Understanding Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a long-term mental health condition that affects both thoughts and behaviors. People with OCD experience persistent, unwanted obsessions such as fears, intrusive thoughts, or urges and feel driven to perform repetitive behaviors or rituals to reduce the distress these obsessions cause.

This cycle of obsessive thinking and compulsive behavior can interfere with everyday activities, work, relationships, and overall well-being. While OCD can be overwhelming, effective treatment is available and many people with OCD can experience significant improvement with proper care.

Here’s what you need to know.

Core Symptoms of OCD

OCD is defined by the presence of obsessions, compulsions, or both:

Obsessions

Obsessions are recurrent, intrusive, and distressing thoughts, urges, or mental images. These are not simply worries about real-life problems they feel uncontrollable and often go against a person’s values.

Common obsessions include:

• Fear of germs, contamination, or illness

• A need for symmetry or order

• Taboo thoughts involving sex, religion, or violence

• Fear of harming oneself or others

• Worry about forgetting or losing things

• Fear of losing control

People with OCD may try to suppress or neutralize these thoughts by engaging in specific actions or rituals leading to compulsions.

Compulsions

Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions. Over time, these behaviors may become automatic and disruptive.

Examples of common compulsions:

• Excessive handwashing or cleaning

• Repeating actions (like checking locks or appliances)

• Organizing items in a specific, precise way

• Ritualistic counting or praying

• Repeatedly seeking reassurance from others

To meet the clinical criteria for OCD:

• The obsessions and/or compulsions must take up at least one hour per day

• They cause significant distress or interfere with important areas of life (like work or social relationships)

• The person recognizes the behaviors as irrational or excessive, but feels unable to stop

How OCD Differs in Children

Children with OCD may struggle to explain their thoughts or behaviors. In many cases, symptoms are first noticed by parents or teachers. Unlike adults, kids may not realize their behaviors are unusual or irrational.

What Causes OCD?

The exact cause of OCD is still unclear, but research points to a combination of biological, genetic, and environmental factors.

One major finding: People with OCD often show differences in brain activity, especially in areas linked to decision-making, error detection, and behavioral inhibition.

• Brain scans suggest that those with OCD have difficulty stopping repetitive behaviors, even when they know the behavior isn’t necessary.

• A 2019 review of nearly 500 individuals found that OCD brains respond too much to errors and too little to “stop” signals, making it harder to interrupt compulsive actions.

OCD may also run in families, and traumatic or stressful life events can act as triggers in people who are genetically predisposed.

Diagnosing OCD

There’s no blood test or brain scan to confirm OCD. Diagnosis is made through a clinical interview with a mental health professional (such as a psychologist or psychiatrist).

They will evaluate:

• Whether obsessive thoughts and compulsive behaviors are present

• How much time the symptoms take each day

• Whether they interfere with daily life or emotional well-being

• If symptoms can be explained by another condition or substance use

Early diagnosis is key yet many people wait years before getting help. One study found the average delay between symptom onset and treatment was 11 years.

Treatment Options for OCD

Thankfully, OCD is highly treatable, and early intervention leads to better outcomes. Treatment typically includes therapy, medication, or both.

Cognitive Behavioral Therapy (CBT)

CBT is a first-line treatment for OCD. One of the most effective forms is Exposure and Response Prevention (ERP).

• ERP helps individuals gradually confront feared thoughts or situations without performing the compulsive ritual.

• Over time, this reduces anxiety and weakens the link between obsessions and compulsions.

• CBT may also address cognitive distortions unhelpful beliefs or assumptions that fuel OCD symptoms.

Motivational interviewing, a technique that enhances engagement in treatment, may also improve outcomes.

Medication

Certain medications, especially selective serotonin reuptake inhibitors (SSRIs), are commonly used to treat OCD.

• Examples include fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox).

• People with OCD often need higher doses and longer treatment durations than those being treated for depression.

• A trial period of 8–12 weeks is usually needed to evaluate effectiveness.

In some cases, atypical antipsychotics or clomipramine (a tricyclic antidepressant) may be added to boost treatment response.

Important Considerations for Medication:

• Never stop medication abruptly without consulting a healthcare provider

• Regular follow-up is crucial to monitor side effects and progress

• Medication may take 4–10 weeks before noticeable improvement occurs

Living with OCD

Coping with OCD can be difficult, especially when symptoms affect work, relationships, or self-esteem. But you’re not alone.

Tips for living with OCD:

• Seek support through therapy, support groups, or online communities

• Educate loved ones so they can better understand and offer appropriate help

• Be patient with the process recovery takes time, and setbacks are normal

• Focus on healthy routines, including adequate sleep, regular exercise, and balanced nutrition

Remember: OCD is not a personal flaw or something you can "just stop." It is a medical condition that requires treatment, just like any physical illness.

If this article helped you or someone you know, share it or subscribe to our newsletter for more insights into mental wellness.