Obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears known as obsessions. These obsessions lead you to do repetitive behaviors, also called compulsions. These obsessions and compulsions get in the way of daily activities and cause a lot of distress.

Ultimately, you feel driven to do compulsive acts to ease your stress. Even if you try to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads you to act based on ritual. This is the vicious cycle of OCD.

OCD often centers around certain themes, such as being overly fearful of getting contaminated by germs. To ease contamination fears, you may wash your hands over and over again until they're sore and chapped.

If you have OCD, you may be ashamed, embarrassed and frustrated about the condition. But treatment can be effective.

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not know that your obsessions and compulsions are beyond reason. But they take up a great deal of time, reduce your quality of life, and get in the way of your daily routines and responsibilities.

Obsession symptoms

OCD obsessions are lasting and unwanted thoughts that keeping coming back or urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by acting based on ritual. These obsessions usually intrude when you're trying to think of or do other things.

Obsessions often have themes, such as:

• Fear of contamination or dirt.
• Doubting and having a hard time dealing with uncertainty.
• Needing things to be orderly and balanced.
• Aggressive or horrific thoughts about losing control and harming yourself or others.
• Unwanted thoughts, including aggression, or sexual or religious subjects.

Examples of obsession symptoms include:

• Fear of being contaminated by touching objects others have touched.
• Doubts that you've locked the door or turned off the stove.
• Intense stress when objects aren't orderly or facing a certain way.
• Images of driving your car into a crowd of people.
• Thoughts about shouting obscenities or not acting the right way in public.
• Unpleasant sexual images.
• Staying away from situations that can cause obsessions, such as shaking hands.

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to do. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. But taking part in the compulsions brings no pleasure and may offer only limited relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are beyond reason and often don't relate to the issue they're intended to fix.

As with obsessions, compulsions usually have themes, such as:

• Washing and cleaning.
• Checking.
• Counting.
• Ordering.
• Following a strict routine.
• Demanding reassurance.

Examples of compulsion symptoms include:

• Hand-washing until your skin becomes raw.
• Checking doors over and over again to make sure they're locked.
• Checking the stove over and over again to make sure it's off.
• Counting in certain patterns.
• Silently repeating a prayer, word or phrase.
• Trying to replace a bad thought with a good thought.
• Arranging your canned goods to face the same way.

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin over time and tend to vary in how serious they are throughout life. The types of obsessions and compulsions you have also can change over time. Symptoms generally get worse when you are under greater stress, including times of transition and change. OCD, usually thought to be a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

When to see a doctor

There's a difference between being a perfectionist — someone who needs flawless results or performance — and having OCD. OCD thoughts aren't simply excessive worries about real issues in your life or liking to have things clean or arranged in a specific way.

If your obsessions and compulsions affect your quality of life, see your doctor or mental health professional.

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

• Biology. OCD may be due to changes in your body's natural chemistry or brain functions.
• Genetics. OCD may have a genetic component, but specific genes have yet to be found.
• Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or learning them over time.

Factors that may raise the risk of causing obsessive-compulsive disorder include:

• Family history. Having parents or other family members with the disorder can raise your risk of getting OCD.
• Stressful life events. If you've gone through traumatic or stressful events, your risk may increase. This reaction may cause the intrusive thoughts, rituals and emotional distress seen in OCD.
• Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Issues due to obsessive-compulsive disorder include:

• Excessive time spent taking part in ritualistic behaviors.
• Health issues, such as contact dermatitis from frequent hand-washing.
• Having a hard time going to work or school or taking part in social activities.
• Troubled relationships.
• Poor quality of life.
• Thoughts about suicide and behavior related to suicide.

There's no sure way to prevent obsessive-compulsive disorder. However, getting treated as soon as possible may help keep OCD from getting worse and disrupting activities and your daily routine.

Steps to help diagnose obsessive-compulsive disorder may include:

• Psychological evaluation. This includes talking about your thoughts, feelings, symptoms and behavior patterns to find out if you have obsessions or compulsive behaviors that get in the way of your quality of life. With your permission, this may include talking to your family or friends.
• Physical exam. This may be done to rule out other issues that could cause your symptoms and check for any related complications.

Diagnostic challenges

It's sometimes hard to diagnose OCD because symptoms can be like those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it's possible to have OCD and another mental health disorder. Work with your doctor so that you can get the right diagnosis and treatment.

Obsessive-compulsive disorder treatment may not result in a cure. But it can help bring symptoms under control so that they don't rule your daily life. Depending on how serious your OCD is, you may need long-term, ongoing or more-intensive treatment.

The two main treatments for OCD are psychotherapy and medicines. Psychotherapy also is known as talk therapy. Often, a mix of both treatments is most effective.

Psychotherapy

Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a part of CBT therapy, involves exposing you over time to a feared object or obsession, such as dirt. Then you learn ways not to do your compulsive rituals. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions.

Medicines

Certain psychiatric medicines can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first.

Antidepressants approved by the Food and Drug Administration (FDA) to treat OCD include:

• Fluoxetine (Prozac) for adults and children 7 years and older.
• Fluvoxamine (Luvox) for adults and children 8 years and older.
• Paroxetine (Paxil) for adults only.
• Sertraline (Zoloft) for adults and children 6 years and older.
• Clomipramine (Anafranil) for adults and children 10 years and older.

However, your doctor may prescribe other antidepressants and psychiatric medicines.

Medicines: What to consider

When talking with your doctor about medicines for OCD, consider:

• Medicine selection. In general, the goal is to effectively control symptoms at the lowest possible dose. OCD may sometimes require higher doses of medicines to be the most effective in controlling your symptoms. It's not unusual to try several drugs before finding one that works well. Your doctor might recommend more than one medicine to effectively manage your symptoms. It can take weeks to months to get better after starting a medicine for your symptoms.
• Side effects. All psychiatric medicines may have side effects. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric drugs. And let your doctor know if you have troubling side effects.
• Suicide risk. Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings. These are the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants. This is especially true in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur, contact your doctor or get emergency help at once. Keep in mind that antidepressants are more likely to lower suicide risk in the long run by making your mood better.
• Interactions with other substances. When taking an antidepressant, tell your doctor about any other prescription medicines available without a prescription, herbs or other supplements you take. Some antidepressants can make some other medicines less effective and cause dangerous reactions when combined with certain medicines or herbal supplements.
• Stopping antidepressants. Antidepressants aren't thought to be addictive, but sometimes physical dependence can occur. Stopping treatment suddenly or missing several doses can cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome. Don't stop taking your medicine without talking to your doctor, even if you're feeling better. You may have a relapse of OCD symptoms. Work with your doctor to lower your dose safely over time.

Talk to your doctor about the risks and benefits of using specific medicines.

Other treatment

Sometimes, psychotherapy and medicines can't control OCD symptoms. In cases that don't respond to treatment, other options may be offered:

• Intensive outpatient and residential treatment programs. Full treatment programs that stress ERP therapy principles may help people with OCD who struggle with being able to function because of how serious their symptoms are. These programs usually last several weeks.
• Deep brain stimulation (DBS). The FDA has approved DBS to treat OCD in adults ages 18 years and older who don't respond to traditional treatment. DBS involves implanting electrodes within certain areas of your brain. These electrodes produce electrical impulses that may help control impulses that aren't typical. DBS isn't widely available, and it is rarely used.
• Transcranial magnetic stimulation (TMS). The FDA has approved three TMS devices — BrainsWay, MagVenture and NeuroStar — to treat OCD in adults. These devices are used when traditional treatment hasn't been effective. TMS doesn't require surgery. It uses magnetic fields to stimulate nerve cells in the brain to make symptoms of OCD better. During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The coil delivers a magnetic pulse that stimulates nerve cells in your brain.

If you're thinking about DBS or TMS, talk with your doctor to make sure you understand all the pros and cons and possible health risks.

Obsessive-compulsive disorder is a chronic condition, which means that it may always be part of your life. While a professional should treat OCD, you can do some things to build on your treatment plan:

• Practice what you learn. Work with your mental health professional to pinpoint methods to help manage symptoms. Practice these methods regularly.
• Take your medicines as directed. Even if you're feeling well, don't skip your medicines. If you stop, OCD symptoms are likely to return.
• Pay attention to warning signs. You and your doctor may have pinpointed issues that can cause your OCD symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
• Check first before taking other medicines. Contact the doctor who's treating you for OCD before you take medicines prescribed by another doctor or before taking any medicines available without a prescription, vitamins, herbal remedies or other supplements. This will help reduce possible interactions.

Coping with obsessive-compulsive disorder can be challenging. Medicines can have unwanted side effects, and you may feel embarrassed or angry about having a condition that requires long-term treatment.

Here are some ways to help cope with OCD:

• Learn about OCD. Learning about your condition can help you stick to your treatment plan.
• Stay focused on your goals. Keep your recovery goals in mind, and remember that recovery from OCD is an ongoing process.
• Join a support group. Reaching out to others facing similar challenges can provide you with support and help you cope with challenges.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies and recreational activities. Exercise regularly, eat a healthy diet and get adequate sleep.
• Learn relaxation and stress management. In addition to professional treatment, stress management methods such as meditation, visualization, muscle relaxation, massage, deep breathing, yoga or tai chi may ease stress and anxiety.
• Stick with your regular activities. Try not to avoid meaningful activities. Go to work or school as you usually would. Spend time with family and friends. Don't let OCD get in the way of your life.

You may start by seeing your primary care team. Because obsessive-compulsive disorder often requires specialized care, you may need to see a mental health professional, such as a psychiatrist or psychologist.

What you can do

To prepare for your appointment, think about your needs and goals for treatment. Make a list of:

• Any symptoms you've noticed, including the types of obsessions and compulsions you've had and things that you may be staying away from or no longer doing because of your distress.
• Key personal information, including any major stresses, recent life changes and family members with similar symptoms.
• All medicines, vitamins, herbal remedies or other supplements, as well as the doses.
• Questions to ask your doctor or therapist.

Questions to ask might include:

• Do you think I have OCD?
• How do you treat OCD?
• How can treatment help me?
• Are there medicines that might help?
• Will exposure and response prevention therapy help?
• How long will treatment take?
• What can I do to help myself?
• Are there any brochures or other printed material that I can have?
• Can you recommend any websites?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you some questions, such as:

• Do certain thoughts go through your mind over and over despite trying to ignore them?
• Do you have to have things arranged in a certain way?
• Do you have to wash your hands, count things, or check things over and over?
• When did your symptoms start?
• Have symptoms been continuous or once in a while?
• What, if anything, seems to improve the symptoms?
• What, if anything, appears to make the symptoms worse?
• How do the symptoms affect your daily life? Do you stay away from anything because of your symptoms?
• In a typical day, how much time do you spend on obsessive thoughts and compulsive behaviors?
• Have any of your relatives had a mental health disorder?
• Have you had any trauma or major stress?

Your doctor or mental health professional will ask more questions based on your responses, symptoms and needs. Preparing for questions like these will help you make the most of your appointment time.