Obsessive Compulsive Disorder, or OCD, is a chronic anxiety disorder in which a person experiences recurrent, unwanted, disturbing thoughts (called “obsessions”) and performs repetitive, often ritualized actions (called “compulsions”) that they feel powerless to stop or control. These thoughts and actions are often accompanied by feelings of anxiety or dread that something terrible is going to happen. OCD was once thought to be a rare disorder; new research, however, has revealed that from 2% to 3% of the general population will have OCD at some point in their lives -- as many as 5-6 million people. OCD seems to effect an equal number of men and women and, while some people develop symptoms in childhood, many others do not develop symptoms until their teenage or early adult years. The average age of onset for symptoms tends to be around 19-21, with most people describing a slow and gradual build-up of obsessions followed by compulsions.
What is an “obsession” and when is “obsessive thought” a problem? 
An obsession is an unwanted, repetitive thought that is most often unpleasant to have. Most people, at some point in their lives, experience repetitive thoughts that are unwanted -- wondering if the door was locked, or the alarm clock turned on, or if the upstairs light was switched off -- but these are a normal part of being human. We check the door, see that the alarm clock is set, or walk upstairs to find the light off and we feel reassured and at ease. Obsessions in OCD are in a different league -- they interfere with day-to-day life and no amount of checking the door, the alarm clock, or the light relives the anxiety of feeling like “it’s not done right.” In fact, it might be just the opposite -- each time the door or alarm clock or light is checked, the anxiety might intensify. In OCD, there is no ease or reassurance with double checking.
Sometimes, when we’re stressed, we might experience “OCD-like” obsessions. For example, you might feel obsessed about a paper you’re completing for school and you might double-check, or triple-check your work for spelling or grammatical errors. You may not be able to “let it go” until you actually turn the paper in or even until you get the paper back. The same might be true when you’re buying a home or a car and you double- or triple-check your loan application to make sure everything is complete. You might even dream about these things but, eventually -- when the paper is returned or the loan application has been answered -- the obsessive thought disappears. In OCD, the obsession is ever-present. It just doesn’t “go away.”
There are some common obsessions for people with OCD. These include fear of contamination by dirt, germs, poison, or toxins; doubt or fear that you will be responsible for something terrible happening, often to a loved one; fear of having a serious illness; sexual thoughts that go against your moral beliefs or values; or fear of acting out aggressive impulses. Others include an extreme inability to discard useless or worn-out objects, and an excessive concern for order, arrangement, or symmetry.
What is a “compulsion” and when is “compulsive-action” a problem?
A compulsion usually consists of a behavior that is performed repeatedly in a ritualistic manner. Most of us have compulsive-like behaviors that are not problematic. For example, many people make coffee in a ritualistic manner, often without thinking about it -- using the same spoon to measure the coffee, doing it the same way day-in and day-out on “auto-pilot” and out of habit. But should the coffee routine be interrupted (because we’re not at home, or because we need to make more or less on a given day), we’re not troubled. Not so in OCD! In OCD, the compulsions are ritualized activities that must be done over and over again, enough that they interfere with every-day living.
In OCD, people usually feel driven to perform the compulsion even though they might at the same time consider the behavior irrational. Some common compulsive behaviors include repetitive washing and cleaning, either of the body of the home; repeated checking on things to be sure that something terrible will not happen; mental counting in a ritualistic way; touching, ordering, and arranging in a ritualistic way; repetitive requests for reassurance; and other repetitive rituals that have been devised to calm fears that something bad will happen. These behaviors often develop as a means of reliving the anxiety that accompanies obsessive thinking; the relief, however, is short-lived and often leads to more anxiety if not done “the right way,” causing people with OCD to engage in the behavior again, and again, and again.
How Do I Know if I Have OCD?
Essential to the diagnosis of OCD is that the obsessions and/or compulsions cause distress, take up more than an hour each day, or otherwise significantly interfere with your life, work, or social interactions. People with OCD are likely to have symptoms common in other disorders as well -- these include depression, “general anxiety,” and addiction. In many cases the symptoms of OCD can be masked or covered up by the symptoms of these other disorders and vice versa. Though it might be difficult -- or even seem silly -- it is very important that you talk about the symptoms you experience when you see a therapist or doctor. Treating the correct disorder can significantly influence your experience in therapy. If you think you spend too much time thinking about something or if you find yourself doing a particular activity in a prescribed or ritualistic way, bring it up. There are effective treatment strategies for OCD.
How is OCD Treated and What Can I Expect?
In the past, effective treatment for OCD was considered very difficult. Fortunately a great deal of progress has been made in recent years. In large part, treatment of OCD is divided into two particular methods -- cognitive behavior therapy and medication therapy -- or a combination of both. Many consider either one to be an effective tool in the treatment of OCD but increasingly the combination of the two is seen to be more effective than either one alone. If you are seeing a therapist who does not prescribe medications, a referral may be made to your primary care doctor or a specialist, like a psychiatrist or a mental health nurse practitioner. If you are seeing someone who prescribes you medication, a referral may be made to a therapist who specializes in cognitive behavioral approaches.
With cognitive behavior therapy, you will most likely be asked to identify and face the things or thoughts that cause anxiety, be helped to understand how this thought leads to ritualized behavior, and then learn skill that help keep you from engaging in them. This process is commonly known as exposure and response prevention. With medication therapy, you will likely be prescribed a medication to re-balance your brain chemistry and the neurotransmitters involved in the imbalance. Regardless, treatment is always participatory. Symptoms do not go away on their own. But with effort and help, they can become less and they can stop interfering with your every day life.
Additional Information and Support
There may be specific support groups in your local community for OCD and there is often significant benefit from joining a support group where people from all walks of life have one thing in common -- OCD.
Contact one of the groups below and see what you find. Remember, you don't have to go at it alone, there is help out there, and OCD is a treatable illness.
The OC Foundation
PO Box 70
Milford, CT 06460
(203) 878-5669
Anxiety Disorders Association of America
6000 Executive Boulevard, Suite 513
Rockville, MD 20852-4004
(301) 231-8368
www.adaa.org
National Mental Health Association
1021 Price Street
Alexandria, VA 22314-2917
(800) 969-NMHA
www.nmha.org
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