Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.
Obsessive-compulsive disorder (OCD) is a mental health condition that involves experiencing recurring thoughts (obsessions) that may then lead to repetitive behaviors (compulsions). An estimated 2.3% of U.S. adults experience OCD at some point in their lives and the condition tends to be more common in women than in men.
These obsessions and compulsions can take up a great deal of time, interfere with a person's ability to function in their daily life, and create significant distress. While the exact causes are not known, genetic, biological, and stress-related factors may play a role. Effective treatments are available and include medications and psychotherapy techniques such as cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) therapy.
The exact causes of OCD are not completely understood, but a combination of factors likely play a role. Research suggests that increased activity in certain areas of the brain is linked to a higher risk for OCD. Environmental factors including sudden life changes, relationship troubles, abuse, illness, and stress may also contribute to the onset of the condition.
OCD is typically treated with medication and psychotherapy. Psychotherapy may focus on changing the underlying thoughts that contribute to the disorder (through cognitive behavioral therapy), or exposing people to things they fear in order to gradually reduce the response (through exposure and response prevention therapy).
Research suggests that genetics may cause people to have a predisposition to OCD, but that does not mean that there is an "OCD gene." Instead, certain groups of genes may increase vulnerability. While a person might have a genetic predisposition to OCD, it is the interaction of these genes and environmental variables that likely triggers the onset of the condition.
OCD shares similarities with some anxiety disorders, but there are important distinctions between the types of disorders. In the earlier version of the Diagnostic and Statistical Manual (DSM), OCD was classed with anxiety disorders. In the 2013 publication of the DSM-5, OCD was separated into its own unique category called "Obsessive-Compulsive and Related Disorders."
While the DSM-5 does not list specific subtypes, research suggests that OCD can present in a few different forms that are distinguished by the type of symptoms involved. Common types of OCD include those that are centered on hoarding, ordering/symmetry, contamination/cleaning, checking, and obsessive thoughts without compulsions.
A mental illness is a condition that affects thinking, emotion, and/or behavior. This creates significant distress and makes it difficult to function in work, school, family, and social activities. Mental illnesses are common and affect approximately 20% of adults in the U.S. Types of mental illnesses include anxiety disorders, depression, eating disorders, OCD, and personality disorders.
In OCD, obsessions are repeated, persistent, and troubling thoughts or images that create distress. These recurring thoughts may compel people to perform certain behaviors, known as compulsions, in order to relieve the anxiety caused by the obsessive thoughts. Some people with OCD experience obsessions on their own, while others experience both obsessions and compulsions.
A compulsion is a behavior or mental act that a person with OCD is driven to repeat. The compulsive behaviors are used to help reduce or manage feelings of anxiety or distress that are caused by obsessive thoughts. While these behaviors differ, some common compulsions often focus on cleaning/washing, checking, repetition, ordering, and thinking/saying specific words or phrases.
A psychological evaluation is a mental health assessment that a doctor or mental health professional performs to determine if a person has a mental disorder. It may involve an interview, questionnaires, psychological tests, a physical exam, and a health history. An evaluation can help doctors make a diagnosis and recommend a course of treatment.
CBT is an approach to treatment that involves identifying and changing the underlying thoughts that contribute to a behavior. Automatic underlying thoughts can often cause or worsen obsessions and compulsions. By learning to identify and then change these thoughts, people can better manage the symptoms of their condition.
ERP is a form of CBT in which people are gradually exposed to the source of their fear or anxiety under the supervision of a mental health professional. People are prevented from carrying out compulsive behaviors and instead learn to engage in other ways of reducing anxiety. Over time, people become habituated to the source of their anxiety so that it no longer triggers the problematic response.
Deep brain stimulation is a procedure used in some cases of treatment-resistant OCD (OCD that does not respond to medication and psychotherapy). DBS involves a neurosurgical treatment in which a device is implanted in the brain to deliver small electrical shocks to certain regions of the brain. Research suggests that targeting specific circuits in the brain may reduce symptoms of severe OCD.
This procedure places magnetic devices on the skull to deliver powerful pulses of magnetic energy to specific areas of the brain. Research suggests TMS may be beneficial for OCD that has not responded to medication or psychotherapy. While it is non-invasive and has few side effects, its effectiveness has not yet been clearly established so it should not be used in place of other treatments.
National Institute of Mental Health. Obsessive-compulsive disorder (OCD). November 2017.
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