Do you have recurring thoughts about harming yourself or others? Are you constantly worrying about germs? If you have these thoughts, do you feel the need to “solve” them by engaging in behaviors like avoiding knives or using excessive amounts of hand sanitizer?
These symptoms are usually a sign of a mental health condition known as obsessive-compulsive disorder (OCD). Keep reading to learn more about what OCD is, its symptoms and causes, and how to find effective treatment.
What are the signs and symptoms of OCD?
OCD is a cycle of unwanted and distressing thoughts that trigger behaviors meant to relieve distress or protect you or others from danger. Think of OCD as an itch. The itch becomes too bothersome to ignore, so you start scratching it. But, scratching makes the itching worse, keeping the cycle of symptoms going.
In OCD terms, we call the itching an obsession and the scratching a compulsion. Here are some deeper insights into what these two terms mean.
Obsessions
Obsessions are intrusive thoughts, feelings, urges, images, and sensations that cause fear and anxiety—and sometimes disgust. Obsessions can center around specific themes, such as an extreme preoccupation with contamination or an intense need for perfection, symmetry, or things to be “just right.”
A few other examples of common obsessions include:
- Unwanted thoughts about violence or hurting yourself or others
- Doubts and fears surrounding relationships
- Recurring doubts about things that happened in the past
- Fears and doubts about your “true” sexuality
- Consistent worry about violating religious, moral, or ethical beliefs
- Fixations on bodily sensations or involuntary bodily functions
As distressing as your obsessions might be, it’s important to know that they don’t reflect your values or desires, says Patrick McGrath, PhD, Chief Clinical Officer at NOCD. In fact, OCD tends to attack the things you care about the most—such as your partner, family, or even pets.
For example, a loving mother might be overwhelmed with mental images of accidentally hurting her newborn, precisely because she cares about her baby more than anything in the world. Or, a devoted teacher could be consumed with fears about being sexually attracted to his students, because it’s the last thing he’d ever want to do.
Everyone experiences intrusive thoughts from time to time, but most people can move on quickly. If you have OCD, however, these thoughts feel meaningful and dangerous, which is what makes them feel so intolerable.
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Compulsions
In response to obsessions, people with OCD engage in compulsions—repetitive mental or physical acts meant to reduce anxiety or distress from intrusive thoughts, or to try to stop something bad from happening. The problem with doing compulsions is that they only bring temporary relief, so the obsessions eventually come back, and the cycle starts all over again.
Common OCD compulsions include:
- Excessive handwashing and cleaning
- Checking stoves, doors, locks, etc.
- Counting objects, steps, or other things in a certain way
- Avoiding certain places, people, or situations
- Excessive prayer
- Rumination or overthinking
- Thought suppression
- Replacing “bad” thoughts with “good” ones
Obsessions and compulsions are time-consuming and can significantly impact your quality of life. Aside from being exhausting, they can stand in the way of everything from daily responsibilities to career and relationship goals.
What are the different types of OCD?
Some people use subtypes or themes—which is how your symptoms present—to better understand and discuss the condition. These subtypes can help you find community with others who share the same fears and behaviors, and can help your therapist address your specific needs.
Common OCD subtypes
While it’s not an exhaustive list, here are the most common subtypes of OCD:
- Contamination OCD
- Existential OCD
- False memory and real event OCD
- Harm OCD
- “Just right” (perfectionism) OCD
- Magical thinking OCD
- Pure obsessional (pure O) OCD
- Relationship OCD
- Religious (scrupulosity) OCD
- Responsibility OCD
- Sensorimotor or somatic OCD
- Sexual orientation OCD
- Postpartum OCD
- Pedophilia OCD
If you can’t find a subtype on this list that matches your symptoms, that doesn’t mean you don’t have OCD. Everyone’s situation is unique and may not fit neatly into any specific theme. Plus, many people with OCD tend to have more than one subtype at once, and these subtypes can change over time.
You might notice that some subtypes feel more taboo than others. What’s important to remember here is that no matter what the content of your OCD is, no subtype is better or easier than another, says Tracie Ibrahim, LMFT, CST, Chief Compliance Officer at NOCD. At the end of the day, they all cause a lot of distress and can impact your ability to handle daily responsibilities.
What causes OCD?
OCD can develop during childhood or early adulthood. Typically, the condition starts in people aged 18 to 29. While the exact cause of OCD is unknown, OCD experts and researchers point to the following as potential factors:
- Genetics: Research shows that if you have a first-degree relative—such as your mother or brother—with OCD, you are at a higher risk of developing the condition yourself.
- Biology: Studies show that OCD is linked to increased activity in some regions of the brain. Also, an imbalance in some of the brain’s chemical messengers (aka neurotransmitters) may play a role.
- Stressful life events: While no research has tested how certain stressors affect people with OCD, self-reported studies reveal that 25 to 67% of people link significant life events to the start of their OCD. According to Ibrahim, stress, hormonal changes (e.g., menstruation, pregnancy, and menopause), and co-occurring conditions (such as anxiety and depression) can also make your OCD symptoms feel worse, so it can be helpful to keep an eye on these potential triggers.
How do you treat OCD?
If you have (or think you have) OCD, your best bet for getting your symptoms under control is a specialized form of cognitive behavioral therapy (CBT) known as exposure and response prevention (ERP) therapy.
You’ll work with an ERP therapist to break the cycle of obsessions and compulsions by learning how to address your fears head-on, while resisting the urge to do compulsions. In time, ERP teaches you to sit with discomfort and anxiety without resorting to compulsions.
While ERP and medications are the first-line treatments for OCD, there are situations where additional or alternative treatment is helpful for managing symptoms, such as acceptance and commitment therapy (ACT) and transcranial magnetic stimulation (TMS).
Does OCD ever go away?
There’s a common misconception that OCD will just disappear on its own over time, but that’s not the case. OCD is a chronic (or long-term) mental health condition that gets worse without treatment. However, the good news is that it can be very manageable with ERP. Over time, Ibrahim says the quality of your life can significantly improve.
Bottom line
If you believe you have OCD, it’s crucial to seek help from a therapist who specializes in OCD to get an assessment, diagnosis, and personalized treatment plan. It can be devastating to deal with OCD on a day-to-day basis, but there is help available.
