OCD: Recognizing and Treating Obsessive-Compulsive Disorder

The main symptoms of OCD are obsessions and compulsions. But these can vary greatly from person to person.

Obsessions

Some potential obsessions include:

• worry about germs
• fear of contamination, illness, or harm
• thoughts about hurting yourself or other people
• a fixation on having things around you placed in a certain way
• intrusive sexual or violent images
• magical thinking, or believing your thoughts have the power to harm other people
• persistent worries about religion or not living up to religious standards

If you have OCD, it's hard to ignore or push away these obsessive thoughts. Instead, you might compulsively carry out certain rituals or behaviors in an effort to reduce distress or prevent harm.

Compulsions

Compulsions can involve:

• praying or repeating certain phrases over and over
• counting to a certain number, sometimes a specific number of times
• collecting or hoarding items
• washing hands or body parts over and over
• cleaning rooms and items, sometimes multiple times or for several hours of the day
• checking locks, burners, electrical outlets more than once or twice, or in a specific pattern
• touching objects or certain parts of your body in a specific pattern
• organizing things in a symmetrical or specific way

If you're able to resist carrying out these compulsions, you might feel 'off' or anxious for the rest of the day.

A key factor in OCD is the time spent on compulsions. You may need to do them again and again until you get that 'just right' feeling. They might help you feel better for a little while, but they generally aren't something you enjoy doing.

Keep in mind that people with OCD are usually very aware that their compulsions aren't necessarily a logical response to their obsessions, which can just lead to more distress and frustration.

recognizing the signs

Everyone has obsessive thoughts or engages in compulsive behaviors from time to time. It's just part of being human.

But these thoughts and behaviors could be symptoms of OCD if:

• It takes longer to do daily tasks because of the time spent on compulsive rituals.
• You often need reassurance from others to help decrease worry or fear.
• You become extremely upset or worried about small deviations from usual behaviors or rituals.
• You can't stop performing rituals or behaviors, even if you realize they're excessive.
• You have trouble sleeping or eating as a result of obsessions, compulsions, or related distress.
• You begin to avoid anything that might trigger an obsessive thought or compulsion.

It's not unusual to want things a certain way. Needing to check that the stove is off or wanting to make sure a picture is perfectly aligned doesn't mean you have OCD.

And while it's common to hear people say things like, 'Oh, I'm just a little OCD,' that's not quite how it works. You either have OCD or you don't, thought some cases may be more severe than others.

Some of the confusion over what OCD truly is stems from the many forms in can take.

Here are some examples of how OCD might manifest in real life:

• Counting. You might believe something bad will happen to someone you love unless you count to 200 five times before going to bed each night.
• Intrusive thoughts. If you have intrusive sexual thoughts, you may believe these thoughts mean you're a bad person. You might have trouble thinking about anything other than the distress they cause. You might worry you'll act on these thoughts and end up avoiding other people.
• Disturbing urges. When holding scissors, you might have graphic, unwanted thoughts of using them to stab your roommate. This may trigger a compulsion to collect every pair of scissors you can find and throw them away, even if you know you would never actually stab someone.
• Symmetry. You might fear something bad will happen unless all of the objects in your room are symmetrical or face the same direction. You might spend hours organizing and aligning objects to make sure they're perfectly in place.
• Religious fear. As a result of worrying you've said or done something sinful or blasphemous to God, you might feel a compulsion to repeat a prayer a certain number of times.

Experts aren't entirely certain what causes OCD. Some research suggests it's partially related to biological factors, including brain chemistry and unusual function in some parts of the brain.

Genetic factors can also play a role, and having a first-degree relative with OCD can greatly increase your risk. However, researchers have yet to identify any specific genes that are responsible.

Experiencing abuse, trauma, or significant stress could also increase risk of developing OCD. So could having another anxiety disorder.

In children, OCD symptoms may begin or get worse in children who've recently had streptococcal infections.

OCD is typically diagnosed by a mental health professional. If you think you might have OCD, contact your healthcare provider for a referral to a specialist.

They'll likely start by asking questions about your symptoms and how much time you spend on compulsive behaviors or rituals each day.

Based on your answers, they may ask some additional questions to rule out other mental health issues, such as:

• generalized anxiety
• hoarding disorder
• skin-picking or hair-pulling disorders
• illness anxiety
• eating disorders
• schizophrenia

The two main treatment approaches for OCD are therapy and medication. A combination of the two is most effective for many people, but therapy alone is enough for others.

Keep in mind that you may need to try a few approaches or combinations before you find the treatment plan that works best for you.

Therapy

Cognitive behavioral therapy (CBT) is one of the most popular types of therapy for treating OCD.

It's an approach that helps you learn how to recognize negative or unwanted thoughts as you experience them and reframe them so they cause less distress.

A therapist might also recommend exposure and response prevention (ERP). In ERP, you'll slowly and safely expose yourself to potential situations or things that cause obsessive thoughts.

Doing this in the safe setting of a therapy session allows you to learn how to avoid responding with a compulsive action. The goal is to help you learn how to address obsessions without acting on compulsions.

Medication

Some people may find therapy helps them manage OCD symptoms. Others may want to combine therapy with medication. A psychiatrist can talk to you about your options if you want to try medication for OCD.

Antidepressants can help reduce OCD symptoms in children and adults. It may take a few tries before you find a drug that works best for your symptoms and has the fewest side effects.

If you notice unpleasant side effects, follow up with your healthcare provider. They can suggest alternatives or adjust your dosage. Just be sure you don't stop taking them abruptly.

For more severe cases of OCD that don't respond to antidepressants, antipsychotic medications may help.

Symptoms of OCD can overlap with those of other mental health conditions.

It's important to tell your therapist about all of your symptoms, even if they don't seem important or related to what you're experiencing. This can help them find the most accurate diagnosis, which can lead to better treatment results.

Several mental health issues may seem similar to OCD:

• Obsessive-compulsive personality disorder involves rigid patterns of perfectionistic behavior and a need for order and control. It can co-occur with OCD. But since it's a personality disorder, people with OCPD typically aren't distressed by their behavior.
• Illness anxiety causes continual worry about developing a serious illness. You might also believe you have one even after healthcare providers give you a clean bill of health. It's common to spend a lot of time checking yourself for symptoms or avoiding situations where you might get sick.
• Body dysmorphic disorder involves preoccupation with a specific part of your body. This feature may seem flawed or abnormal to you. You may spend a lot of time thinking about it and trying to conceal or change it.
• Schizophrenia often involves behaviors that seem obsessive or compulsive. The difference is that these behaviors usually occur in the context of a delusion. Recently, some experts have proposed schizo-obsessive disorder as a new diagnostic category that describes OCD symptoms that occur with schizophrenia but aren't related to delusions.
• Hoarding is marked by difficulty throwing out or give away unneeded items. Even getting rid of broken things or items you no longer need can cause distress. Hoarding behaviors can occur with OCD, but when they do, they're generally linked to compulsions. For example, collecting three of each item in a set could be a compulsion linked to preventing a feared event.

Living with OCD can be difficult, especially if you don't have any close friends or family who understand the condition.

But there are resources that can help:

• The International OCD Foundation can connect you with a local support group in your area or an online one. They also have a tool that allows you to search for mental health professionals in your area.
• The Anxiety and Depression Association of America offers support group listings and a therapist finder. They also have several resources aimed at helping parents and loved ones better understand OCD.