What is OCD?

The definition of OCD, obsessive-compulsive disorder, is a mental health condition that causes a person to have persistent, negative, obsessive thoughts, to engage in repetitive, ritualized, compulsive behaviors, and in most cases to have both obsessions and to engage in the behaviors. OCD is a serious mental illness because it is difficult or impossible to control, causes a lot of distress and anxiety, and causes significant impairment in a person’s life. OCD is not uncommon, affecting more than two percent of the population in any given year.

Although this condition can be devastating and cause a lot of dysfunction, it can also be treated and managed. Behavioral therapies, particularly a subtype of behavioral therapy that involves facing one’s fears and obsessive thoughts, can really help individuals learn to manage and control their thoughts and to restrict their compulsive behaviors.

OCD is a mental illness. It was previously categorized as an anxiety disorder, but now is grouped with other related conditions, like hoarding disorder and body dysmorphic disorder. OCD and the similar conditions are characterized by persistent thoughts that are not logical or true, but that a person cannot control and cause a lot of distress. OCD causes two major categories of symptoms:

• Obsessions. One of the characteristics of having OCD is experiencing obsessive thoughts. These may be about anything but are always negative and troubling. They cause anxiety, fear, and distress. They are difficult or impossible to control and persist despite efforts to think about something else. Examples of common obsessive thoughts include being contaminated by germs or chemicals or fearing that a loved one will be hurt.
• Compulsions. Someone with OCD also typically has compulsions, which are repetitive behaviors that are difficult not to do. The purpose of the behaviors is to twofold: to reduce the anxiety caused by obsessive thoughts and to prevent something bad from happening that is the subject of the obsessive thoughts. These behaviors are often ritualized, like turning a light switch on and off a specific number of times before bed, and they may provide temporary relief, but then the anxiety returns.

Mental health professionals diagnose OCD by using the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders. The symptoms of OCD may be easy to recognize, but no one can be certain they have the condition unless they have been screened and diagnosed by a psychiatrist or other type of mental health professional. A screening may include a medical evaluation, observations, and questionnaires or interviews.

The first requirement for being diagnosed with OCD is having obsessions, compulsions, or both. They must be persistent, troubling, and cause distress. A person who genuinely has OCD may try to control the thoughts and the behaviors, but struggles to do so or finds it impossible to turn the thoughts off or stop performing the behaviors.

Additionally, and individual must experience significant impairment in their lives because of the OCD symptoms. This may include an inability to leave the house for fear of germs or spending so much time on compulsions that getting anything else done is impossible. To be diagnosed, the symptoms must cause impairment and distress, and take up a lot of time. The symptoms cannot be explained by substance abuse, another mental illness, or a medical condition.

The content of the thoughts and the compulsions that are caused by OCD can literally be anything. However, there are some common themes that present more often in people with OCD. What they all have in common is that the thoughts are negative and unwanted. The behaviors that follow each type of obsessive thoughts may also follow a common thread or may be completely different and unrelated to the content of the obsessions.

• Aggression and harm. A common type of OCD obsession is the fear of harming others, violent imagery, or fear that harm will come to loved ones. These thoughts may have sexual elements. They tend to trigger compulsions related to getting reassurance of being a good person, or repetitive behaviors to prevent harm.
• Germs and contamination. Fear of germs or contamination by other substances is also common. The typical behaviors that follow these obsessions are related to staying clean, like excessive handwashing.
• Doubt and incompletion. This type is characterized by obsessive worries that something has not been done, like not locking the door when leaving the house, and that it could lead to harm. Common compulsions that follow are repeatedly checking things, like the locked door.
• Superstitions. Some people obsess over superstitions, like unlucky numbers, and engage in repetitive behaviors to compensate. Counting words is one example.
• Symmetry and order. People with OCD who are obsessed with order may spend a lot of time rearranging and ordering objects.
• Religion and morals. OCD may cause some people to obsess over being immoral or sinning. They tend to pray compulsively and excessively.
• Self-control. A fear of doing something embarrassing or disruptive in public is related to a fear of losing control over oneself. This type of obsession may cause any number of compulsions, but it also tends to cause a person to become socially isolated.

The term OCD is often used casually, to describe someone who is obsessing over something or who is a perfectionist or likes to have their desk neat and tidy. Most people who are referred to in this way don’t actually have OCD and using the term so lightly can be damaging to those who really do struggle with this very serious condition. OCD is not a personality quirk or trait, and person cannot be “a little bit OCD” sometimes.

It is true, though, that people may have some of the signs of OCD without meeting all the criteria for being diagnosed. Most people have at some point been troubled by obsessive thoughts and have used repetitive or ritualized behaviors. The difference between this and actual OCD is that the latter can be debilitating, making normal functioning difficult or even impossible. Someone with OCD cannot turn off the bad thoughts or use distractions to shove them to the background. They cannot stop using the repetitive behaviors, even if they realize it is not logical.

The origins of OCD run deep in the brain. While as with most mental illnesses it is impossible to pin down a single cause of OCD, researchers have found that there are significant differences in several parts of the brain in people with OCD as compared to those who do not have the condition. Antidepressants that increase serotonin levels in the brain help most people with OCD, which suggests that there is a deficiency that plays a role in the disease.

Other changes in the brain are structural. Imaging studies have found that there are three main areas in the brain that show more activity in people with OCD. These regions are associated with things like the ability to filter thoughts, to manage social behaviors, to manage habits, and to regulate thoughts that are troubling.

When treated as a chronic condition, OCD can be treated and successfully managed. While antidepressants can help, the foundation for treatment is behavioral therapy, specifically exposure and response prevention therapy. This kind of therapy can be stressful initially, but it works for most people who stick with it. The treatment involves exposing a person to what scares them or forcing them to face their troubling, obsessive thoughts.

This exposure helps a patient to face fears and learn strategies for managing those fears and for resisting the urge to give into compulsive behaviors. It takes time for this therapy to work, and when combined with other treatments in a residential setting, even someone with severe symptoms can learn to manage them and live a normal life again.

OCD is a real and a serious mental illness. It is nothing to take lightly, but it is still important to remember that anyone might have some difficulties with obsessive thoughts or display occasional repetitive behaviors without having the condition. This is why it is so important to seek a professional evaluation for any troubling symptoms. A diagnosis can lead to treatment and management of symptoms.