routines as well as compulsive behavior around household cleaning or obsessions with preventing contamination. 
  • Checking that the person did not or will not harm themselves or others or that nothing terrible happened due to a mistake.
  • Repeating, rereading or rewriting behaviors, such as repeating routine activities or body movements. Some people perform tasks in numbers such as three times to symbolize “good,” “right,” “safe” or other reasonings.
  • Mental compulsionsor mentally reviewing events to prevent harm to self or others. This can include praying to prevent harm to self or others. Some people count when performing tasks or “cancelling” or “undoing” behavior such as replacing a “bad” world with a “good” word to neutralize the thought.
  • Other compulsionsinclude putting things or arranging things until it “feels right” or asking and confessing for reassurance from others(1).
  • Tics or sudden, repetitive movements such as eye blinking, body twitches or shoulder shrugging. These also include uncontrollable, vocal tics such as throat-clearing, sniffing or grunting noises(2).
Infographic detailing OCD obsessions versus compulsions

Not all obsessions and compulsions are OCD

As humans, many of us participate in obsessive or compulsive behavior at times. But some may wonder, “What is OCD behavior and what is normal behavior?”

Not all repetitive behaviors are compulsions. Bedtime routines, religious practices, arranging objects and other repetitive activities are usually functional and positive behaviors that add to daily life. Stocking shelves at a store as part of a job, while repetitive, is not an obsessive repetitive behavior(1).

One of the main symptoms of OCD is a lack of control. Those with OCD struggle to control their thoughts or behaviors even if they are aware that those thoughts and behaviors are considered excessive. Experts say that OCD symptoms can take up to one hour or more of a person’s day and offer temporary relief from anxiety even if the person does not enjoy performing the behaviors or rituals(2). People with OCD often feel driven to engage in a ritual or behavior even if they don’t want to as compulsions can often be time-consuming and stressful(1).

Studies show most people experience “intrusive thoughts” from time to time but they are not necessarily considered obsessive or compulsive. The difference between OCD and typical anxiety is that someone without OCD may have nervous thoughts or obsessions, be concerned momentarily and then move on from the thought. For example, a person without OCD could think about getting sick or wonder if they made a mistake, but move on from the thought after a few minutes. A person with OCD experiences these intrusive thoughts more frequently along with extreme anxiety that gets in the way of day-to-day functioning(2).

How is OCD diagnosed?

A person can be diagnosed with OCD when the cycle of obsessions and compulsions becomes so extreme that it disrupts a person’s daily life and prevents them from engaging in important activities(1).

OCD symptoms may come and go, get better, or worsen over time. People with OCD may try to cope by avoiding triggering situations or use alcohol or drugs to relieve intrusive thoughts. Most adults with OCD recognize their thought and behavior patterns; however, some adults and children don’t realize their behavior is unique. Although research shows the average onset of OCD is 19 years old, 25 percent of cases occur by age 14, which is why parents and teachers are usually the first ones to recognize OCD symptoms(2).

A mental health professional, such as a psychiatrist or psychologist, can perform a screening for OCD. Patients with the disorder may hint at intrusive thoughts or repetitive behaviors. They could also allude to avoiding particular locations or situations, seek repetitive reassurance and experience uncontrollable patterns of behaviors around organization or perfectionism(4).

Some of the questions a professional may ask are

  • Do you wash things or clean often?

  • Do you check certain things often?

  • Are there any thoughts that bother you that you can’t control?

  • How long does it take you to finish certain activities?

  • Are you concerned about things being in a specific order or do you get upset when there is a mess?

  • How often do you think about these things?

If a person experiences some or more of these symptoms and they cause significant distress, a psychiatrist should look into the symptoms further.

Patient talking to therapist at appointment

What causes OCD?

While there are no known causes of OCD, researchers have identified some risk factors that can contribute to its development.

Some studies show that a person can be more prone to OCD if their first-degree relative (such as a parent or sibling) developed OCD as a child. Other imaging studies show that there appear to be differences in the frontal cortex and subcortical structures of the brain in patients with OCD. This research is still underway and not many studies have been conducted to prove the connection(2).

Additional research has found a correlation between OCD symptoms and low serotonin or a dysfunction in the serotonin transporter function of the brain. Serotonin is a natural chemical in the brain that regulates mood, cognition, learning, memory and various other physiological processes. People with OCD have also shown elevated glutamine and gamma aminobutyric acid (GABA) levels. These natural brain chemicals can block certain communications between the body’s nerves and brain. Low levels of GABA are often linked to anxiety, depression and other mood disorders(3).

Other studies found vitamin imbalances in OCD patients. One study of 48 patients with OCD to 48 healthy controlled patients found that zinc, iron and magnesium levels decreased in patients with OCD, while manganese and calcium were increased(3). This supports the understanding that zinc, iron and magnesium supplements can help to support many functions in the body, including a healthy nervous system response and brain function.

Who is most likely to experience OCD?

Research shows that pregnant and postpartum women as well as children are more likely to be diagnosed with OCD. Women who are pregnant or are postpartum are 1.5 to 2 times more likely to experience OCD symptoms compared to the overall female population. Women who were diagnosed with OCD before pregnancy may experience worsened symptoms and are at a higher risk of developing postpartum depression(4).

Childhood OCD makes up 1-2 percent of the OCD population in the U.S. Some studies show that streptococcal infections, a bacteria commonly seen as strep throat, can cause future OCD symptoms in children. This type of condition is referred to as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS)(4).

Treatment and Therapies

OCD is typically treated and managed with medication, psychotherapy or a combination of the two. Although some patients get better with treatment, some continue to experience symptoms.

Medication usually consists of serotonin reuptake inhibitors (SRIs) which help boost serotonin in the body and potentially reduce OCD symptoms. Certain supplements are known to boost serotonin in the body as well. Tryptophan, probiotics, vitamin B12, magnesium, zinc and selenium have shown some improvement in OCD symptoms in ongoing research(3).* 

Psychotherapy also shows to be an effective treatment in OCD patients. Cognitive behavior therapy and other related therapies can help some patients as much as a medication. Some research shows that Exposure and Response Prevention therapy in which patients are placed in triggering situations and prevented from performing their typical ritual or compulsion, can be helpful for those who did not respond to medication(2).

Woman standing on the beach looking at the water

In Summary

OCD can significantly impact a person’s daily life. If you or someone you know is experiencing potential symptoms, a mental professional can evaluate the situation and provide supporting treatment if necessary. It’s also important to note that OCD is commonly misdiagnosed as another mental disorder such as attention deficit disorder (ADHD), anxiety, autism spectrum, depression or Tourette syndrome. In fact, 90 percent of OCD patients are diagnosed with another mental disorder in addition to OCD(4). A proper evaluation can help someone evaluate the condition and get you or a loved one feeling better, faster. 

Regina Kaza - Contributing Writer, Physician's Choice