What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an illness that affects thoughts and actions and is believed to be rooted in faulty information processing in certain brain circuits. Studies suggest that two to three percent of the U.S. population (roughly five million Americans) may suffer from OCD at some point during their lifetimes.

OCD is characterized by recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. Individuals with OCD usually try to actively dismiss the obsessions or neutralize them by engaging in a ritual or avoiding situations that trigger them. In most cases, compulsions serve to decrease the distress and anxiety that is triggered by obsessions. However, it is common for the compulsions themselves to engender anxiety, especially when they become very demanding.

A hallmark of OCD is that the affected individual recognizes that his/her thoughts or behaviors are senseless or excessive. However, the discomfort and drive can be so powerful that the person gives in to the compulsion even though he/she knows it makes no sense.

Symptoms of OCD

The onset of OCD is usually in adolescence or early adulthood. Nearly one half of all cases begin during the childhood or teenage years and it is rare to see onset after age 35 years. Among adults with OCD, men and women are almost equally affected. Factors that predispose an individual to develop OCD have not been identified. However it is not uncommon for other family members to have similar tendencies or difficulties, indicating that there is a biological and genetic vulnerability that underlies OCD.

Common Obsessions:

  • Contamination: fear of dirt, illness, or germs
  • Responsibility: fear of leaving the stove on, fear of making a mistake
  • Aggressive: images of harming a child, spouse or loved one; fear of saying racial slurs
  • Sexual: unwanted sexual thoughts
  • Symmetry: need for items to be in order

Common Compulsions:

  • Excessive Cleaning: repetitive hand washing or use of hand sanitizer
  • Repeated Checking: checking stove, homework, locks
  • Counting/rearranging items
  • Asking others for reassurance

Typical Course of OCD

If untreated, OCD is usually chronic and follows a waxing and waning course. Only about 5-10 percent of OCD sufferers enjoy a spontaneous remission in which all symptoms of OCD go away for good. Another 5-10 percent experience progressive deterioration in their symptoms. Stress can make OCD worse, but trying to eliminate all stress is unlikely to quell OCD. If untreated, approximately one third to one half of children and adolescents with OCD continue to have OCD in adulthood. Early recognition and intervention is, therefore, very important.

Conditions Associated with OCD

Depression is a common complication of OCD. Approximately 75 percent of patients with OCD report that they have suffered from symptoms of depression, including feelings of despair, inability to experience pleasure, disturbed sleep, loss of energy, weight loss (or gain), decreased sexual drive, and suicidal thoughts.

Uncontrollable hair pulling or trichotillomania is present in some patients with OCD.

Several lines of evidence suggest a relationship between OCD and the childhood-onset disorder Tourette's syndrome (TS). About 50 percent of patients with TS develop obsessive-compulsive symptoms during the course of their illness.