What Is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder (OCD) is a neurobiologic disorder in which a person has recurrent obsessions or compulsions that are severe enough to be time-consuming (take up at least one hour per day) and/or cause marked distress or significant impairment in daily living. The person recognizes that the obsessions or compulsions are excessive or unreasonable. We now have a lot of research evidence to suggest that OCD is caused by a malfunction in certain important information-processing circuits in the brain.

In OCD, an obsession is defined as a persistent idea, thought, image, or impulse that is experienced as intrusive and inappropriate and anxiety-provoking. The person with an obsession feels that the obsessive thought is strange and distressing and not within her control, even though she recognizes that it is coming from her own mind (in other words, it is not like having a hallucination).

Typical obsessions include: Severe and unrelenting worries about contamination, constantly repeated worries or doubts (Did I lock the door? Did I get in a traffic accident?), needing to have things in a certain order, having aggressive or horrific impulses (e.g. to shout out an obscenity, to harm one’s child), experiencing intrusive sexual imagery. Obsessions are not the same as having a lot of worries about real-life problems (like a relationship problem or a conflict at work); true OCD obsessions are usually not related to a real-life situation in any realistic way.

A compulsion is a repetitive behavior that a person feels driven to perform in order to try and reduce a sense of distress or anxiety. It does not provide pleasure or satisfaction. Common compulsions include hand washing, putting things in a certain order, checking, counting, praying repetitively, repeating words silently a certain number of times, touching things a certain way or a certain number of times. Often, a person feels driven to perform the compulsive behavior in an effort to reduce the anxiety that accompanies her obsession or to prevent some dreaded event or situation. For example, someone with an obsession about contamination may wash her hands until they are raw; someone who has obsessions about leaving the door unlocked may need to check the door every few minutes.

OCD usually begins in adolescence or adulthood, but it can start in childhood, especially in males. The typical age of onset for males is between 6 and 15 years; for females, it is between ages 20 and 29 years. It is estimated that about 2-4 percent of the population will develop OCD, but many people never seek treatment for it, even when the symptoms are very distressing and have started to interfere with their activities. OCD seems to run in families and definitely has a genetic component. Some forms of OCD appear to be related to Tourette’s syndrome.

OCD is a lifelong disorder with a course that waxes and wanes, and it must be distinguished from simply having a personality that is “obsessive-compulsive.” Lots of people are preoccupied with orderliness, perfectionism, control, and doing things a certain way, without having true OCD. In OCD, the obsessions and compulsions are well-defined and well-circumscribed, and they feel alien and distressing (or at least they start out that way, although in kids, this is not always the case). Dealing with the obsessions and compulsions takes up a great deal of mental and physical energy and intrudes on the person’s life. In contrast, people with obsessive personalities feel perfectly at home with their compulsive and controlling behavior, which often extends into many aspects of their lives and is simply a part of their overall style of coping.

It’s important to realize that OCD can occur along a spectrum of severity — from mild to very severe. If you have compulsive symptoms, like needing to check the locks over and over, or needing to set all of your clocks a certain way and check them over and over, you should ask yourself how much time each day is taken up with these compulsions. If it is an hour or more, or if it feels intrusive to you, or if you experience severe anxiety when you do not do the compulsive behavior, then you may have OCD. You will find it helpful to consult with a psychiatrist, who can tell you about some of the medications which have been used to treat OCD with good success. SSRI antidepressants — such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox) — which act on the serotonin neurotransmitter system in the brain, can be highly effective, as can a medication called clomipramine (Anafranil). Certain kinds of cognitive-behavioral therapies are sometimes used also.

The information provided on Health Search Online is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment.