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Obsessive-Compulsive Disorder (Part 1)

When Unwanted Thoughts or Repetitive Behaviors Take Over

People who are distressed by recurring, unwanted, and uncontrollable thoughts or who feel driven to repeat specific behaviors may have obsessive-compulsive disorder (OCD). The thoughts and behaviors that characterize OCD can interfere with daily life, but treatment can help people manage their symptoms.

What is OCD?

OCD is a common, long-lasting disorder characterized by uncontrollable, recurring thoughts (obsessions) that can lead people to engage in repetitive behaviours (compulsions).

Although everyone worries or feels the need to double-check things on occasion, the symptoms associated with OCD are severe and persistent. These symptoms can cause distress and lead to behaviors that interfere with day-to-day activities. People with OCD may feel the urge to check things repeatedly or perform routines for more than an hour each day as a way of achieving temporary relief from anxiety. If OCD symptoms are not treated, these behaviors can disrupt work, school, and personal relationships and can cause feelings of distress.

OCD symptoms tend to emerge in childhood, around age 10, or in young adulthood, around age 20 to 21, and they often appear earlier in boys than in girls. Most people are diagnosed with OCD by the time they reach young adulthood.

What are the signs and symptoms of OCD?

People with OCD may have obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common obsessions include

• Fear of germs or contamination
• Fear of forgetting, losing, or misplacing something
• Fear of losing control over one's behavior
• Aggressive thoughts toward others or oneself
• Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
• Desire to have things symmetrical or in perfect order

Compulsions are repetitive behaviors that a person feels the urge to do in response to an obsessive thought. Common compulsions include

• Excessively cleaning or handwashing
• Ordering or arranging items in a particular, precise way
• Repeatedly checking on things, such as that the door is locked or the oven is off
• Compulsive counting

How do I know if it's OCD?

Not all rituals or habits are compulsions. Everyone double-checks things sometimes. In general, people with OCD

• Can't control their obsessive thoughts or compulsive behaviors, even when they recognize those thoughts or behaviors as excessive
• Spend at least one hour a day on these obsessive thoughts or compulsive behaviors
• Don't get pleasure when performing compulsive behaviors or rituals but may feel brief relief from the anxiety brought on by obsessive thoughts
• Experience significant problems in daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds. It is common for people with OCD also to have a diagnosed mood disorder or anxiety disorder.

Symptoms of OCD may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that their compulsive behaviors don't make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you or your child may have OCD, talk to a health care provider about the possible symptoms. If left untreated, OCD can interfere in all aspects of life.

What causes OCD?

The exact causes of OCD aren't known; however, a variety of factors are associated with an increased chance of developing the disorder.

Genetics is one factor associated with OCD. Studies have shown that having a first-degree relative (parent, sibling, or child) with OCD is associated with an increased chance of developing the disorder. Scientists have not identified any one gene or set of genes that definitively lead to OCD, but studies exploring the connection between genetics and OCD are ongoing.

In addition to genetics, other biological factors may play a role. Brain-imaging studies have shown that people with OCD often have differences in the frontal cortex and subcortical structures of the brain, areas of the brain that underlie the ability to control behavior and emotional responses. Researchers also have found that several brain areas, brain networks, and biological processes play a key role in obsessive thoughts, compulsive behavior, and associated fear and anxiety. Research is underway to better understand the connection between OCD symptoms and parts of the brain.

Some studies have reported an association between childhood trauma and obsessive-compulsive symptoms. More research is needed to understand this relationship.

Children who develop a sudden onset or worsening of OCD symptoms after a streptococcal infection may be diagnosed with a condition called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).