Obsessive-compulsive Disorder (OCD)

Learn about the symptoms, risk factors, and treatment for obsessive-compulsive disorder (OCD).

Learn more about OCD:

Definition

Obsessive-compulsive disorder (OCD) is a common mental disorder. It affects children, adolescents, and adults. A person with OCD has unwanted and upsetting thoughts, images, or urges—obsessions—or repetitive actions or mental acts—compulsions. There are many treatment options to manage OCD.

Signs and Symptoms

People with OCD have obsessions, compulsions, or both. The obsessions and compulsions are time consuming, cause distress, and impair daily life.

Obsessions are repeated and unwanted thoughts, urges, or mental images. These cause anxiety, distress, guilt, or shame. The person tries to ignore or stop the obsessions. Examples of obsessions include:

  • Fears about safety and uncertainty, such as forgetting to turn off the stove or lock the door
  • Unwanted thoughts and doubts about having harmed others, such as running over someone in your car or hurting a loved one
  • Unwanted or taboo thoughts about things such as sex (such as inappropriate sexual relations), religion (such as blasphemous thoughts), and harming others (such as stabbing others)
  • Fear of germs or contamination
  • Concerns or urges about having things balanced, in perfect order, or just right

Compulsions are excessive repetitive actions or mental acts that a person with OCD feels the urge to do in response to an obsession. The aim is to reduce distress or prevent a feared event or situation. Compulsions provide short-term relief from distress caused by obsessions, but make OCD symptoms worse over time. Compulsions are extreme or not based in reality.

Examples of compulsions include:

  • Repeatedly checking things such as assignments, or seeing if the door is locked or the stove is off
  • Mental rituals such as excessive counting or repeatedly reviewing past events conversations
  • Excessively asking for reassurance, “confessing” and apologizing for intrusive thoughts
  • Actions to make things perfect, such as excessive rewriting and arranging things
  • Extreme religious or moral rituals such as repetitive prayer, confessing, and following rules rigidly outside of typical faith practice
  • Excessive cleaning or hand washing
  • Avoiding people, places, objects, or situations that bring on obsessions or compulsions

Most people with OCD also have another mental disorder. This might be depression, anxiety, substance use or an eating problem.

Some people with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements. Tics may involve eye blinking and other eye movements, grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat clearing, sniffing, or grunting sounds.

Risk Factors

OCD affects about 2–3% of the population. OCD affects men and women equally. Symptoms start in childhood or the early 20s. Often, symptoms are not diagnosed for many years. The causes of OCD are unknown. Risk factors include genetics, brain structure and function, environmental factors, and issues related to thoughts and actions.

Genetics

OCD tends to run in families. Twin and family studies show that a person with a close relative with OCD—such as a parent, sibling, or child—is at a higher risk for OCD. Genetic factors play a role, but no specific genetic cause is known.

Brain Structure and Function

Imaging studies have shown differences in brain structures and brain functioning in people with OCD. How this is related to OCD is unknown. Some research suggests that imbalances of chemicals in the brain may cause OCD.

Environmental Factors

Environmental stressors may trigger OCD in some people. Stressors may include abuse, trauma, illness, death in the family, conflict with loved ones, pregnancy and childbirth, or major life changes. These events may also worsen OCD symptoms. Rarely, illnesses such as infection, brain injury, or stroke can lead to OCD symptoms.

Cognitive and Behavioral Factors

A person’s thinking patterns, temperament, or ways of interacting with the world may increase the risk of OCD.

Evidence-based Treatments

OCD is treatable. Without proper treatment, symptoms usually get worse. But people often do not get proper diagnosis and treatment until years after symptoms start.

Effective treatments for OCD include cognitive behavior therapy, medication, and combinations of both. The treatment plan should consider each person’s needs and choices. A person should consult a healthcare professional when choosing the right treatment and consider his or her own gender, race, ethnicity, language, and culture.

Psychotherapy

There are many forms of psychotherapy, sometimes called “talk therapy,” that are effective for OCD.

Cognitive behavioral therapy is the most effective treatment for OCD. Cognitive behavior therapy often involves working one-to-one with a therapist. Families are often involved with children and teens with OCD. Cognitive behavior therapy may be offered in group and family-based formats. Treatment often involves 12 to 20 weekly sessions, but some people need longer or more frequent therapy. Medication to reduce anxiety about starting treatment may help a person start and succeed with psychotherapy.

Exposure and response prevention is a type of cognitive behavioral therapy that reduces obsessions, compulsions, and anxiety in OCD. In this therapy, people with OCD gradually face their fears while avoiding compulsions. Facing fears (exposure) while resisting rituals (response prevention) reduces OCD symptoms over time. Exposure and response prevention helps people manage OCD through reduced anxiety and accepting uncertainty. Eventually, the obsession causes little or no anxiety. Most people improve after treatment.

Visit Psychotherapies from the National Institute of Mental Health (NIMH) to learn more about psychotherapies.

Medication

The most commonly used medications for OCD symptoms are selective serotonin reuptake inhibitors (SSRIs).These medications may take several weeks to start working, but some people improve faster.If symptoms do not improve, the treatment plan may include trying other medications. Not all medications have been thoroughly tested in children with OCD, so this requires caution. People who do not respond to medication alone may benefit from exposure and response prevention instead of medication or combined with medication.

For basic information about medications, visit Mental Health Medications from NIMH. For up-to-date information on medications, side effects, and warnings, visit the Food and Drug Administration.

Other Treatment Options

Most people with OCD respond to treatment in an office setting. Some people need more intensive treatment, such as intensive outpatient programs, day programs, residential care, and inpatient care.

Complementary Therapies and Activities

Complementary therapies and activities can help people improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, access the National Center for Complementary and Integrative Health.

Cognitive therapy is a form of cognitive behavior therapy that reduces OCD symptoms. The person learns to change their thinking about obsessive thoughts. Often, the person keeps a record of obsessions to identify and correct negative ideas. Cognitive therapy may be helpful when used with exposure and response prevention.

Motivational interviewing can help a person accept the need for treatment and overcome the difficult aspects of treatment. Motivational interviewing may help people with OCD be willing to start exposure and response prevention.

Family therapy may help families when stress and tension may be making a person’s OCD symptoms worse. Also, it may help families cope with the symptoms.

Acceptance and commitment therapy is sometimes combined with exposure and response prevention. This approach helps a person prepare for life’s difficulties and be more flexible in thoughts and actions. It helps people to think about their problems, and to not overreact or avoid them.

Regular aerobic exercise can help reduce OCD-related stress and anxiety. Also, staying connected with family and friends, getting enough sleep, getting good nutrition, and using relaxation techniques can help a person engage in treatment and manage OCD symptoms.

Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, visit the Federal Government Mobile App Directory.

Recovery and Social Support Services and Activities

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This includes:

  • Overcoming or managing one’s condition(s) or symptoms
  • Having a stable and safe place to live
  • Conducting meaningful daily activities, such as a job, school, volunteerism, and family caretaking
  • Having relationships and social networks that provide support, friendship, love, and hope

Recovery helps a person develop resilience, increasing the ability to cope with adversity, and adapt to challenges or change. To learn more, visit the SAMHSA Recovery and Recovery Support topic.

Self-help and support groups can provide people with the knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help people find local and online support groups. Peer and family support services can help foster hope and promote outreach and engagement for those with behavioral health conditions. This includes both peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills.

Resources for people with OCD and their families include:

Future Directions in Research and Treatment

The National Institute of Mental Health (NIMH) funds research into new treatments for people whose OCD does not respond well to usual therapies. These new approaches include finding genetics and biological causes, new therapy approaches, and other medical techniques.

For more information on the latest research, including how to participate in OCD research, visit Treatments and Therapies and Join a Study at NIMH.

Finding Treatment

Consult a healthcare professional who has training and experience working with OCD. For general information on mental disorders and to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the NIMH Help for Mental Illnesses webpage have more information and resources.

If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).

Last Updated: 05/12/2017