What causes OCD? And is there a cure?

Obsessive-compulsive disorder (OCD) is a chronic disorder in which a person experiences unwanted and intrusive thoughts, images or urges (obsessions), then engages in repetitive behaviors or mental acts (compulsions) to attempt to get relief from the discomfort or prevent a perceived “bad outcome” from happening. Symptoms of OCD can cause significant distress and interfere with daily life, work, and relationships. But what causes OCD in the first place?

Today, most experts believe OCD to be caused by a combination of genetic, biological, and environmental factors.

What causes OCD? 

No single cause of OCD has been identified. Rather, research has found several factors that are more common or likely to occur in individuals who are diagnosed with OCD. Let’s answer some common questions about what leads to OCD.

Is OCD hereditary? 

Research suggests that a family history of OCD puts you at a greater risk for developing the condition. Some studies estimate that 10 to 20% of individuals diagnosed with OCD have a member in their immediate family with OCD.

What’s more, studies looking at OCD in twins showed that when one twin had OCD, it significantly upped the odds that the other one would develop the disorder. This was especially true among identical twins.

While genetics do seem to play a role, there’s no single gene that is responsible for OCD. 

Is OCD a result of brain differences?

In addition to one’s genetic makeup, some theories suggest that OCD may be related to differences in the brain. 

For instance, in some people with OCD, certain regions of the brain may be overactive or differently sized. “The prevailing opinion is obsessions tend to occur in that same area of the brain that houses our natural fight, flight, or freeze response for anxiety,” says Taylor Newendorp, the Network Clinical Training Director at NOCD.

Additionally, some evidence points to an imbalance between chemical messengers or neurotransmitters in certain brain regions, though research is still inconclusive.

While these biological factors may indeed play a role, experts caution against oversimplification. “We’ve learned that it’s much more complex than a simple chemical imbalance. Our brains are not like a stew, where if you don’t have 40% glutamate levels, then you’re going to have OCD,” says Dr. Jamie Feusner, MD, Chief Medical Officer at NOCD, 

Can trauma cause OCD?

That said, trauma may make someone more vulnerable or increase their chances of developing OCD. 

One study found that compared to control groups, individuals with OCD were much more likely to report a stressful life event in the six months prior to the onset of their OCD. One group of researchers found that among individuals with both PTSD and OCD, 59% experienced the traumatic event first. Another study found that those who reported exposure to traumatic events in childhood are five to nine times more likely to be diagnosed with OCD in adulthood than those without a trauma history.

Can infections cause OCD in children?

The link between a streptococcal infection, aka strep throat, and sudden onset OCD was first proposed by Dr. Susan Swedo and her colleagues at the National Institute of Mental Health. They observed that some children who had strep infections went on to develop OCD symptoms, seemingly out of the blue. This led to the recognition of PANDAS as a distinct clinical phenomenon—it stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, a rare but significant condition in children and adolescents.

Symptoms often manifest as obsessive thoughts, compulsive behaviors, and, in some cases, motor or vocal tics. (Research suggests that the antibody response to the infection, and not the infection itself, may be the culprit.)

Newendorp says it’s equally important to treat the underlying infection alongside incorporating Exposure and Response Prevention (ERP) therapy—the gold standard for OCD treatment—to manage OCD symptoms. Sometimes, the OCD will go away once the infection is cured. “But unfortunately, an equal number of people will report that once the OCD starts, it is chronic,” Newendorp says.

It’s also worth noting that while PANDAS is a recognized condition, there is ongoing debate and research within the medical community about its diagnosis and treatment. “Not all sudden onset OCD cases can be attributed to PANDAS, and other factors, such as stress, trauma, or genetic predisposition, may also play a role in somewhat rapid development of OCD,” says Dr. McGrath. 

Can substances cause OCD?

There’s no evidence that the use of drugs or other substances causes OCD. But it’s true that OCD and substance use disorders often co-occur. 

As Dr. McGrath notes, “Any stimulant could make OCD worse.” That said, “it’s most likely the other way around, where OCD will make substance abuse worse.” The idea here is that some substances may provide (temporary) relief from OCD symptoms, which may lead to them being abused over time. 

Substance use is a dangerous and ill-advised way to deal with OCD—and not a substitute for evidence-based treatment.

What makes OCD more severe?

OCD, like all mental health conditions, exists on a spectrum. The severity of OCD can vary significantly from person to person, and there are degrees to how significantly the symptoms of OCD affects a person’s daily life and functioning. Even on an individual level, the distress caused by obsessions and compulsions can look different each day. Many of the factors mentioned above—like stress, substance use, and other environmental triggers—can influence OCD severity.

Even if it feels like your symptoms have completely disappeared, it is critical to remember that OCD is a chronic disorder—and a flare-up can occur at any time. The good news is that there are steps you can take to get back on track and overcome an OCD episode when it rears its head.

How is OCD diagnosed?

OCD, according to the DSM-5, requires the following criteria to be diagnosed:

• Presence of obsessions and/or compulsions that
  • are time-consuming, meaning they either take up at least one hour per day or considerably interfere with a person’s normal routine
  • cause significant distress
  • Impairment in important areas of functioning”

You may also experience physical symptoms of stress and anxiety, which can include:

• A tight chest
• Gastrointestinal issues
• Jaw-clenching
• Dizziness
• Headaches 

Can OCD be cured?

Often, people think that “if I can just understand what caused my OCD, maybe I can reverse it or cure it.”

According to Dr. McGrath, there’s technically no cure for OCD, but it can 100% be managed. And there are plenty of effective methods for tackling your OCD and living a life largely without obsessions and compulsions.

As mentioned earlier, the gold-standard treatment is a type of therapy called ERP, or Exposure Response Prevention Therapy. And lifestyle habits can definitely make a difference, too. For instance, getting as much sleep as you can, exercising, and eating healthy will not only help you live longer, it’ll help manage your symptoms. 

Exposure and Response Prevention therapy, explained

Exposure and Response Prevention (ERP) is a behavioral therapy that was developed specifically to treat OCD, and is backed by decades of clinical research.

ERP works by carefully exposing people to situations that trigger their obsessions, then helping them resist the urge to engage in compulsions as a result. In time, this process teaches them to sit with the discomfort and anxiety that comes from obsessions, rather than resorting to compulsions that perpetuate the OCD cycle and make it worse over time.

For instance, a person with OCD may practice rituals when they leave their house, like compulsively checking the door to make sure that it is locked. A therapist may guide this person through a process in which they leave the house and while refraining from performing their checking routine. When they feel anxiety and the urge to check, they sit with those feelings and eventually learn to tolerate them.

ERP teaches you to handle fear and uncertainty (“what if I forgot to lock the door?” or “what if I did not check enough times?”). 

“OCD’s core message is that uncertainty is bad, and bad things will happen if you are uncertain,” explains McGrath. “Doubt is something that we live with on a daily basis. It doesn’t have to stifle us and stop us from living our lives. ERP’s role is to help prove that to you.”