Obsessive compulsive disorder (OCD) is a common long-term mental health condition which causes obsessive thoughts and compulsive behaviours.

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Find out more about the symptoms, treatment and management of the condition

What is OCD?

OCD is a mental health condition that can affect both thoughts and behaviour. While it can develop in childhood, it usually emerges in early adulthood.

People with OCD experience obsessive and unwanted thoughts, images, or urges. They often deal with or neutralise these thoughts by engaging in compulsive and repetitive behaviours. This can lead to a cycle of repeated, uncontrolled and unwanted thoughts and behaviours that can have a significant impact on their daily lives. For example, a person with an obsessive fear of burglars may repeatedly and excessively check door and window locks.

Many people will experience similar distressing and unwanted thoughts and the urge to complete repetitive behaviours at some point, but this can be short-lived and doesn’t mean they have OCD. In OCD, the distressing thoughts and repetitive behaviours are persistent. People with OCD will continue to struggle with their obsessive thoughts, even if they know the ideas they reflect aren’t based in reality.

The compulsive behaviours that individuals use in response to their obsessive thoughts can temporarily relieve the anxiety, but the obsession and anxiety soon return, causing the cycle to begin again.

What are the main types of OCD?

OCD is a single condition, but people may experience it in different ways. Most people with OCD tend to experience both obsessive thoughts and compulsions, but it is possible to just experience one without the other. In addition, the types of obsessive thoughts and compulsive behaviours will vary between individuals; for example, some people may focus on cleanliness while others may develop hoarding as a symptom.

Some experts think the OCD that begins in childhood differs from that which develops in adults. One study looking at pairs of twins showed that genes play a larger role in OCD that starts in childhood than in OCD whose symptoms begin in adulthood.

How many people have OCD?

A study of OCD prevalence in people aged 20 and over in 17 major European countries estimated that there were 6.4 million cases in 2019, and forecast the 12-month prevalence in 2029 to range from 16 per 1,000 in Italy to 17 per 1,000 in Norway.

Worldwide rates of OCD have been estimated at 1.5% for women and 1.0% for men. Males are more commonly affected in childhood, although women have a slightly higher prevalence in adulthood., The condition affects people of all genders, ethnicities, and socio-economic statuses.

Symptoms

It’s important to remember that everyone experiences autism differently. Just like anyone else, autistic people have their own strengths and weaknesses, likes and dislikes.

What are the symptoms of Autism?

People with OCD may have symptoms of obsessions, compulsions, or both. The symptoms can have a negative impact on all aspects of their life, such as work, school, college, and personal relationships.

What are the symptoms of OCD?

OCD can cause people to experience repeated unwanted and distressing thoughts, known as obsessions. They may also feel the urge to complete certain repetitive behaviours to respond to and neutralise those thoughts; these are known as compulsions. Common symptoms include:

Obsessions

  • A fear of germs or becoming contaminated in some way by other people or the environment
  • Recurrent intrusive thoughts
  • Unwanted and disturbing thoughts involving sex or violence
  • A fear of self-harm or of harming others, either on purpose or by accident
  • A need for symmetry, precision, and order
  • A fear of blurting out obscenities
  • A fear of losing something important

While some obsessive thoughts may be frightening for people with OCD, having these thoughts in no way means they will act on them.

Compulsions

  • Excessive cleaning – for example, within the home
  • Excessive personal hygiene – for example, repeated handwashing or showering
  • Repeatedly checking locks and switches
  • Ordering and arranging items in a precise way
  • A need to keep counting to the same number
  • Hoarding
  • Frequently asking for reassurance or another person’s approval

Not all compulsions have an obvious or logical link to the obsessive thought they are used to neutralise; however, acting out the behaviour can provide the individual with some relief from that thought.

Some individuals with OCD may also have a tic disorder. These can include sudden repetitive movements such as blinking, grimacing, or jerking of the head or shoulders, or vocalisations such as repetitive throat-clearing, sniffing, or grunting.

What are the stages of OCD?

OCD symptoms may come and go and may reduce or get worse over time. Treatments will help most people with the condition to manage their symptoms and reduce the impact on their day-to-day life.

Parents or teachers typically recognise OCD symptoms in children, while many adults will seek support when they realise their obsessive thoughts and behaviours are not based in reality and are affecting their quality of life.

In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible.

What are the early signs of OCD?

People with OCD usually first display mild symptoms of obsessions and compulsions, which can worsen over time. Early signs can include repetitive behaviours and set ways of doing things, problems with relationships, and hoarding.

Often parents or teachers will first notice the early signs in children, which are similar to those in adults and may include being obsessed with germs, looking for reassurance or checking things constantly, and worrying that a particular thing might happen.

Causes, risk factors and life expectancy

The exact causes of OCD are unknown; however, risk factors are thought to include genetics, the make-up of the brain, and the wider environment.

What causes OCD?

There are a number of possible causes of OCD. People may develop it as a result of their genes; those who have parents or siblings with OCD are at a higher risk of developing it themselves.

There could also be a connection between OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear, and research is continuing. Some people with OCD have areas of unusually high activity in their brain, or low levels of the chemical serotonin.

OCD may be more common in people who have been bullied, abused, or neglected, and can be triggered by an important life event such as becoming a parent or suffering a bereavement. It may also be more likely to develop in people who are highly methodical with high personal standards, or in those who are generally anxious with a very strong sense of responsibility for themselves and others.

In some cases, children may develop OCD symptoms following an infection with streptococcal bacteria – this is known as ‘paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections’ (PANDAS). PANDAS happens very suddenly, with symptoms appearing seemingly overnight, and has a very severe impact on the child’s life.

Is OCD hereditary?

Genes are likely to play a role in people developing OCD, meaning that it does run in families. However, the causes of OCD are not clear, and other factors such as life experiences may also be involved.

Who gets OCD?

OCD can affect men, women, and children. Some people start having symptoms early – often around puberty – but the condition usually starts during early adulthood.

Women can sometimes develop OCD during pregnancy or after their baby is born. In this instance, obsessions will commonly relate to worry about harming the baby, with compulsions such as repeatedly checking the baby is breathing.

How long can you live with OCD?

OCD is not life-threatening. Its impact can vary over time as the severity of the symptoms varies. The obsessive thoughts and compulsive behaviours may naturally reduce or increase at different times. Treatments and coping mechanisms can help people affected by OCD to manage the effects of the symptoms and improve overall quality of life in the longer term.

Diagnosis

Most people are diagnosed by about age 19, with the onset of symptoms typically earlier in boys than girls. However, onset after the age of 35 can also occur.5

How is OCD diagnosed?

OCD must be diagnosed by an experienced mental healthcare professional. They will generally talk with the patient about their obsessions and compulsions, how often they occur, and the impact they are having on that person’s day-to-day activities and their quality and enjoyment of life overall.

Generally, for a diagnosis, the symptoms should be present for an hour or more each day and should be having a long-lasting impact on the patient’s life and activities.

Assessment scales may be used to measure the severity of OCD. The National Institute of Mental Health–Global Obsessive Compulsive Scale (NIMH-GOCS) can be used to assess overall OCD severity on a scale from 1 (minimal symptoms) to 15 (very severe), while the Yale-Brown Obsessive Compulsive Scale is used to measure the severity of symptoms of OCD, without being influenced by the type of obsessions or compulsions present. This scale is used by clinicians to rate symptoms from non-existent to extreme, with separate subtotals for severity of obsessions and compulsions.

Healthcare professionals will also need to rule out any other possible mental health conditions that may be causing the symptoms, and consider any other conditions the patient may have (for example, depression, anxiety, or an eating disorder) so that the right treatment is offered.

Test to diagnose OCD

There are no physical tests that can be used to diagnose OCD. It is diagnosed through consultations with an experienced mental healthcare professional who can assess a patient’s thoughts, behaviours and their impact on daily life.

Treatment and medication

OCD can be distressing for the affected individual and those close to them; however, treatment can help manage the symptoms. This can both improve everyday life and help those affected to enjoy relationships and better social and leisure time.

How is OCD treated?

OCD is typically treated with psychological therapy, medication, or a combination of both. Although most patients with OCD respond to treatment, some will continue to experience symptoms.

Sometimes people with OCD also have other mental disorders, such as anxiety, depression, or body dysmorphic disorder. These must be taken into account when discussing potential treatments.

A short course of therapy is usually recommended for relatively mild OCD. People with moderate symptoms may need a longer course of therapy and possibly medication, and most will respond to treatment. People with more severe OCD will generally receive both therapy and medication, and some may be referred for specialist mental health support.

Medication

The medication used to treat OCD is usually in the form of anti-depressant medicines known as selective serotonin reuptake inhibitors (SSRIs). These can help reduce symptoms by altering the balance of chemicals in the brain.

For some patients, it may take several weeks for treatment to have an effect, but in other individuals the effects are felt much more quickly.

People taking an SSRI should only stop doing so with the support of their doctor, as some people may experience side effects if they stop suddenly.

There are several different SSRIs available, and people who do not respond to one medication might respond to another. The doctor will help to find the right medication for each individual.

Some people may find that SSRIs are not effective at all, in which case specific tricyclic antidepressants (TCA), which also inhibit serotonin reuptake, may be prescribed instead.

Therapy and intervention

Therapy for OCD often involves a type of cognitive behavioural therapy (CBT) which includes exposure and response prevention (ERP).

This involves the therapist working with the patient to identify the different elements of their symptoms – their thoughts, feelings, and behaviours.

During the sessions, patients are encouraged to face their fears and obsessive thoughts while not following through with their usual neutralising compulsive behaviours. This is known as response prevention. It helps patients to confront their thoughts and obsessions in a way that reduces the anxiety they feel in response to them, and they learn that their fears are not rooted in reality.

The therapist will work with patients over time, starting with those obsessions that cause the lowest amount of anxiety and working up to the ones that cause the most distress.

Neuromodulation techniques, where a chemical or electrical stimulus is used to alter nerve activity, may also be available. These techniques include: transcranial direct current stimulation (tDCS), in which a weak electrical current is applied to the scalp; repetitive transcranial magnetic stimulation (rTMS), a noninvasive technique that uses electric currents to modulate neuronal activity; and deep brain stimulation (DBS), which involves surgically implanting an electrode to activate neural circuitry. Neuromodulation techniques have so far been used for OCD mainly in a research context, but rTMS has now been approved in the US.

Diet

People with OCD should eat a normal, healthy, balanced diet and make sure they eat regularly so that their blood sugar levels don’t drop, as this can cause a low mood. Good foods to include in the diet are nuts and seeds, proteins such as eggs, beans and meat, and complex carbohydrates such as wholegrains, vegetables, and fruit. Caffeine should be limited.

Exercices

Maintaining a healthy lifestyle can help people who live with OCD. Exercise is beneficial for general physical and mental health, and it’s often recommended as one of the main treatments for mild depression. Regular exercise helps to raise self-esteem and promote a positive mood.

Exercise doesn’t have to be taken as part of an organised activity; it can be as simple as just keeping regularly active by going for a walk at lunchtime or after work, or having an informal game of football at the park.

The anxiety caused by OCD can also be reduced through relaxation techniques such as meditation, yoga, and massage.

Prevention

While OCD can’t be prevented, its symptoms can be reduced through therapy and medication. Early identification and treatment can also prevent mild OCD worsening into a more severe form.

Scientific studies

Research is ongoing into the efficacy of pharmacological interventions in OCD. A 2019 review of research into drug treatment found prolonged administration of SSRIs to be most effective and that combining the treatment with cognitive behavioural therapy (CBT) or exposure and response prevention (ERP) gives best results.

Other studies are underway into medications and other new treatment approaches that could be used for patients who do not respond to SSRIs, including combination and add-on treatments and deep brain stimulation.5 Some studies show that a type of surgery known as anterior capsulotomy can also be effective.,

Referenced sources

  1.  Inouye E. Similar and dissimilar manifestations of obsessive-compulsive neuroses in monozygotic twins. Am J Psychiatry. 1965;121:1171-1175. doi:10.1176/ajp.121.12.1171
  2.  Khan MK, Dupuy AV. Estimating the prevalence of obsessive compulsive disorder in Europe over the next ten years. Poster presented at: World Congress of Psychiatry; August 21-24, 2019; Lisbon, Portugal. doi:10.26226/morressier.5d1a038557558b317a140ebd
  3.  Weissman MM, Bland RC, Canino GJ, et al. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry. 1994;55 Suppl:5-10.
  4. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication (published correction appears in Arch Gen Psychiatry. 2005 Jul;62(7):709. Merikangas, Kathleen R [added]). Arch Gen Psychiatry. 2005;62(6):617-627. doi:10.1001/archpsyc.62.6.617
  5.  Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006-1011. doi:10.1001/archpsyc.1989.01810110048007
  6.  Stein DJ, Costa DLC, Lochner C, et al. Obsessive-compulsive disorder. Nat Rev Dis Primers. 2019;5(1):52. doi:10.1038/s41572-019-0102-3
  7. Del Casale A, Sorice S, Padovano A, et al. Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Curr Neuropharmacol. 2019;17(8):710-736. doi:10.2174/1570159X16666180813155017
  8.  Doshi PK. Anterior capsulotomy for refractory OCD: First case as per the core group guidelines. Indian J Psychiatry. 2011;53(3):270-273. doi:10.4103/0019-5545.86823
  9.  Pepper J, Zrinzo L, Marwan H. Anterior capsulotomy for obsessive-compulsive disorder: a review of old and new literature. Journal of Neurosurgery. 2019;133:1-10. 10.3171/2019.4.JNS19275
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