Do you have recurring thoughts about harming yourself or others? Are you constantly worried 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). If your thoughts cause significant anxiety and distress, and the ways you respond to them are very time-consuming, it’s important to investigate what’s going on. Keep reading to learn more about what OCD is, its symptoms and causes, and how treatment can help you return to a life you deserve.
What are the signs and symptoms of OCD?
OCD is more common than you might think. In fact, an estimated 1 in 40 people will develop this condition over the course of their lifetime. However, it can be hard to get diagnosed and properly treated for OCD because the condition is widely misunderstood. Some people think OCD is only about germs, is a personality quirk, or is a superpower—but these are all common misconceptions.
So, what is the definition of OCD? In its simplest form, the condition 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.
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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:
- Fears and doubts about your “true” sexuality
- Consistent worry about violating religious, moral, or ethical beliefs
- Fixations on bodily sensations or involuntary bodily functions
- Unwanted thoughts about violence or hurting yourself or others
- Doubts and fears surrounding relationships, most often the intimate ones
- Recurring doubts about things that happened in the past
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.
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.
- Body-checking, such as weighing yourself, pinching your skin, taking your measurements, or looking for a groinal response
- Counting objects, steps, or other things in a certain way
- Ordering or arranging items in a particular way until they feel “just right”
- Repeating acts or behaviors (e.g., repeatedly walking back and forth through a doorway)
- Seeking reassurance from others
- Performing rituals, such as repeating certain words or phrases
- Hoarding possessions
- Avoiding certain places, people, or situations
- Excessive prayer
- Excessive confession
- Excessive research
- Mentally reviewing past events
- Counting in your head while performing tasks
- Mental reassurance (e.g., replaying an incident in your mind countless times to convince yourself you didn’t do anything wrong)
- Rumination or overthinking
- Mental checking
- Memory hoarding
- 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?
Even though OCD can present differently for different people, if you meet the criteria for the condition, you receive an OCD diagnosis. That being said, 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—which we’ll cover more later in this article.
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.
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
As you check out these subtypes, you might notice that some 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: Major life changes also could be a reason for developing OCD. 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, life changes, hormonal changes (e.g., menstruation, pregnancy, postpartum, and menopause), and co-occurring conditions (such as anxiety and depression) can also make your OCD symptoms feel worse at various points throughout life, 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. ERP is designed to treat OCD, and is proven to be highly effective; 80% of people see a significant reduction in their symptoms.
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. “If you face the fears that OCD tells you are scary, you realize the worst-case scenarios don’t happen,” explains Ibrahim. “This helps your brain learn that when you’re triggered, you don’t need to have the same response.”
ERP is not an overnight cure. You’ll need to be patient, be consistent with therapy sessions, and do the homework to see changes in your symptoms. Understandably, it can be scary to face your fears and change your responses, but it’s worth it in the end to get your life back from OCD.
If you have severe OCD or other mental health conditions (such as anxiety or depression), supplementing ERP with medication can be an effective treatment plan. While ERP and medications are the first-line treatments for OCD, there are situations where additional or alternative treatment is helpful for managing symptoms. Acceptance and commitment therapy (ACT) and transcranial magnetic stimulation (TMS) are just a few treatments that may be recommended.
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 and ERP 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. You can get your symptoms under control and return to a life you deserve.
Key takeaways
- OCD is a cycle of obsessions and compulsions that cause significant distress and disrupt daily life.
- While much remains unknown about what causes OCD, potential factors include genetics, stress, and life changes.
- OCD subtypes can include various themes, ranging from harm or contamination to sexual or religious topics.
- The recommended treatment for OCD is exposure and response prevention (ERP) therapy, which may be combined with medication to reduce symptoms.
