OCD can be treated completely

Obsessive-Compulsive Disorder (OCD)


Katharine A. Phillips

, MD, Weill Cornell Medical College;

Dan J. Stein

, MD, PhD, University of Cape Town

Last full review / revision Sep 2018 | Content last changed Sep 2018
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Obsessive-compulsive disorder is characterized by obsessions, compulsions, or both. Obsessions are recurring, persistent, undesirable, frightening, intrusive ideas, conceptions or drive impulses .. Compulsions (also called rituals) are certain actions or trains of thought that those affected feel compelled to perform repeatedly in order to reduce or prevent the fear caused by the compulsions.
  • Most obsessive-compulsive disorder behaviors are associated with concern about danger or risk.

  • Doctors diagnose the disorder when a person has obsessions, compulsions, or both.

  • Treatment may include exposure therapy (preventing the response from compulsive rituals) and taking certain antidepressants (selective serotonin reuptake inhibitors, or clomipramine).

Obsessive-compulsive disorder (OCD) is slightly more common in women than men and affects approximately 1 to 2 percent of the population. On average, obsessive-compulsive disorder sets in at around 19 to 20 years of age, but over 25 percent of cases begin before the age of 14 ({blank} Obsessive-Compulsive Disorder (OCD) and related diseases in children and adolescents). Up to 30 percent of people with Obsessive Compulsive Disorder have or have had tic disorder.

Obsessive-compulsive disorder is different from psychoses, in which the sufferer loses touch with reality. Obsessive-Compulsive Disorder is also different from Obsessive-Compulsive Personality Disorder, although people with these disorders may share some common characteristics, such as: B. pedantry, reliability or perfectionism.


People with obsessive-compulsive disorder suffer from compulsions, i. H. Thoughts, ideas or impulses that come up again and again, although the person concerned does not want them to. These compulsions become imposed even when the person concerned is thinking about other things or doing other things. In addition, the compulsions usually lead to considerable suffering and severe fears. They usually include thoughts of harm, risk, or danger.

To the common obsessive-compulsive disorder belong:

  • Concerns about pollution (for example, worrying that touching a doorknob could catch you with an illness)

  • Doubts (such as worrying that the front door is unlocked)

  • Worrying that items are not perfectly lined up or straight

Because the compulsions are uncomfortable, those affected try to ignore and / or control them.

Compulsions (also known as rituals) are a way for those affected to deal with their compulsions. For example, they may feel driven to do something repeatedly, purposefully, and deliberately in an attempt to avoid or reduce the anxiety caused by the compulsions.

To the frequent compulsions belong:

  • Washing or brushing to remove dirt

  • Control actions to remove doubts (e.g. checking many times that the door is locked)

  • Counting (for example a certain number of repetitions of an action)

  • Organize (for example, the arrangement of dishes or objects at the workplace according to a certain pattern)

Most of the rituals, such as excessive hand washing or repeatedly checking that the door is locked, can be observed. Other rituals only take place in the head of the person concerned, e.g. B. repeated counting or constant low murmuring to avert danger, and are not visible from the outside.

Rituals may have to be performed in a certain way according to strict rules. The rituals can have a logical connection with the coercion, but this does not have to be the case. If there is a logical connection between the obsession and the obsession (for example, showering to avoid being dirty or checking the stove to avoid fire) these are clearly exaggerated. People may shower for hours each day or check the stove 30 times before leaving the house. All compulsions and rituals are time consuming. Those affected can spend many hours on it every day. This can cause so much suffering or affect the way of working or living so much that people are unable to work.

Most people with OCD suffer from obsessions and compulsions.

Most obsessive-compulsive disorder sufferers understand to some extent that their obsessions have nothing to do with real danger and that their compulsions are exaggerated. However, a few people believe that their compulsions are justified and that their compulsions are justified.

Some people with obsessive-compulsive disorder realize that their compulsions are excessive. Therefore, they may perform their rituals in secret, although some rituals take several hours a day.

Obsessive-compulsive disorder symptoms can cause people to lose their relationships with others and perform less well in school or at work.

Many people with obsessive-compulsive disorder also have other mental health disorders. About 75 percent of people with obsessive-compulsive disorder also have a lifelong diagnosis of anxiety disorder, around 50 to 60 percent have a lifelong diagnosis of major depressive disorder, and 23 to 32 percent have an obsessive-compulsive personality disorder. About 15 to 20 percent of people with obsessive-compulsive disorder have major depressive disorder at the time of diagnosis.

Around half of those affected have thoughts of suicide at some point and up to a quarter try to kill themselves. The risk of attempting suicide is increased if the person also has a major depressive disorder.

Did you know ...

  • Most people with obsessive-compulsive disorder know that their obsessions and compulsions are irrational.


  • Medical assessment based on certain diagnostic criteria

Doctors make the diagnosis of obsessive-compulsive disorder based on symptoms: obsessions, compulsions, or both. The obsessions or compulsions must include at least one of the following:

  • represent a significant burden or impair the person's lifestyle


  • Exposure Therapy with Prevention of Reaction

Often effective in treating obsessive-compulsive disorder are exposure therapy with prevention of rituals (reaction). In exposure therapy, the patient gradually and repeatedly exposes himself to situations or people that cause certain obsessions, rituals, or discomfort; however, the patient is prevented from performing his compulsive rituals (reaction prevention therapy). Discomfort and anxiety gradually decrease if the person concerned succeeds in not performing the ritual whenever he is exposed to the situation. In this way he learns that the ritual is not necessary in order to feel comfortable. Success usually lasts for years, presumably because those who have mastered this approach are able to continue following this procedure even after treatment is complete.

Selective serotonin reuptake inhibitors (like fluoxetine), a type of antidepressant, and clomipramine, a tricyclic antidepressant, are effective here. Many professionals believe that a combination of exposure therapy for ritual prevention and drug treatment is best.

Psychodynamic psychotherapy (which focuses on identifying unconscious patterns of current thoughts, feelings, and behaviors) and psychoanalysis have generally not proven effective in people with obsessive-compulsive disorder.

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