Obsessive compulsive disorder (OCD)
Obsessive compulsive disorder (OCD) is characterized by obsessions and compulsions with the urge to repeat them over and over.

OCD is a common disorder that affects adults, adolescents, and children all over the world. Most people are diagnosed at about age 19, with boys typically experiencing earlier onset than girls.

The causes of OCD are unknown.

Signs and symptoms

People with OCD may have obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include these:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, or harm
  • Aggressive thoughts toward others or self
  • Needing symmetry or a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include these:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a precise way
  • Repeatedly checking on things, such as whether the door is locked or the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. Generally, OCD differs from ordinary habits in these ways:

  • Lack of control over thoughts or behaviors, even when they are recognized as excessive
  • Spending at least one hour a day on the thoughts or behaviors
  • Lack of pleasure in the behaviors or rituals, but their performance may bring temporary relief from anxiety
  • Significant problems in daily life due to the thoughts or behaviors

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

Types

Harm OCD causes people to be deeply disturbed by the violent thoughts that just about everyone has experienced. While most people are able to shrug off these thoughts, those with harm OCD can become completely overwhelmed by them.

Obsessions
  • I could jump in front of the train right now.
  • I could stab my husband with this knife.
  • What if I drove into that person?
  • What if I killed my nephew and I just can’t remember?
Compulsions
  • Refusing to stand near train tracks
  • Keeping all knives hidden away somewhere
  • Repeatedly going back to check if you ran someone over
  • Calling your sibling to check if your nephew is safe and sound
Sexual orientation OCD involves obsessions about one’s sexuality. It’s often called homosexual OCD (or HOCD), but this is misleading. It can happen to people of any sexuality, about any other sexuality.

Obsessions
  • I was attracted to that guy back there. This means I’m gay.
  • Other people can detect that deep down I’m into women.
  • Was I really into her when we dated? Or am I more into guys?
Compulsions
  • Looking at pictures of women to see if you’re attracted to them
  • Asking people repeatedly if you seem straight to them
  • Avoiding people of the same sex altogether to avoid confusion
Pedophilia OCD is especially prone to stigma because of how strong people’s feelings are about pedophiles. However, as with all types of OCD, these obsessions are not desires. In fact, people are so distressed by these thoughts because they don’t reflect what they really want.

Obsessions
  • What if I have sexual thoughts about the kid I’m babysitting?
  • I just had a sexual thought when I was around my cousin’s kid; am I attracted to them?
  • What if I molested a kid and I just can’t remember?
Compulsions
  • Looking online for stories of real pedophiles so you can find evidence you’re not one
  • Staying away from kids altogether
  • Repeatedly beating yourself up in your head for these thoughts
Relationship OCD leaves people completely unable to tolerate the uncertainty of intimate relationships, giving them obsessions about the “rightness” of their own relationship and the countless other possibilities that daily life brings.

Obsessions
  • Is this the right person for me?
  • Couldn’t there be someone better out there?
  • Are we meant for one another?
  • What if we’re not meant to be but we still end up stuck together?
Compulsions
  • Taking relationship quizzes online
  • Looking up other people on social media to see if their relationships seem better
  • Remembering situations over and over: did we really have fun together on vacation that time?
“Just Right” OCD is a little different from these other subtypes, in that it’s difficult to identify a specific fear, or set of fears, underlying it. Instead, it’s usually more like a strong feeling that something just isn’t right when things aren’t a certain way. It’s often caricatured in TV shows, movies, and jokes.

Obsessions
  • Something is just not right with this.
  • I need to start this over to make it perfect.
  • This just doesn’t feel right.
Compulsions
  • Performing any action over and over, e.g. closing doors
  • Rearranging, reordering, organizing things repeatedly
  • Changing wording many times in emails or notes
Contamination OCD is probably the most stereotyped form of OCD. People with this subtype are afraid of getting sick, or infecting someone they care about, after coming in contact with serious bacteria.

Obsessions
  • Oh no, this time I’ve really gotten AIDS.
  • I just gave my sister’s baby a serious illness when I held him.
  • This whole place is full of bad bacteria, I can just tell.
Compulsions
  • Repeatedly washing hands, sanitizing things
  • Always cleaning different sources around the house
  • Avoiding being in public, doctor’s offices, being around kids
Pure-O, or Pure Obsessional OCD, is one of the murkier subtypes, and some experts say it doesn’t even exist. People with Pure-O have obsessions without visible compulsions, but since they still have compulsions they’re not exactly “purely obsessional.” Many people identify with Pure-O because they don’t have the more obvious compulsions listed. The obsessions can be about sex, sexuality, religion, harm, personal health, romance, etc.

Obsessions
  • What if I’m actually not a good person?
  • How do I know that life is even worth it?
  • What if I go over there and push that guy off this bridge?
  • If I don’t clean my mess up well enough someone will get slip and get seriously hurt because of me.
Compulsions
  • Making sure to spend time only with people who will tell you you’re a good person
  • Always thinking through the “meaning of life” question
  • Looking for signs in your mind that you would never push someone off a bridge
  • Trying repeatedly to remember a situation because you haven’t done it correctly if you’ve missed a detail

When to see a doctor

If you think you have OCD, talk to your healthcare provider about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Treatment

OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms. Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, in which they mistakenly believe a part of their body is abnormal. Consider these other disorders when making decisions about treatment.

Psychotherapy

Certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training), can be as effective as medication for many individuals. Exposure and response prevention (EX/RP) is a type of CBT. It involves putting the person in a triggering situation (e.g., touching dirty objects) but prevents him or her undertaking the related compulsion (e.g., handwashing). It is effective in reducing compulsive behaviors, even for people who do not respond well to medication.

Resources