What Is Obsessive-Compulsive Disorder? - Psychiatry.org

Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel ... AsdescribedinthePrivacyPolicyoftheAmericanPsychiatricAssociation(APA),thiswebsiteutilizescookiesformultiplepurposesincludingtoprovideyouwithpersonalizedcontent,evaluateandanalyzetheuseofoursite,andtoidentifywhichadvertisementsbringuserstoAPA’swebsites.Byclosingthismessage,continuingthenavigation,orotherwisecontinuingtoviewtheAPA’swebsites&applications,youconfirmthatyouunderstandandacceptthetermsoftheAPA’sPrivacyPolicy,includingtheuseofcookies.ReadourfullPrivacyPolicyhere. Accept Skiptocontent Important!APA'sOnlineSystemsUpdated.Passwordresetrequired. Closealert Important!APA'sOnlineSystemsUpdated. Passwordresetwillberequired. Readmorehere> Closealert Youarehere: PatientsandFamilies Obsessive-CompulsiveDisorder WhatIsObsessive-CompulsiveDisorder? Share Print SubNavigation Obsessive-CompulsiveDisorder TogglePageListing WhatIsObsessive-CompulsiveDisorder? ExpertQ&A:Obsessive-CompulsiveDisorder OnThisPage WhatIsObsessive-CompulsiveDisorder? Obsessive-compulsivedisorder(OCD)isadisorderinwhichpeoplehaverecurring,unwantedthoughts,ideasorsensations(obsessions).Togetridofthethoughts,theyfeeldriventodosomethingrepetitively(compulsions).Therepetitivebehaviors,suchashandwashing/cleaning,checkingonthings,mentalactslike(counting)orotheractivities, cansignificantlyinterferewithaperson’sdailyactivitiesandsocialinteractions. ManypeoplewithoutOCDhavedistressingthoughtsorrepetitivebehaviors.However,these donottypicallydisruptdailylife.ForpeoplewithOCD,thoughtsarepersistentandintrusive,andbehaviorsarerigid.Notperformingthebehaviorscommonlycausesgreatdistress,oftenattachedtoaspecificfearofdireconsequences(toselforlovedones)ifthebehavirosarenotcompleted. ManypeoplewithOCDknoworsuspecttheirobsessionalthoughts arenotrealistic;othersmaythinktheycouldbetrue.Eveniftheyknowtheirintrusivethoughts arenotrealistic,peoplewithOCDhavedifficultydisengagingfromtheobsessivethoughtsorstoppingthecompulsiveactions. AdiagnosisofOCDrequiresthepresenceofobsessionalthoughts and/orcompulsionsthataretime-consuming(morethanonehouraday),causesignificantdistress,andimpairworkorsocialfunctioning.OCDaffects2-3%ofpeopleintheUnitedStates,andamongadults,slightlymorewomenthanmenareaffected.OCDoftenbeginsinchildhood,adolescence,orearlyadulthood.SomepeoplemayhavesomesymptomsofOCDbutdonotmeetfullcriteriaforthisdisorder. Obsessions Obsessionsarerecurrentandpersistentthoughts,impulses,orimagesthatcausedistressingemotionssuchasanxiety,fearordisgust.ManypeoplewithOCDrecognizethattheseareaproductoftheirmindandthattheyareexcessiveorunreasonable.However,thedistresscausedbytheseintrusivethoughtscannotberesolvedbylogicorreasoning.MostpeoplewithOCDtrytoeasethedistressoftheobsessionalthinking,ortoundotheperceivedthreats,byusing compulsions.Theymayalsotrytoignoreorsuppresstheobsessions ordistractthemselveswithotheractivities. Examplesofcommoncontentofobessionalthoughts: Fearofcontamination bypeopleortheenvironment Disturbingsexualthoughtsorimages Religious,oftenblasphemous,thoughtsorfears Fearofperpetratingaggressionorbeingharmed(selforlovedones) Extremeworrysomethignisnotcomplete Extremeconcernwithorder,symmetry,orprecision Fearoflosingordiscardingsomethingimportant Canalsobeseeminglymeaninglessthoughts,images,sounds,wordsormusic Compulsions Compulsionsarerepetitivebehaviorsormentalactsthatapersonfeelsdriventoperforminresponsetoanobsession.Thebehaviorstypicallypreventorreduceaperson'sdistressrelatedtoanobsessiontemporarily,andtheyarethenmorelikelytodothesameinthefuture.Compulsionsmaybeexcessiveresponsesthataredirectlyrelatedtoanobsession(suchasexcessivehandwashingduetothefearofcontamination)oractionsthatarecompletelyunrelatedtotheobsession.Inthemostseverecases,aconstantrepetitionofritualsmayfilltheday,makinganormalroutineimpossible. Examplesofcompulsions: Excessiveorritualizedhandwashing,showering,brushingteeth,ortoileting Repeatedcleaningofhouseholdobjects Orderingorarrangingthingsinaparticularway Repeatedlycheckinglocks,switches,appliances,doors,etc. Constantlyseekingapprovalorreassurance Ritualsrelatedtonumbers,suchascounting,repeating,excessivelypreferencingoravidingcertainnumbers PeoplewithOCDmayalsoavoidcertainpeople,places,orsituationsthatcausethemdistressandtriggerobsessionsand/orcompulsions.Avoidingthesethingsmayfurtherimpairtheirabilitytofunctioninlifeandmaybedetrimentaltootherareasofmentalorphysicalhealth. Treatment PatientswithOCDwhoreceiveappropriatetreatmentcommonlyexperienceincreasedqualityoflifeandimprovedfunctioning.Treatmentmayimproveanindividual'sabilitytofunctionatschoolandwork,developandenjoyrelationships,andpursueleisureactivities. CognitiveBehavioralTherapy Oneeffectivetreatmentisatypeofcognitive-behavioraltherapy(CBT)knownasexposureandresponseprevention(ERP).Duringtreatmentsessions,patientsareexposedtofearedsituationsorimagesthatfocusontheirobsessions.Althoughitisstandardtostartwiththosethatonlyleadtoildormoderatesymptoms, initiallythetreatmentoftencauses increasedanxiety.Patientsareinstructedtoavoidperformingtheirusualcompulsivebehaviors(knownasresponseprevention).Bystayinginafearedsituationwithoutanythingterriblehappening,patientslearnthattheirfearfulthoughtsarejustthoughts.Peoplelearnthattheycancopewiththeirthoughts withoutrelyingonritualisticbehaviors,andtheiranxietydecreasesovertime.Usingevidence-basedguidelines,therapistsandpatientstypicallycollaboratetodevelopanexposureplanthatgraduallymovesfromloweranxietysituationstohigheranxietysituations.Exposuresareperformedbothintreatmentsessionsandathome.SomepeoplewithOCDmaynotagreetoparticipateinCBTbecauseoftheinitialanxietyitevokes,butitisthemostpowerfultoolavailablefortreatingmanytypesofOCD. Medication Aclassofmedicationsknownasselectiveserotoninreuptakeinhibitors(SSRIs),typicallyusedtotreatdepression,canalsobeeffectiveinthetreatmentofOCD.TheSSRIdosageusedtotreatOCDisoften higherthanthatusedtotreatdepression.PatientswhodonotrespondtooneSSRImedicationsometimesrespondtoanother.Themaximum benefitusuallytakessixtotwelveweeksorlongertobefullyvisable.PatientswithmildtomoderateOCDsymptomsaretypicallytreatedwitheitherCBTormedicationdependingonpatientpreference,thepatient’scognitiveabilitiesandlevelofinsight,thepresenceorabsenceofassociatedpsychiatricconditions,andtreatmentavailability.ThebesttreatmentofOCDisacombinationofCBTandSSRIs,especiallyifOCDsymptomsaresevere.  Neurosurgicaltreatment  Somenewerstudiesshowthatgammaventralcapsulotomy,asurgicalprocedure,canbeveryeffectiveforpatientswhodonotrespondtotypicaltreatmentsandareveryimpaired,butitisunderusedduetohistoricalprejudiceanditsinvasiveness.Deepbrainstimulation,whichinvolvesanimplanteddeviceinthebrain,hasdatatosupportefficacyanddoesnotpermanentlydestroybraintissueasdoneinacapsulotomy.However,itisstillhighlyinvasiveandcomplextomanage,andtherearelimitedprovidersandhospitalsystemstrainedtoofferthistreatmentand,abletoprovidethelong-termsupportneededbyDBSpatients. HowtoSupportaLovedOneStrugglingwithOCD InpeoplewithOCDwholivewithfamily,friends,orcaregivers,enlistingtheirsupporttohelpwithexposurepracticeathomeisrecommended.Infact,theparticipationoffamilyandfriendsisapredictoroftreatmentsuccess. Self-care MaintainingahealthylifestylecanhelpincopingwithOCD.Gettingenoughgoodqualitysleep,eatinghealthyfood,exercising,andspendingtimewithotherscanhelpwithoverallmentalhealth.Also,usingbasicrelaxationtechniques(whennotdoingexposureexercises)suchasmeditation,yoga,visualization,andmassagecanhelpeasethestressandanxiety. RelatedConditions HoardingDisorder BodyDysmorphicDisorder Individualswithbodydysmorphicdisorderarepreoccupiedwithwhattheyperceiveasflawsintheirphysicalappearance.Theperceivedflawsarenotnoticeableorappearonlyslighttoothersbutareseenasuglyorabnormaltothepersonwithbodydysmorphicdisorder.Itisnotthesameasthetypicalconcernsmanypeoplehaveabouttheirappearance. Bodydysmorphicdisorderalsoinvolvesrepetitivebehaviors(suchascheckingamirrororseekingreassurance)orrepetitivethinking(suchascomparingone’sappearancewithothers).Thepreoccupationscanfocusononeormanybodyareas,mostcommonlytheskin,hairornose.& Thepreoccupationsandbehaviorsareintrusive,unwanted,andtime-consuming(occurring,onaverage,threetoeighthoursperday).Theindividualfeelsdriventoperformthemandusuallyhasdifficultyresistingorcontrollingthem.Thepreoccupationcausessignificantdistressorproblemsindailyactivitiessuchasworkorsocialinteractions.Thiscanrangefromavoidingsomesocialsituationstobeingcompletelyisolatedandhousebound.Bodydysmorphicdisorderisassociatedwithhighlevelsofanxiety,socialanxiety,socialavoidance,depressedmoodandlowself-esteem. Manyindividualsseekandtoooftenreceivecosmetictreatment,suchasskintreatmentsorsurgery,totrytofixtheirperceiveddefects.Peoplewithbodydysmorphicdisordermayormaynotunderstandthattheirconcernsabouttheirappearancearedistorted.Manyindividualswithbodydysmorphicdisorderbelievethatotherpeopletakespecialnoticeofthemormockthembecauseofhowtheylook. Itaffectsanestimated2%ofpeople.Ittypicallybeginsbeforeage18andaffectsbothmenandwomen.Bodydysmorphicdisorderisusuallytreatedwithacombinationofcognitivebehaviortherapyandmedication,suchasselectiveserotoninreuptakeinhibitors(SSRIs). Muscledysmorphia,aformofbodydysmorphicdisorder,morecommoninmales,consistsofpreoccupationwiththeideathatone’sbodyistoosmallortooheavyornotmuscularenough.Individualswiththisformofthedisorderactuallyhaveanormal-lookingbodyorareevenverymuscular.Amajority(butnotall)diet,exercise,and/orliftweightsexcessively. Trichotillomania(Hair-PullingDisorder) Trichotillomania,orhair-pullingdisorder,involvesapersonrepeatedlypullingouttheirownhair,mostcommonlyfromthescalp,eyebrows,andeyelids.Manypeopletwistandplaywiththeirhairorbitetheirhair,butthesebehaviorsarenotthesameastrichotillomania. Thehairpullingcausessignificantdistressandproblemsfunctioning.Thepersonmayavoidwork,schoolorotherpublicsituations.Thedistresscanincludefeelingalossofcontrol,embarrassment,andshame.Hairpullingmaybeprecededoraccompaniedbyvariousemotionssuchasanincreasingsenseoftension.Itmaybetriggeredbyfeelingsofanxietyorboredom. Individualswithtrichotillomaniamakerepeatedattemptstodecreaseorstophairpulling.Inthegeneralpopulation,trichotillomaniaaffectsanestimated1%-2%ofadultsandadolescentsinagivenyearanditismuchmorecommonamongfemales.Itusuallybeginsaroundpuberty.Itmaycomeandgoovertime,butusuallycontinuesifitisnottreated.Treatmentusuallyinvolvescognitivebehaviortherapy(CBT),includingatechniquecalledhabitreversaltherapy,whichcanhelpidentifytriggersandenhanceawareness,disruptinghabitualpatternsofpullingepisodesandhelpingpatientsgainmorecontrolovertheirbehaviors. Excoriation(Skin-Picking)Disorder Apersonwithexcoriation(skin-picking)disorder,alsoknownasdermatillomania,repeatedlypicksatone’sownskinenoughtocauselesions.Theskin-pickingbehaviorcausessignificantdistressorproblemsinwork,socialinteractionsorotheractivities.Itcancausefeelingsofalossofcontrol,embarrassment,andshameandcanleadtoavoidingsocialsituations.Individualswithexcoriationdisorderhaveusuallymaderepeatedattemptstodecreaseorstopskinpicking. Thebehaviormaybetriggeredbyfeelingsofanxietyorboredom.Itmaybeprecededbyanincreasingsenseoftensionandmayleadtoasenseofreliefafter,oritmaybeamoreautomaticbehavior.Itsometimesinvolvesacompulsiontotrytofixperceived“blemishes.” Inthegeneralpopulation,thelifetimeprevalenceforexcoriationdisorderinadultsisestimatedatlessthan2%anditismuchmorecommonamongwomenthanmen.Itmostoftenbeginsinadolescence,anditmaycomeandgoovertime. Treatmentforskinpickingdisordertypicallyinvolvescognitivebehavioraltherapy,includingatechniquecalledhabitreversaltherapy,whichcanhelpidentifystressorsandtriggers,tolerateandreduceurges,andreplacethebehaviorwithonethatislessharmful. Peoplewithexcoriationdisorderoftenhaveotherpsychiatricdisorders,suchasdepressionorobsessive-compulsivedisorder. PhysicianReview JamarieGeller,M.D.,M.A. October2022 MoreResources AnxietyDisordersAssociationofAmerica OCD Hoarding Findatherapist InternationalOCDFoundation Findhelp:therapists,clinics,supportgroups,organizations OCDinKids MentalHealthAmerica Obsessive-compulsivedisorder LiveYourLifeWell 800-969-6642 NationalAllianceonMentalIllness Discussiongroups 1-800-950-NAMI(6264) NationalInstituteonMentalHealth OCD Medicalleadershipformind,brainandbody. JoinToday Mobilemenu Closemenu Home Psychiatrists Residents&MedicalStudents PatientsandFamilies Membership AboutAPA Newsroom Advocacy&APAPAC APASites RENEW JOIN SignIn Back Psychiatrists Education Practice Diversity&HealthEquity Research&Registry Advocacy&APAPAC Meetings&Events SearchDirectories&Databases International Back Residents&MedicalStudents Residents MedicalStudents Back PatientsandFamilies ViewAllTopics WhatisPsychiatry? 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