Obsessive-compulsive disorder (OCD) is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both. People with OCD have time-consuming symptoms that can cause significant distress or interfere with daily life. However, treatment is available to help people manage their symptoms and improve their quality of life.
People with OCD may have obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that are intrusive, unwanted, and make most people anxious. Common obsessions include:
Compulsions are repetitive behaviors a person feels the urge to do, often in response to an obsession. Common compulsions include:
Everyone rethinks or double-checks things sometimes. Not all repeated thoughts are obsessions, and not all rituals or habits are compulsions. However, people with OCD generally:
excessive.
from their anxiety.
Some people with OCD also have a tic disorder involving repetitive movements or sounds. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Vocal tics include things like repetitive throat-clearing, sniffing, or grunting sounds. It is common for people with OCD to also have a diagnosed mood disorder or anxiety disorder.
OCD symptoms may begin anytime but usually start between late childhood and young adulthood. Most people with OCD are diagnosed as young adults.
The symptoms of OCD may start slowly and can go away for a while or worsen as time passes. During times of stress, the symptoms often get worse. A person’s obsessions and compulsions also may change over time.
People with OCD might avoid situations that trigger their symptoms or use drugs or alcohol to cope. Many adults with OCD recognize that their compulsive behaviors do not make sense. However, children may not realize that their behavior is out of the ordinary and often fear that something terrible will happen if they do not perform certain compulsive rituals. Parents or teachers typically recognize OCD symptoms in children.
If you think you or your child may have OCD, talk to a health care provider. If left untreated, OCD symptoms can become severe and interfere with daily life.
Although the exact causes of OCD are unknown, various risk factors increase the chances of developing the disorder.
of the brain that impact the ability to control behavior and emotional responses. Researchers also have found that several brain areas, brain networks, and biological processes play a key role in obsessive thoughts, compulsive behavior, and associated fear and anxiety. Research is underway to better understand the connection between OCD symptoms and parts of the brain. This knowledge can help researchers develop and adapt treatments targeted to specific brain locations.
Children who suddenly develop OCD symptoms or experience a worsening of OCD symptoms after a streptococcal infection may be diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
Diagnosing OCD can be difficult because symptoms such as worry, anxiety, and low mood—which are often people’s most distressing concerns—can be similar to those of other mental illnesses. Also, people with OCD may not tell their health care provider about their obsessions and compulsions out of fear of judgment.
If you are experiencing symptoms, the first thing you should do is speak with a health care provider. They will examine you and ask about your health history to ensure other illnesses or conditions are not causing your symptoms. A health care provider may refer you to a mental health professional for further evaluation or treatment.
Treatment helps many people, even those with the most severe forms of OCD. Mental health professionals treat OCD with medications, psychotherapy, or a combination of treatments. A mental health professional can help you decide which treatment option is best for you and explain the benefits and risks of each.
Following your treatment plan is important because psychotherapy and medication can take some time to work. Although there is no cure for OCD, treatments help people manage their symptoms, engage in day-to-day activities, and lead full, active lives.
Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavioral therapy and other related therapies, can be as effective as medication for many people. For others, psychotherapy may be most effective when combined with medication.
Children with OCD may need additional help from family members and health care providers to recognize and manage their OCD symptoms. Mental health professionals can work with young children to identify strategies for managing stress and increasing support so they can control their OCD symptoms.
Health care providers may prescribe medication to help treat OCD. The most common medications prescribed for OCD are antidepressants that target
serotonin, a chemical transmitter in the brain involved in depression and OCD. The largest category of antidepressants is called selective serotonin reuptake inhibitors.
Antidepressant treatment can take 8–12 weeks before symptoms begin to improve, and treatment for OCD may require higher doses than are typically used to treat depression. For some people, these medications may cause side effects such as headaches, nausea, or difficulty sleeping. Most people with OCD find that medication, often in combination with psychotherapy, can help them manage their symptoms.
Your health care provider can adjust medication doses over time to minimize side effects or withdrawal symptoms. Do not stop taking your medication without first talking to your health care provider. They can work with you to monitor your health and adjust your treatment plan safely and effectively.
In 2018, the FDA approved using a deep form of repetitive transcranial magnetic stimulation (rTMS)—along with medication, psychotherapy, or a combination of both—to treat people with severe OCD who did not respond to other treatments. In 2022, this approval was extended to standard TMS devices.
Most commonly used to treat depression, rTMS is a noninvasive therapy that uses a magnet to deliver repeated low-intensity pulses to stimulate a particular part of the brain. Unlike most treatments, rTMS can target specific brain areas associated with OCD.
Deep brain stimulation (DBS) is a surgical procedure that uses electricity to directly stimulate sites in the brain. Health care providers may use DBS to treat people with severe OCD when other treatments have not worked. However, this therapy is considered experimental.
Although DBS has received FDA approval to treat certain neurological disorders
such as Parkinson’s disease, its effectiveness for treating mental disorders is still being actively researched. The FDA has approved using DBS to treat severe cases of OCD under a Humanitarian Device Exemption. This exemption allows the use of a medical device, such as DBS, for rare diseases or conditions that affect a relatively small number of people, making it challenging to gather enough evidence to
establish the device’s effectiveness.
You can do several things to manage the stress and anxiety associated with OCD.