What is OCD?
“Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress.”
Types of OCD
OCD is not one thing. Some of the patterns it takes:
- Contamination. Fear of getting sick, or of infecting someone you care about, after contact with something you believe is dirty. The most stereotyped form.
- Harm, with checking. Being deeply disturbed by violent intrusive thoughts that almost everyone has and most people shrug off.
- Symmetry. Fixation on how objects are positioned and arranged, and real distress when things are not aligned or look incomplete.
- Sexual orientation OCD. Obsessions about one's own sexuality. Often called Homosexual OCD, which is misleading: it happens to people of any sexuality, about any sexuality.
- Pedophilia OCD. Heavily stigmatised, and badly misunderstood. As with every type of OCD, these obsessions are not desires — the distress exists precisely because the thoughts are the opposite of what the person wants.
- Relationship OCD. An inability to tolerate the ordinary uncertainty of a relationship, and obsessions about whether it is the “right” one.
- “Just right” OCD. Harder to pin to a specific fear: a strong sense that something is wrong unless things are a certain way. The form most often played for laughs.
- Pure-O. Obsessions without visible compulsions. Some experts dispute that it is a distinct thing, since compulsions are usually there but mental. Many people recognize themselves in it.
The numbers
- An estimated 1.2% of US adults had OCD in the past year.
- Past-year prevalence was higher for women (1.8%) than for men (0.5%).
- Lifetime prevalence among US adults is 2.3%.
Watch: Debunking the myths of OCD — Natascha M. Santos for TED-Ed.
In their words
Obsessive-compulsive disorder is no joke
“The biggest lie about Obsessive-Compulsive Disorder is that it's funny, though it is, at times. I laugh when I remember running for the school bus barefoot every morning… because I had to button and unbutton my uniform so many times — in multiples of four — that I could never quite find the time to clothe my feet.”
Read the article (TIME, via the Internet Archive — the original page has been taken down)
A look inside my world with OCD
“A seemingly ‘normal’ day can flip in an instant… Many people experience fear, but in some people, fear isn't just a worry — it consumes every thought and action.”
Read the article (The Mighty)
Quirks that made more sense once I was diagnosed with OCD
“I would often count how many steps it took to get across a room… I even thought maybe if I accomplished this, I would somehow have good luck. And if I did not, maybe something bad would happen… At first, I thought everyone just did this.”
Read the article (The Mighty)
The chemistry behind OCD
Serotonin is a leading candidate. Antidepressants that increase serotonin — SSRIs — work well for most people with OCD, which suggests serotonin is involved, though it is very unlikely to be the single cause for any one person.
Imaging has identified three brain regions that are more active in people with OCD:
- The caudate nucleus, associated with filtering thoughts and managing habits. When OCD is well managed with treatment, activity here goes down.
- The prefrontal orbital cortex, associated with social behavior. Reduced activity lowers inhibitions; increased activity can produce social anxiety and worries about cleanliness or acting inappropriately.
- The cingulate gyrus, in the center of the brain, thought to regulate how a person reacts to troubling thoughts. Over-activity here may trigger compulsive behavior.
More recent work in laboratory mice has looked at a protein called SPRED2, which is concentrated in the brain. Removing it produced compulsive, excessive grooming. That is a finding in mice, not a treatment; researchers hope the pathway it sits on might eventually lead to one.
How does treatment help?
Exposure and Response Prevention (ERP) and the medications known as serotonin reuptake inhibitors are OCD's first-line treatments — the ones with the strongest evidence behind them, and the place to start. As the International OCD Foundation puts it, these are “the most effective and well-studied options for managing OCD”, and most people who complete a course of ERP get better.
- Exposure and Response Prevention is the form of cognitive behavioral therapy with the strongest evidence in OCD. It is usually done with a licensed therapist in an outpatient setting, once or a few times a week.
- Serotonin reuptake inhibitors are the medication class used, prescribed by a doctor or psychiatrist who ideally works with your therapist. Our medications guide covers how they work.
If ordinary outpatient ERP has not worked, more intensive levels of care exist — intensive outpatient programmes upward. The IOCDF keeps a directory of treatment providers.
If you need help right now
- Call 911 for emergency services, or go to the nearest emergency room.
- Call 988 — the 988 Suicide & Crisis Lifeline, 24 hours.
- Text HOME to 741741 — Crisis Text Line, if talking is too much right now.
A note from the team
We are not experts and do not seek to diagnose or act in place of professional psychiatric treatment. We are an organization seeking to raise awareness. If you have concerns about any of this material, please email us.
Sources
- International OCD Foundation — About OCD (the definition)
- International OCD Foundation — OCD treatment guide (the treatment section)
- NOCD — Different types of OCD (the subtypes)
- Verywell Mind — What is an obsession? (the subtypes)
- National Institute of Mental Health — Obsessive-compulsive disorder statistics (the numbers)
- Bridges to Recovery — What causes obsessive-compulsive disorder? (the chemistry section)