What Is Obsessive-Compulsive Disorder? - Psychiatry.org

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel ... AsdescribedinthePrivacyPolicyoftheAmericanPsychiatricAssociation(APA),thiswebsiteutilizescookiesformultiplepurposesincludingtoprovideyouwithpersonalizedcontent,evaluateandanalyzetheuseofoursite,andtoidentifywhichadvertisementsbringuserstoAPA’swebsites.Byclosingthismessage,continuingthenavigation,orotherwisecontinuingtoviewtheAPA’swebsites&applications,youconfirmthatyouunderstandandacceptthetermsoftheAPA’sPrivacyPolicy,includingtheuseofcookies.ReadourfullPrivacyPolicyhere. Accept Skiptocontent Youarehere: PatientsandFamilies Obsessive-CompulsiveDisorder WhatIsObsessive-CompulsiveDisorder? Share Print SubNavigation Obsessive-CompulsiveDisorder TogglePageListing WhatIsObsessive-CompulsiveDisorder? ExpertQ&A:Obsessive-CompulsiveDisorder OnThisPage WhatIsObsessive-CompulsiveDisorder? Obsessive-compulsivedisorder(OCD)isadisorderinwhichpeoplehaverecurring,unwantedthoughts,ideasorsensations(obsessions)thatmakethemfeeldriventodosomethingrepetitively(compulsions).Therepetitivebehaviors,suchashandwashing,checkingonthingsorcleaning,cansignificantlyinterferewithaperson’sdailyactivitiesandsocialinteractions. ManypeoplewithoutOCDhavedistressingthoughtsorrepetitivebehaviors.However,thesethoughtsandbehaviorsdonottypicallydisruptdailylife.ForpeoplewithOCD,thoughtsarepersistent,andbehaviorsarerigid.Notperformingthebehaviorscommonlycausesgreatdistress.ManypeoplewithOCDknoworsuspecttheirobsessionsarenotrealistic;othersmaythinktheycouldbetrue(knownaslimitedinsight).Eveniftheyknowtheirobsessionsarenotrealistic,peoplewithOCDhavedifficultydisengagingfromtheobsessivethoughtsorstoppingthecompulsiveactions. AdiagnosisofOCDrequiresthepresenceofobsessionsand/orcompulsionsthataretime-consuming(morethanonehouraday),causesignificantdistress,andimpairworkorsocialfunctioning.OCDaffects2-3%ofpeopleintheUnitedStates,andamongadults,slightlymorewomenthanmenareaffected.OCDoftenbeginsinchildhood,adolescence,orearlyadulthood;theaverageagesymptomsappearis19yearsold. Obsessions Obsessionsarerecurrentandpersistentthoughts,impulses,orimagesthatcausedistressingemotionssuchasanxietyordisgust.ManypeoplewithOCDrecognizethatthethoughts,impulses,orimagesareaproductoftheirmindandareexcessiveorunreasonable.However,thedistresscausedbytheseintrusivethoughtscannotberesolvedbylogicorreasoning.MostpeoplewithOCDtrytoeasethedistressoftheobsessionswithcompulsions,ignoreorsuppresstheobsessions,ordistractthemselveswithotheractivities. Typicalobsessions: Fearofgettingcontaminatedbypeopleortheenvironment Disturbingsexualthoughtsorimages Fearofblurtingoutobscenitiesorinsults Extremeconcernwithorder,symmetry,orprecision Recurrentintrusivethoughtsofsounds,images,words,ornumbers Fearoflosingordiscardingsomethingimportant Compulsions Compulsionsarerepetitivebehaviorsormentalactsthatapersonfeelsdriventoperforminresponsetoanobsession.Thebehaviorstypicallypreventorreduceaperson'sdistressrelatedtoanobsession.Compulsionsmaybeexcessiveresponsesthataredirectlyrelatetoanobsession(suchasexcessivehandwashingduetothefearofcontamination)oractionsthatarecompletelyunrelatedtotheobsession.Inthemostseverecases,aconstantrepetitionofritualsmayfilltheday,makinganormalroutineimpossible. Typicalcompulsions: Excessiveorritualizedhandwashing,showering,brushingteeth,ortoileting Repeatedcleaningofhouseholdobjects Orderingorarrangingthingsinaparticularway Repeatedlycheckinglocks,switches,orappliances Constantlyseekingapprovalorreassurance Repeatedcountingtoacertainnumber Treatment PatientswithOCDwhoreceiveappropriatetreatmentcommonlyexperienceanincreasedimprovedqualityoflifeandimprovedfunctioning.Treatmentmayimproveanindividual'sabilitytofunctionatschoolandwork,developandenjoyrelationships,andpursueleisureactivities. CognitiveBehavioralTherapy Oneeffectivetreatmentisatypeofcognitive-behavioraltherapy(CBT)knownasexposureandresponseprevention.Duringtreatmentsessions,patientsareexposedtofearedsituationsorimagesthatfocusontheirobsessions,initiallyleadingtoincreasedanxiety.Patientsareinstructedtoavoidperformingtheirusualcompulsivebehaviors(knownasresponseprevention).Bystayinginafearedsituationwithoutanythingterriblehappening,patientslearnthattheirfearfulthoughtsarejustthoughtsratherthanreality.Peoplelearnthattheycancopewiththeirobsessionswithoutrelyingonritualisticbehaviors,andtheiranxietydecreasesovertime.Usingevidence-basedguidelines,therapistsandpatientstypicallycollaboratetodevelopanexposureplanthatgraduallymovesfromloweranxietysituationstohigheranxietysituations.Exposuresareperformedbothintreatmentsessionsandathome.SomepeoplewithOCD(especiallythosewithlimitedinsightintotheirillness)maynotagreetoparticipateinCBTbecauseoftheinitialanxietyitevokes. Medication Aclassofmedicationsknownasselectiveserotoninreuptakeinhibitors(SSRIs),typicallyusedtotreatdepression,canalsobeeffectiveinthetreatmentofOCD.TheSSRIdosageusedtotreatOCDiscommonlyhigherthanthatusedtotreatdepression.PatientswhodonotrespondtooneSSRImedicationsometimesrespondtoanother.Otherpsychiatricmedicationscanalsobeeffective.Noticeablebenefitusuallytakessixtotwelveweeks.PatientswithmildtomoderateOCDsymptomsaretypicallytreatedwitheitherCBTormedicationdependingonpatientpreference,thepatient’scognitiveabilitiesandlevelofinsight,thepresenceorabsenceofassociatedpsychiatricconditions,andtreatmentavailability.ItisrecommendedthatpatientswithsevereOCDsymptomsreceivebothCBTandmedication. CaregiverInterventions InpeoplewithOCDwholivewithfamilyorcaregivers,enlistingthesupportofcaregiverstohelpwithexposurepracticeathomeisrecommended. Self-care MaintainingahealthylifestylecanhelpincopingwithOCD.Also,usingbasicrelaxationtechniques,suchasmeditation,yoga,visualization,andmassage,canhelpeasethestressandanxietycausedbyOCD. Neurosurgicaltreatment(e.g.,deepbrainstimulation,anteriorcapsulotomy)inrefractorycases DeepbrainstimulationhasgainedpopularityintreatingpeoplewithsevereOCDthatisnotrespondingtoothertreatments.Somestudiesshowthatanteriorcapsulotomy,asurgicalprocedure,canalsobeeffectivebutitisunderusedduetohistoricalprejudiceratherthanlackofclinicaleffectiveness. RelatedConditions BodyDysmorphicDisorder HoardingDisorder Hair-PullingDisorder(Trichotillomania) Skin-PickingDisorder(Excoriation) PhysicianReviewBy: HectorColon-Rivera,M.D.,CMRO MollyHowland,M.D. December2020 Medicalleadershipformind,brainandbody. 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