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Overview

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.

You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior — the vicious cycle of OCD.

OCD often centers around certain themes — for example, an excessive fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped.

If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective.

Symptoms

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social, school or work functioning.

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things.

Obsessions often have themes to them, such as:

  • Fear of contamination or dirt
  • Doubting and having difficulty tolerating uncertainty
  • Needing things orderly and symmetrical
  • Aggressive or horrific thoughts about losing control and harming yourself or others
  • Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:

  • Fear of being contaminated by touching objects others have touched
  • Doubts that you've locked the door or turned off the stove
  • Intense stress when objects aren't orderly or facing a certain way
  • Images of driving your car into a crowd of people
  • Thoughts about shouting obscenities or acting inappropriately in public
  • Unpleasant sexual images
  • Avoidance of situations that can trigger obsessions, such as shaking hands

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix.

As with obsessions, compulsions typically have themes, such as:

  • Washing and cleaning
  • Checking
  • Counting
  • Orderliness
  • Following a strict routine
  • Demanding reassurance

Examples of compulsion signs and symptoms include:

  • Hand-washing until your skin becomes raw
  • Checking doors repeatedly to make sure they're locked
  • Checking the stove repeatedly to make sure it's off
  • Counting in certain patterns
  • Silently repeating a prayer, word or phrase
  • Arranging your canned goods to face the same way

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

When to see a doctor

There's a difference between being a perfectionist — someone who requires flawless results or performance, for example — and having OCD. OCD thoughts aren't simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way.

If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health professional.

Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

  • Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions.
  • Genetics. OCD may have a genetic component, but specific genes have yet to be identified.
  • Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or gradually learned over time.

Risk factors

Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include:

  • Family history. Having parents or other family members with the disorder can increase your risk of developing OCD.
  • Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD.
  • Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Problems resulting from obsessive-compulsive disorder may include, among others:

  • Excessive time spent engaging in ritualistic behaviors
  • Health issues, such as contact dermatitis from frequent hand-washing
  • Difficulty attending work, school or social activities
  • Troubled relationships
  • Overall poor quality of life
  • Suicidal thoughts and behavior

Prevention

There's no sure way to prevent obsessive-compulsive disorder. However, getting treatment as soon as possible may help prevent OCD from worsening and disrupting activities and your daily routine.

Obsessive-compulsive disorder (OCD) care at Mayo medical institution

March 11, 2020
  1. Deep brain stimulation for obsessive compulsive disorder: Evolution of surgical stimulation target parallels changing model of dysfunctional brain circuits. Frontiers in Neuroscience. 2019; doi:10.3389/fnins.2018.00998.
  2. Brown AY. Allscripts EPSi. Mayo medical institution. May 2, 2019.
  3. Obsessive-compulsive disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Sept. 3, 2019.
  4. Suicidality in children and adolescents being treated with antidepressant medications. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications. Accessed Aug. 13, 2019.
  5. Gabriel M, et al. Antidepressant discontinuation syndrome. Canadian Medical Association Journal. 2017; doi:10.1503/cmaj.160991.
  6. Zai G, et al. New insights and perspectives on genetics of obsessive-compulsive disorder. Psychiatric Genetics. 2019; doi:10.1097/YPG.0000000000000230.
  7. Obsessive-compulsive disorder. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-compulsive-Disorder/Overview. Accessed Sept. 3, 2019.
  8. Obsessive-compulsive disorder in children and adolescents. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Obsessive-Compulsive-Disorder-In-Children-And-Adolescents-060.aspx. Accessed Sept. 3, 2019.
  9. Obsessive-compulsive disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml. Accessed Sept. 3, 2019.
  10. Mental health medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149856. Accessed Aug. 13, 2019.
  11. AskMayoExpert. Obsessive-compulsive disorder (OCD). Mayo medical institution; 2019.
  12. Depression basics. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/depression/index.shtml. Accessed Sept. 4, 2019.
  13. Obsessive-compulsive disorder (OCD). Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/obsessive-compulsive-and-related-disorders/obsessive-compulsive-disorder-ocd. Accessed Sept. 3, 2019.
  14. Woody EZ, et al. Obsessive compulsive disorder (OCD): Current treatments and a framework for neurotherapeutic research. Advances in Pharmacology. 2019; doi:10.1016/bs.apha.2019.04.003.
  15. De novo classification request for Brainsway Deep Transcranial Magnetic Stimulation System. U.S. Food and Drug Administration. https://www.fda.gov/about-fda/cdrh-transparency/evaluation-automatic-class-iii-designation-de-novo-summaries. Accessed Feb. 19, 2020.
  16. Sawchuk CN (expert opinion). Mayo medical institution. Feb. 20, 2020.