Obsessive-Compulsive Disorder (OCD): Understanding Types, Causes, Symptoms, and Treatment Options

What is OCD?

We’ve all experienced that feeling of doubt that makes us go back and double-check if we turned off the stove. You’ve also probably had an unpleasant or even violent thought from time to time that makes you wonder where it came from. But people with obsessive-compulsive disorder experience obsessive thoughts like this followed by compulsive behaviors so frequently and intensely that it interferes with their daily life.

Washing Hands

OCD falls under the umbrella of anxiety disorders and it is characterized by unwanted, uncontrolled thoughts and repetitive, ritualized behaviors that people feel forced to perform. People are aware of the irrational nature of these thoughts and behaviors, but they feel like they are unable to control and resist them.

Obsessions and compulsions – a vicious cycle

Obsessions are thoughts, images, or impulses that occur involuntarily. They are unpleasant and feel forced, i.e. the person doesn’t have control over them. People don’t want to experience these thoughts, they are often disturbing and distracting, but they feel powerless to stop them from occurring continually.

Compulsions are behaviors or rituals usually performed to eliminate obsessions. People feel driven to do certain things repeatedly and excessively to make intrusive thoughts go away. For example, if a person is terrified that they might cause a fire and burn down their building, they can develop a compulsion of checking their stove over and over again. They feel certain relief when they perform the act, but that feeling usually does not last for long. Obsessive thoughts come back and people often feel even more compelled to perform the ritual or behavior. This makes the person even more anxious because obsessions and compulsions take more energy and can become very time-consuming. This is called a “vicious cycle of OCD”.

Symptoms

People suffering from OCD can experience obsessions, compulsions, or a combination of both. Usually, the symptoms interfere with daily life and personal performance at work, in school, and in personal relationships.

Common obsessions

1. Contamination
Germs and/or disease
Household chemicals
Body fluids (feces, urine)
Environmental contaminants (radiation, asbestos)

2. Perfectionism
The pressure that things need to be even or exact
Worry about losing an important item or forgetting important information when they throw something out
Difficulty deciding whether to keep things or discard them
Worry about losing things

3. Losing control – fear of:
Harming oneself
Harming other people
Disturbing and violent mental images
Saying insults or vulgarities out loud
Stealing something

4. Harm – fear of:
Being the cause of a terrible event (for example, causing a fire or burglary)
Harming others by their negligence (for example, infecting someone with germs if they touch them)

5. Religious obsessions
Fear of offending God and blasphemy
Extreme attention to morality and worry about right and wrong

6. Undesired sexual thoughts
Inappropriate or perverted sexual ideas and images
Inappropriate or perverted sexual impulses concerning others
Taboos involving children or incest
Thoughts about violent sexual behavior

7. Other
Concerns about personal sexual orientation
Fear of getting sick not by contamination (for example, getting cancer)
Superstitions about (un)lucky numbers, colors, etc.

Common compulsions

1. Cleaning
Washing hands excessively or in a certain manner
Showering, tooth-brushing, etc. excessively
Cleaning household or other items excessively
Other acts to prevent or remove contaminants

2. Checking
Checking if they harmed others or themselves
Checking that nothing terrible happened
Checking that they did not make a mistake

3. Repeating:
Routine activities (for example, going through the doors)
Body movements (touching, crossing, stepping, etc.)
Activities a certain amount of times (for example, turning lights on and off three times in a row)

4. Mental compulsions
Going over events mentally to prevent harm to others or themselves
Praying or other religious rituals to prevent harm
Counting items or counting while doing something until they feel “right”
“Cancelling” or “undoing” (for example, saying a good word after a bad one to cancel it out)

5. Other
Arranging things in order until they feel “right”
Avoiding triggering situations

People usually begin experiencing symptoms in their teen or young adult years, but OCD can start even in early childhood. Symptoms typically develop over time and they vary in frequency and severity throughout life. Specific obsessions and compulsions can also vary and change as time passes. Symptoms usually become worse when a person experiences a lot of stress. OCD is often a lifelong struggle for people, but there are treatment options out there to help manage the disorder.

If your symptoms are affecting your ability to function on a daily basis, you should consider seeing a doctor or mental health professional.

Causes

Professionals do not fully understand how and why OCD develops. There are several theories about what causes the disorder:

Biological – OCD is a result of a change in brain chemistry or function.
Genetic – Obsessions and compulsions have a genetic component, but specific genes have not been identified yet.
Learning – Fears and behaviors associated with OCD can be learned over time or by watching people close to us.

Scientific research supports each theory to some degree, so it is likely that we need to consider multiple factors when it comes to the development of OCD. Further research is needed to bring us closer to understanding the causes of this disorder.

Risk factors

There are certain factors to be considered because they may increase the risk of developing OCD. Some of them are:

Family history – having biological relatives with OCD increases the risk of developing it.
Life events – stressful and traumatic events can cause emotional distress, which can act as a trigger for intrusive thoughts and repetitive behaviors typical for OCD.
Other mental health issues – it is possible that OCD can be related to other disorders like anxiety, depression, tic disorders, or disorders with substance abuse.

Treatment options for OCD

Psychotherapy, medication, or a combination of the two are the most common options to treat OCD. Most patients respond well to treatment, however, there are cases in which symptoms persist after getting treated.

An important thing to consider when making decisions regarding treatment is the presence of other mental health disorders.

Psychotherapy

Research shows that some types of psychotherapy, such as cognitive-behavioral therapy (CBT) and others related to CBT (for example, habit reversal training) are more effective than others when it comes to OCD treatment. CBT appears to be as effective as medication for many patients, according to research.

The most effective type of CBT for compulsive symptoms reduction is called Exposure and response prevention. The process of this approach includes exposure to triggering situations (for example, touching dirty items) and being prevented to act out the compulsive behavior that usually follows that situation (washing hands). It appears that even patients who did not respond to medication therapy benefit from this approach.

Medication

Medications used to treat and reduce obsessive-compulsive symptoms are called serotonin reuptake inhibitors. This class of medication is used to treat depression as well, but doses are usually higher when treating OCD and may take eight to twelve weeks before patients start to notice the difference in symptoms. Sometimes, if a patient does not respond well to this type of treatment, professionals prescribe antipsychotic medication. Research shows that this approach can help manage symptoms of OCD, but there are mixed results when it comes to research about the effectiveness of antipsychotics on this disorder.

Treatment should be personalized for most mental health disorders. The same goes for OCD as well. The process might begin with medication or psychotherapy only, and the other option can be an add-on treatment to assure a better outcome for the patient.