Obsessions are intrusive thoughts that repeatedly surface. Often people with OCD will try to reduce the obsessions by acting out certain rituals (compulsions).
Everyone has bothersome worries now and again. Worries that consume a person are called obsessions. Obsessions are uninvited or intrusive thoughts, urges or images that surface in the mind over and over again. People with obsessive-compulsive disorder (OCD) usually know that their obsessions are creations of their own minds, but they can't control, ignore or get rid of them.
Often people with OCD will try to reduce or suppress their obsessions by acting out certain rituals. Many people have rituals or specific ways of doing things. For people with OCD, however, rituals may become "stuck" and last for hours. When taken to this extreme, rituals are called "compulsions."
When obsessions and compulsions get out of control, it is called obsessive-compulsive disorder.
OCD is an anxiety disorder that affects about one adult in 40. OCD exists throughout the world and affects men and women at an equal rate. OCD usually begins gradually. Approximately two thirds of people with OCD develop the disorder in adolescence or early adulthood.
Signs & Symptoms
The main symptoms of OCD are recurrent obsessions or compulsions that interfere with a person's life. The symptoms:
are time-consuming (e.g. take more than one hour per day) or
cause clinically significant distress or impairment in social, occupational or other important areas of functioning (American Psychiatric Association, pp. 235–237).
Common obsessions include:
fear of contamination (fear of dirt, germs, body fluids or diseases)
repeated doubting (e.g., whether the stove is turned off)
focus on exactness and order
preoccupation with religious images and thoughts or fear of having blasphemous thoughts
fear of harming oneself or others
fear of blurting out obscenities in public
forbidden or unwanted sexual thoughts, images or urges.
Common compulsions include excessive:
cleaning/washing (e.g., washing hands too often, cleaning household items or other objects)
checking (e.g., repeatedly checking paperwork for mistakes)
ordering/arranging (e.g., making sure objects are in a certain order)
hoarding (collecting seemingly useless items, such as paper, magazines, towels, bottles or pieces of garbage)
mental rituals, such as praying, counting or repeating words.
Causes & Risk Factors
OCD appears to be caused by a combination of psychological, biological and genetic factors.
One theory suggests that people with OCD associate certain objects or situations with fear, and that they learn to avoid the things they fear or to perform rituals that help reduce the fear. Another theory suggests that people with OCD misinterpret their thoughts to an extent that they are threatened and frightened by them.
Research into the biological causes and effects of OCD has revealed a link between OCD and certain brain chemicals, or neurotransmitters, such as serotonin, dopamine and glutamate. Serotonin plays a role in regulating mood, aggression, impulse control, sleep, appetite, body temperature and pain.
Researchers have also found that people with OCD appear to have more than usual activity in areas of the brain that are thought to be involved in controlling feelings and actions.
OCD seems to "run in the family." It is believed that genetic factors play an important role in the tendency to develop obsessions and compulsions. Research studies indicate that there is no one gene specifically linked to OCD. Rather, it appears that multiple combinations of different genes can contribute to the total risk of developing OCD.
Diagnosis & Treatment
People with OCD should get treatment that is specific to OCD from a fully qualified therapist. Some forms of traditional psychotherapy do not relieve symptoms of OCD.
Treatment for OCD ideally involves a combination of counselling (cognitive-behavioural therapy is the most common) and medication (usually antidepressant medication, sometimes anti-anxiety medication).
Group therapy (with people who have similar concerns) can also help.
While cognitive-behavioural therapy and medication usually help to reduce the symptoms of OCD, the process of recovery, like the onset of the illness, is gradual and ongoing. Continuing with treatment, even when symptoms have improved, can help maintain these gains and prevent relapse. People who are recovering from OCD may also benefit from individual, group or family therapy or a support group.