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What is OCD?
Obsessive-compulsive disorder (OCD)
Obsessive-Compulsive Disorder (OCD) is a chronic mental health condition marked by persistent, unwanted thoughts, urges, or mental images that lead to significant distress. To alleviate this discomfort, individuals with OCD often engage in compulsive behaviors or mental rituals, hoping to reduce the anxiety these obsessions cause. These symptoms can interfere with daily life, causing intense fear and emotional turmoil. However, effective treatments—such as Exposure and Response Prevention (ERP) therapy and medication—can help individuals manage their symptoms and significantly improve their quality of life.
Despite affecting approximately 1 in 40 people worldwide, OCD is often misunderstood. According to mental health professionals, “Society—through movies, social media, and casual conversation—frequently spreads misconceptions and confusion about what OCD truly is.”
In This Article
The primary symptoms of OCD consist of obsessions and compulsions.
What are obsessions?
Obsessions in OCD are commonly referred to as intrusive thoughts, but they can also manifest as intrusive images, sensations, feelings, or urges that lead to anxiety or distress. These obsessions often revolve around specific themes, such as an intense fear of contamination from germs or a fear of causing harm to oneself or others.
Typical obsessions associated with OCD encompass:
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An overwhelming desire for perfection, symmetry, or for things to be "just right"
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Concerns and uncertainties regarding one's "true" sexuality
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A strong fear of contamination or illness
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Ongoing anxiety about breaching religious, moral, or ethical values
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Preoccupations with bodily sensations or involuntary physical functions
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Intrusive thoughts about violence or causing harm to oneself or others
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Doubts and anxieties related to relationships, particularly intimate ones
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Persistent doubts about past events (False Memory OCD)
What are compulsions?
Compulsions are repetitive actions or mental processes that individuals with OCD feel compelled to perform in reaction to their obsessions. These behaviors aim to alleviate anxiety or distress or to avert a perceived negative outcome. However, since engaging in compulsions only offers temporary relief, the obsessions inevitably resurface, which contributes to what is known as the OCD cycle.​​
Common compulsions seen in OCD include:
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Checking: Repeatedly verifying things like whether the stove is off or the door is locked.
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Tapping/Touching: Performing specific actions, such as tapping a knee a certain number of times, to feel “right” or “safe.”
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Reassurance-seeking: Asking others questions like, “Did I accidentally push someone when we were walking down the street?” or “Are you sure you love me?”
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Avoidance: Staying away from certain places, situations, or triggers that could lead to intrusive thoughts.
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Excessive washing/cleaning: Repeatedly washing hands, showering, or disinfecting surfaces throughout the day.
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Rumination: Overthinking or obsessively dwelling on thoughts for long periods.
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Mental reassurance: Trying to calm yourself by repeating affirmations like, “I would never do anything harmful because I’m not a bad person.”
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Thought-replacing: Replacing a “bad” thought with a “good” one in an attempt to neutralize anxiety.
Obsessions and compulsions can be incredibly time-consuming and draining, often taking a heavy toll on daily life. They can affect everything from routine tasks to career goals and personal relationships, severely impacting the quality of life for those living with OCD.
OCD can develop in childhood or early adulthood, with the majority of cases beginning in individuals aged 18 to 29. While the exact causes of OCD are not fully understood, several potential risk factors have been identified.
Genetics
Although scientists have not identified a specific gene or set of genes that directly causes OCD, it is believed that genetic factors contribute to its development. Studies indicate that individuals with a first-degree relative, such as a parent or sibling, who has OCD are at an increased risk of developing the disorder themselves.
Biology
Research indicates that individuals with OCD share certain biological characteristics. For example, there is evidence suggesting that OCD is associated with heightened activity in specific areas of the brain. Compulsions such as excessive cleaning and checking may be related to the wiring of the thalamus, which is responsible for relaying motor and sensory signals. Additionally, an imbalance in certain neurotransmitters, the brain's chemical messengers, might also contribute to the disorder.
Stressful life events
While no research has specifically examined how stressors impact individuals with OCD, self-report studies indicate that 25 to 67% of people with the disorder associate significant life events with the onset of their symptoms. Many individuals with OCD note that their symptoms emerged during particularly stressful periods or following specific traumatic experiences.
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However, experts advise against making definitive conclusions about cause and effect. “Some individuals with OCD have also gone through traumatic events, but that doesn’t imply that such an event will necessarily lead to OCD,” Ibrahim stated.
Many individuals seeking treatment for OCD often turn to therapy; however, a lack of relief may indicate that the wrong type of therapy was used, rather than therapy itself being ineffective. For example, while talk therapy and general Cognitive Behavioral Therapy (CBT) can benefit various mental health issues, they may actually worsen OCD symptoms in some cases.
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The gold-standard treatment for OCD is Exposure and Response Prevention (ERP), a specialized behavioral therapy developed specifically for this condition and supported by extensive clinical research.​
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Regarding medication, it can play a crucial role in treating OCD, especially for individuals experiencing severe symptoms or co-occurring mental health conditions. Combining medication with ERP may enhance the effectiveness of therapy. Commonly prescribed medications include SSRI antidepressants.
While Exposure and Response Prevention (ERP) and medication are generally considered the primary treatments for OCD, there are situations where supplementary or alternative treatments may be needed to effectively manage symptoms. Below are some additional treatment options that a healthcare provider might suggest for OCD:
Transcranial magnetic stimulation (TMS)
When traditional therapies such as ERP and ACT fall short in effectively treating OCD, a non-invasive medical option like Transcranial Magnetic Stimulation (TMS) may be considered. Ibrahim explains, “TMS is a secondary treatment choice when your combination of medication and therapy hasn’t yielded sufficient results.”
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TMS utilizes short magnetic pulses to stimulate the neurons in the brain. Initially approved by the U.S. Food and Drug Administration (FDA) for depression, subsequent research demonstrated its efficacy in alleviating OCD symptoms, leading to the FDA's approval for this use in 2018. “TMS targets a specific area of the brain, regulating the neural activity of the brain structures linked to OCD,” Ibrahim states. She also notes that deep TMS, a variation of TMS, can be particularly effective for those with treatment-resistant OCD, potentially resulting in a reduction of symptoms by 30% or more.