What Is Obsessive-Compulsive Disorder?
Everyone feels anxiety, fear, uncertainty, or worry at some time. These normal emotions and reactions help people protect themselves, stay safe, and solve problems. Usually these feelings don't last long and don't come too often.
But for people with obsessive-compulsive disorder (OCD), these feelings are taken to extremes. It's as if the brain's filter for sorting out what's dangerous from what's not dangerous isn't working properly. Instead of keeping normal worry in perspective, there is a constant stream of uncertainty, doubt, or fear in the person's mind.
OCD is a type of anxiety disorder. People with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty — or with thoughts about bad stuff that might happen. With OCD, upsetting or scary thoughts or images, called obsessions, pop into a person's mind and are hard to shake.
People with OCD also may worry about things not being "in order" or "just right." They may worry about losing things, sometimes feeling the need to collect these items, even though they might seem useless to others.
People with OCD feel strong urges to do certain things repeatedly — called rituals or compulsions — in order to banish the scary thoughts, to try to ward off the bad thing they dread, or to make extra sure that things are safe or clean or right. By doing a ritual, someone with OCD is trying to feel absolutely certain that something bad won't happen.
Sometimes the obsessions and compulsions seem to be related to each other. For example, if a person with OCD has obsessions (worry thoughts) about germs and about getting sick, these might be accompanied by compulsions (urges and behaviors) to wash a lot, clean things, or try not to touch things that might be germy.
But sometimes the compulsions don't seem to have anything to do with the fear a person is trying to banish. Someone with OCD might get the idea that if things aren't arranged just so on a desk, someone they love could get sick or die. Many times, the rituals seem odd even to the person with OCD. For this reason, many people with OCD try to hide their symptoms from others.
Although people with OCD feel a brief sense of relief when they do a compulsion, the compulsions actually strengthen the OCD thoughts, encouraging them to return. The more someone does the compulsions, the stronger the illness becomes.
When OCD is severe, the obsessions can be extremely distressing and rituals can take up hours of a person's day. But for someone with OCD, resisting the urge to do compulsions can be very difficult.
What Causes OCD?
Doctors and scientists don't know exactly what causes OCD, although recent research has brought better understanding about OCD and what causes it. Before that, OCD was thought to be difficult to treat, but now it's much easier.
Experts believe OCD is related to levels of a normal chemical in the brain called serotonin. When the flow of serotonin is blocked, the brain's "alarm system" overreacts and misinterprets information. "False alarms" mistakenly trigger danger messages. Instead of the brain filtering out these unnecessary thoughts, the mind dwells on them — and the person experiences unrealistic fear and doubt.
Also, imaging studies of the brain have shown that people with OCD have different patterns of brain activity than people without OCD.
Evidence is strong that OCD tends to run in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain's serotonin levels. Because of this, scientists have come to believe that the tendency (or predisposition) for someone to develop the serotonin imbalance that causes OCD can be inherited through the person's genes.
Having the genetic tendency for OCD doesn't mean people will develop OCD, but it means there is a stronger chance they might. OCD is genetic, so it's not caused by parenting or family dynamics — although sometimes stress or illness may trigger the symptoms of OCD in someone who is genetically prone to develop it.
Doctors used to think OCD was rare and untreatable, but now much more is known. As many as 3 in 100 people have OCD. Although there is no cure yet, with proper treatment most people can live free of its symptoms.
OCD is an illness, and having it is not a person's fault, just like having asthma or diabetes is not someone's fault. Like asthma, diabetes, or any other illness, OCD can be treated so people can get relief from its symptoms.
But unlike diabetes or other illnesses, you can't have a lab test or blood test to tell you if you have OCD. Instead, a doctor such as a psychologist or psychiatrist has to ask you questions about obsessions and compulsions. They will ask and discuss questions like:
- Do you have worries, thoughts, images, feelings, or ideas that bother or upset or scare you?
- Do you feel you have to check, repeat, ask, or do things over and over again?
- Do you feel you have to do things a certain number of times, or in a certain pattern?
Once someone is diagnosed with OCD, doctors can begin treating the condition. The good news is that there are treatments that really work. Lots of mental health specialists, psychiatrists, psychologists, and counselors are trained in treating OCD.
Getting Therapy for OCD
For many teens, the thought of going to therapy can be a little scary and overwhelming. A lot of people are so embarrassed by their obsessions and compulsions that they don't even tell their parents and friends about them, never mind a stranger.
But most people find they feel comfortable — even relieved — after they meet with a therapist once or twice and know what to expect. The therapist will often begin by teaching about OCD and how the therapy works.
A type of talk therapy called cognitive-behavioral therapy (CBT) offers specific methods, called exposure and ritual (or response) prevention (ERP) that work for people with OCD.
CBT helps people learn to use the power of their own behavior to change their thoughts and feelings for the better. First, a person learns how OCD works — how giving in to compulsions makes OCD stronger and how resisting compulsions makes OCD weaker.
Exposure therapy and ritual prevention allow people to face their fears in a safe way, little by little, without doing compulsions. Therapists who treat OCD teach people new ways to react to worries and fear without doing rituals.
This type of therapy actually helps "reset" the brain's mechanisms that trigger obsessions and compulsions. At first, it can seem hard to stop doing rituals, but eventually people feel safe and stronger about dealing with their obsessions and compulsions.
Overcoming OCD is not a fast or easy process. It takes patience, practice, and hard work. People with OCD usually go to therapy about once or twice a week for a while, then less often as they begin to get better. Sometimes the doctor may also prescribe medications to help with symptoms.
Feeling better can take anywhere from a few months to a few years. For many teens with OCD, the symptoms might get better for a time and then get worse during stressful events in their lives. But learning how to deal with OCD makes it easier to take care of it when there is a flare-up.
Many people with OCD find that support groups help them feel less alone and let them make friends with others who understand and are living with the same challenges.
Having OCD doesn't mean a person is crazy — or that he or she should just be able stop the obsessions and compulsions alone. Going to the doctor when you have the flu isn't embarrassing, and neither is seeking treatment if you think you have OCD.
With help, people can get relief from OCD and have more time and energy to spend doing things they enjoy.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: February 2012