Obsessive Compulsive Disorder (OCD): Symptom, Causes, and Treatment

Obsessive-compulsive disorder (OCD) refers to a condition characterized by recurring thoughts, fears, or impulses, leading to compulsive behaviors aimed at reducing anxiety. These obsessions and compulsions interfere with daily functioning, creating distress for those affected.

The main symptoms of OCD include persistent and intrusive thoughts, which involve fears of contamination, harm, or perfectionism. Compulsions, such as repetitive cleaning, checking, or organizing, are performed to alleviate the anxiety caused by these obsessions. These signs vary in severity and duration, but they usually lead to significant distress, according to a study by Stein DJ, Costa DLC, et al. 2019, titled “Simpson HB. Obsessive-compulsive disorder.”

The causes of this mental disorder are not fully understood but are thought to involve a combination of genetic, neurological, and environmental factors. A family history of OCD, exposure to stressful events, or a predisposition to distorted thinking patterns increase the risk of developing the disorder, according to a study in Medline Plus, “Obsessive-compulsive disorder.”

Treatments for OCD include a combination of cognitive-behavioral therapy (CBT) and medications, as studied by Brock H, Rizvi A, Hany M., et al. 2024, “Obsessive-Compulsive Disorder.” CBT, particularly exposure and response prevention (ERP), helps individuals confront their fears without resorting to compulsive behaviors. Medications such as SSRIs target chemical imbalances in the brain. Addressing OCD early with the right treatment greatly improves the quality of life, though ongoing management is needed.

What is Obsessive-Compulsive Disorder?  

Obsessive-Compulsive Disorder (OCD) is a mental health condition that involves the presence of obsessions and compulsions. Individuals with OCD experience intrusive thoughts or unwanted thoughts that provoke intense fears, leading them to engage in repetitive behaviors or mental acts to alleviate the anxiety associated with these obsessions.

According to an article published in the American Psychiatric Association, “What Is Obsessive-Compulsive Disorder?” “Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions). To get rid of the thoughts, they feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing/cleaning, checking on things, and mental acts like (counting) or other activities, significantly interfere with a person’s daily activities and social interactions. This definition highlights the significant impact OCD has on an individual’s life as they struggle to manage the cycle of intrusive thoughts and the resulting compulsive behaviors.

What are the Symptoms of Obsessive-Compulsive Disorder?

The symptoms of obsessive-compulsive disorder are categorized into obsessions such as intrusive thoughts about contamination, fears of harming others, doubts about safety, and compulsions like excessive cleaning, repetitive checking, and counting rituals, according to a study by Stein DJ, Costa DLC, et al. 2019, “Simpson HB. Obsessive-compulsive disorder.”

Obsessions and compulsions are distinct but interrelated symptoms of Obsessive-Compulsive Disorder (OCD). Obsessions refer to persistent, unwanted thoughts, images, or urges that cause significant anxiety, such as fears of contamination or harm. Compulsions manifest as repetitive behaviors performed to alleviate the stress caused by these obsessions, such as excessive hand washing or checking. 

Individuals experiencing severe OCD symptoms find that their daily functioning is severely impaired, regardless of their age or gender. OCD symptoms in adults manifest as concerns over orderliness or fear of germs, while OCD in women displays additional social pressures or relationship-related worries. Conversely, OCD in children presents differently, involving play rituals or fears of imaginary threats, reflecting developmental stages and understanding. Understanding these distinctions is crucial in recognizing how OCD affects individuals across different demographics and in varying severities.

Obsessions

Obsessions in Obsessive-Compulsive Disorder (OCD) are defined as persistent, intrusive thoughts, images, or urges that cause significant anxiety or distress. These unwanted thoughts lead individuals to engage in compulsive behaviors in an attempt to alleviate the discomfort associated with them, according to a study by Kozak MJ, Foa EB, et al. 1994, “Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder.” This aspect of the condition is understood as a type of obsessional disorder, where the individual feels trapped by their intrusive thoughts. Each of these obsessions significantly affects a person’s mental health, frequency, and overall quality of life, requiring targeted therapeutic interventions to manage effectively.

The symptoms of obsessions in OCD include the following:

• Contamination Obsessions: Contamination obsessions are irrational fears of germs, dirt, or illness that lead individuals to believe they will be contaminated through contact with people, surfaces, or objects. The impact of this obsession is severe, as individuals engage in excessive cleaning or hand-washing rituals to ease their anxiety. This significantly disrupts daily life, with common triggers including public spaces, doorknobs, or anything perceived as unclean.
• Violent Obsessions: Violent obsession consists of unwanted, distressing thoughts about causing harm to oneself or others, even though the individual has no intention of acting on them. The frequency of these intrusive thoughts is debilitating, causing intense anxiety, guilt, and avoidance of situations where harm seems possible. Violent obsession severely impacts the person’s mental well-being, leaving them fearful of losing control.
• Symmetry and Order Obsessions: Individuals with symmetry and order obsessions feel an overwhelming need to have items arranged in perfect order or symmetry. The compulsion to fix or rearrange objects consumes a significant amount of time, leading to frustration and an inability to focus on other tasks. The severity of this obsession results in disrupted routines, as individuals are stuck in a cycle of organizing and rechecking their environment.
• Sexual Obsessions: Sexual obsession involves recurring, unwanted sexual thoughts or images that conflict with the individual’s values, causing deep anxiety and distress. These thoughts lead to guilt and shame, with individuals avoiding situations or people that trigger such thoughts. The intensity and frequency of sexual obsessions vary, but they lead to isolation and social withdrawal.
• Religious and Moral Obsessions: Religious and moral obsessions center around an exaggerated fear of violating religious or moral standards, leading to compulsive behavior like repetitive prayers, confession, or seeking reassurance. This causes significant emotional distress, as individuals feel constant anxiety about being morally impure or sinful. The frequency of these thoughts results in compulsive rituals that momentarily ease their fears but reinforce the obsession over time.
• Doubt and Uncertainty Obsessions: Doubt and uncertainty obsessions are characterized by persistent doubts, such as whether the door is locked or the stove is off. The individual feels an intense need to repeatedly check or seek reassurance, causing time-consuming rituals that interfere with daily functioning. The compulsion to confirm or verify something triggered by ordinary tasks leads to prolonged disruptions in daily routines.

Compulsions

Compulsions in Obsessive-Compulsive Disorder (OCD) are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to obsessions or according to rigid rules. These repetitive behaviors are aimed at reducing the distress associated with the obsessions or preventing a feared event or situation, even though they do not realistically control the feared outcome. Compulsions vary widely in nature and severity but serve to provide temporary relief from anxiety, according to a study by Starcevic V. et al.2011, “Functions of Compulsions in Obsessive–Compulsive Disorder.” Each of these compulsions serves to alleviate the anxiety associated with obsessions temporarily but ultimately perpetuates the cycle of OCD, making effective treatment essential for long-term management.

The symptoms of compulsions in OCD include the following:

• Cleaning and Washing Compulsions: Cleaning and washing compulsion is defined as the repetitive need to clean or wash excessively to reduce fears of contamination. Individuals wash their hands repeatedly or clean their environment obsessively for hours at a time. The severity of this compulsion leads to physical consequences such as skin damage and infections due to over-washing. Triggers include contact with surfaces perceived as dirty or unclean, and the compulsion severely disrupts daily life, leading to social isolation and the inability to engage in normal activities.
• Checking Compulsions: Checking compulsion involves repeatedly verifying things such as whether doors are locked, appliances are turned off, or tasks are completed correctly. The goal is to alleviate fears of harm, danger, or mistakes. The frequency of this behavior becomes extreme, with some individuals spending excessive time checking the same items multiple times. The compulsion creates frustration and anxiety, especially when the repeated checking does not reduce the sense of unease or fear.
• Repeating Compulsions: Repeating compulsions are characterized by the need to perform certain actions or behaviors multiple times, such as touching objects, performing tasks in a specific sequence, or saying phrases repeatedly. The duration of these compulsions is prolonged, and the individual feels intense distress if the action is not repeated as compelled. This compulsion consumes time and energy, leaving individuals mentally exhausted and interfering with their ability to complete daily tasks.
• Organizing and Arranging Compulsions: Organizing and arranging compulsions are defined as the obsessive need to arrange items in a particular order based on symmetry or specific patterns. Individuals spend a significant amount of time organizing or rearranging their surroundings to achieve a sense of order. The impact of this compulsion is disruptive, as daily routines and responsibilities are neglected. Triggers include seeing items out of place, which causes intense discomfort until the individual restores the perceived order.
• Mental Compulsions: Mental compulsion involves internal rituals, such as mentally repeating words, counting, praying, or visualizing specific images to alleviate anxiety or prevent feared outcomes. Though not visible to others, mental compulsions are just as debilitating as physical ones. The frequency and duration of these internal rituals are prolonged, interrupting the person’s ability to focus on other tasks. Cognitive fatigue and emotional distress are common consequences, as the individual feels trapped in an unrelenting cycle of mental rituals.

What are the Causes of Obsessive-Compulsive Disorder? 

The exact causes of obsessive-compulsive disorder (OCD) are unknown; however, genetic predisposition, neurobiological factors, and environmental influences contribute to its development.

There is a hereditary component, and abnormalities in brain circuits and neurotransmitters, such as serotonin, are thought to play a role in the disorder. Additionally, life experiences such as trauma or significant stress trigger or worsen OCD symptoms, indicating that both biological and environmental factors are important in the disorder’s onset.

The factors that cause/lead to OCD are given below:

• Genetic factors
• Neurological factors
• Psychological factors
• Biochemical factors
• Cognitive factors

Genetic Factors

Genetic factors refer to the hereditary components that predispose an individual to obsessive-compulsive disorder (OCD).  Variations in certain genes that provide instructions for proteins that react to or transport serotonin have been associated with an increased risk of OCD. Variations in other genes involved in communication in the brain are also associated with the condition, according to a study in Medline Plus, “Obsessive-compulsive disorder.” 

Neurological Factors

Neurological factors involve the brain’s structure and function, particularly in areas associated with anxiety and compulsive behavior. An imaging study by Hazari N, Narayanaswamy JC, Venkatasubramanian G., et al. 2019, “Neuroimaging findings in obsessive-compulsive disorder: A narrative review to elucidate neurobiological underpinnings,” has shown that individuals with OCD have abnormalities in brain regions such as the orbitofrontal cortex and the basal ganglia. These areas have altered activity in those with OCD, contributing to the intrusive thoughts and compulsions characteristic of the disorder.

Psychological Factors

Psychological factors encompass individual psychological traits and experiences that contribute to OCD. These include personality traits such as perfectionism, high levels of anxiety, or a tendency to overestimate threats. These psychological traits increase the likelihood of developing OCD by influencing how individuals perceive and respond to intrusive thoughts, according to a study by Law C. et al. 2023, titled “Personality traits as predictors of OCD remission: A longitudinal study.”

Biochemical Factors

Biochemical factors pertain to the balance of neurotransmitters in the brain, particularly serotonin. Imbalances in serotonin levels have been implicated in OCD. The selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels, effectively reduce OCD symptoms, according to a study by Soomro GM, Altman D, Rajagopal S, Oakley-Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive-compulsive disorder (OCD).”

Cognitive Factors

Cognitive factors relate to the way individuals process thoughts and perceive threats. Cognitive theories of OCD propose that individuals with the disorder misinterpret intrusive thoughts as dangerous or unacceptable, leading to compulsive behaviors as a means of reducing anxiety. Cognitive distortions, such as overestimation of danger and inflated responsibility, contribute to the maintenance of OCD symptoms, as studied by Abramowitz JS, Khandker M, Nelson CA, Deacon BJ, Rygwall R., et al. 2006, “The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study.”

What are the Treatments of Obsessive-Compulsive Disorder? 

The treatments of the obsessive-compulsive disorder include various approaches, primarily psychotherapy and medications, as studied by Brock H, Rizvi A, Hany M., et al. 2024, “Obsessive-Compulsive Disorder.”

Psychotherapy, particularly cognitive-behavioral therapy (CBT), is considered the most effective treatment for OCD. It helps patients understand and manage their obsessions and compulsions by challenging irrational thoughts and behaviors under the guidance of a licensed mental health professional. Medications, such as selective serotonin reuptake inhibitors (SSRIs), are also effective in managing symptoms, enhancing the benefits of psychotherapy.

A combination of treatments yields the best results, as it addresses both the cognitive and biological aspects of the disorder.

1. Psychotherapy

Psychotherapy refers to various therapeutic approaches aimed at helping individuals understand and cope with their intrusive thoughts and compulsive behaviors. It provides increasing support for patients to explore their feelings and learn effective coping mechanisms. Psychotherapy helps treat OCD by allowing individuals to confront their fears and anxieties in a structured manner, thereby reducing the intensity and frequency of their symptoms, as studied by Gragnani A., Zaccari V, Femia G., Mancini F., et al. 2022, “Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study.”

The benefits of psychotherapy include improved emotional regulation, increased support from a licensed mental health professional, and enhanced ability to manage stress. However, there are risks, such as the possibility of initially feeling overwhelmed when addressing distressing thoughts or memories during therapy. Psychotherapy is effective when combined with medication, especially for severe cases of OCD in adults and children.

The types of psychotherapies used in OCD include:

• Cognitive Behavioral Therapy (CBT): CBT is a therapeutic approach that focuses on recognizing and altering negative or irrational thought patterns contributing to OCD symptoms. In CBT, patients are taught how their thoughts, feelings, and behaviors are interconnected, and they work to challenge irrational beliefs. The therapy aims to reduce obsessive thoughts and compulsive behaviors by helping individuals adopt healthier, more realistic thinking patterns.
• Exposure and Response Prevention Therapy (ERP): ERP is a specialized form of CBT designed to expose individuals gradually to their feared thoughts or situations while preventing them from engaging in their usual compulsive responses. The goal of ERP is to help patients confront and tolerate anxiety without relying on compulsions, allowing their anxiety to diminish naturally over time and reducing the frequency of compulsive behaviors.

Both therapies are instrumental in managing stress and developing healthier coping strategies, ultimately leading to better outcomes in overcoming OCD symptoms.

2. Medication

Medication for obsessive-compulsive disorder (OCD) helps alleviate the symptoms associated with the disorder. These medications are effective in reducing the severity of obsessions and compulsions by targeting the brain’s neurochemical systems, specifically focusing on the regulation of serotonin, a key chemical transmitter involved in mood and anxiety regulation, according to an article by the International OCD Foundation, “Medications for OCD.”

Medications help treat OCD by balancing neurotransmitters in the brain, particularly serotonin, which reduces anxiety levels and improves overall mood. This leads to decreased obsessive thoughts and compulsive behaviors. The benefits of medication include a significant reduction in symptoms, improved functioning, and the potential to enhance the effectiveness of psychotherapy. However, risks consist of higher doses leading to adverse side effects, such as gastrointestinal issues, insomnia, or increased anxiety during the initial adjustment period.

The types of medications used in OCD include:

• Tricyclic Antidepressants: Tricyclic antidepressants (TCAs) are a class of medications that are used to treat OCD by increasing serotonin levels in the brain. While effective, they come with more side effects compared to other options, making them less commonly prescribed today. They are considered for individuals who do not respond well to different medications.
• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are the first-line treatment for OCD due to their ability to target serotonin more directly, leading to fewer side effects than TCAs. They work by blocking the reabsorption (reuptake) of serotonin in the brain, which increases the availability of serotonin and helps alleviate OCD symptoms, as studied by Kotapati VP et al. 2018, “The Effectiveness of Selective Serotonin Reuptake Inhibitors for Treatment of Obsessive-Compulsive Disorder in Adolescents and Children: A Systematic Review and Meta-Analysis.” SSRIs are effective in managing symptoms at lower doses, helping to minimize side effects while still providing relief for many individuals.

What Risk Factors Increase the Likelihood of Developing OCD?

The risk factors that increase the chances of developing obsessive-compulsive disorder (OCD) are genetics, temperament, and experiences of childhood trauma.

The main factors that increase the likelihood of developing OCD are as follows:

• Genetics: A family history of OCD or other mental health disorders increases the likelihood of developing OCD, suggesting a hereditary component to the condition.
• Temperament: Certain personality traits, such as a tendency toward anxiety, perfectionism, or a heightened sensitivity to stress, predispose individuals to OCD.
• Traumatic Childhood: Experiences of trauma during childhood, including significant stressors or adverse life events, contribute to the development of OCD.
• Abuse: Physical, emotional, or sexual abuse during formative years has long-lasting psychological effects, increasing the risk of developing OCD.
• Childhood Trauma: Generalized trauma, such as the loss of a parent or exposure to violence, triggers OCD symptoms in vulnerable individuals.

What Causes OCD Symptoms to Get Worse?

The factors that cause OCD symptoms to get worse include stress, particularly during periods of significant transition or change in a person’s life. High-stress situations, such as moving to a new home, starting a new job, or experiencing personal loss, trigger or exacerbate symptoms, according to an article by the National Register of Health Service Psychologists, “Stressful Life Events and Obsessive Compulsive Disorder (OCD).” Changes in routine or environment also increase anxiety levels, leading to a resurgence of intrusive thoughts and compulsive behaviors associated with OCD.

What Does an OCD Episode Look Like?

An OCD episode looks like an intense period of obsessions and compulsions. A person experiences intrusive, unwanted thoughts (obsessions) that provoke extreme anxiety or distress, according to an article by Medical News Today, “What is obsessive-compulsive disorder (OCD)?” In response, they engage in repetitive behaviors or mental acts (compulsions) to alleviate the discomfort caused by these thoughts. For example, someone with contamination obsessions wash their hands repeatedly for fear of germs, while someone with checking compulsions repeatedly verifies if doors are locked or appliances are turned off. During an episode, these actions become time-consuming and interfere with daily functioning.

How Long Does an OCD Episode Last? 

A typical OCD episode lasts between a few minutes to several hours. However, the duration varies greatly depending on the individual and the severity of the condition, according to an article by Treat My OCD, “OCD Flare-ups: What causes them & how long they last.” Some people experience brief episodes of compulsions, while others engage in repetitive behaviors or obsessive thinking for extended periods throughout the day. The persistence of the episode is influenced by external stressors, overall mental health, and how well the condition is being managed through treatment such as therapy or medication.

Is OCD Considered an Anxiety Disorder?

Yes, OCD is considered an anxiety disorder because the intrusive obsessions and compulsive behaviors are driven by overwhelming anxiety and fear. In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from anxiety disorders, although within the same larger category as anxiety disorders (as one of the “neurotic, stress-related, and somatoform disorders”), according to  Stein DJ, Fineberg NA, Phillips KA. et al. 2010, in the study titled “Should OCD be classified as an anxiety disorder in DSM-V?” 

People with OCD experience heightened levels of stress when their compulsions or rituals are not performed, and the compulsive actions are aimed at reducing the anxiety caused by their persistent, unwanted thoughts.