Obsessive Compulsive Disorder (OCD) is a mental health disorder marked by intrusive, unwanted thoughts that cause a sense of distress or anxiety. People manage these thoughts through rituals or compulsions, which can cause impairments in daily life functioning. Treatment through exposure and response prevention therapy  and medications are available and evidence-based. Though OCD is quite common with one in forty adults affected by the condition, less than 10% of those experiencing symptoms will seek treatment.

Learn more about the symptoms, diagnoses, causes, and treatments for OCD below.

OCD Definition, Symptoms, and Diagnosis

What is OCD?

Obsessive Compulsive Disorder (OCD) is a mental health disorder that manifests as repetitive intrusive thoughts (obsessions) that are scary or uncomfortable and repetitive behaviors (compulsions) such as checking or washing that serve to alleviate the anxious or uncomfortable feeling. In many cases, obsessions and compulsions can be intrusive to the point where the client may not be able to function normally. These thoughts or obsessions need to take up an hour a day for the disorder to be diagnosed.

What are symptoms of OCD?

Symptoms of OCD, which can range from mild to severe, can be broken into two categories: obsessions and compulsions.

Obsessions are thoughts, images, or feelings that an individual does not want to have and finds distressing. Many people frequently have unwanted or scary thoughts or images, but a person without OCD can dismiss the thoughts without anxiety or discomfort, and a person with OCD cannot. Often, people have insight into their obsessions as being irrational, but this does not necessarily help them dismiss the thought. Obsessions can be time-consuming and can get in the way of daily life.

Compulsions are behaviors that are done with the goal of neutralizing the anxiety and/or discomfort associated with the obsessional thought. They may be completely unrelated to the thought or image but provide temporary relief from the distressing obsession. Over time, a person with OCD begins to associate the ritual with the experience of relief and that makes it challenging to resist doing the compulsion. It is important to note that not all repetitive behaviors or rituals are an indication of OCD; it depends largely on the function of the behavior. If the compulsion succeeds in reducing anxiety/distress, we classify that as a compulsion. If the behavior does not serve a function of decreasing distress, we tend not to classify that as a compulsion.

How do you diagnose OCD?

While there are no lab tests or imaging procedures used to diagnose OCD, there are criteria for diagnosing OCD in the DSM-5 (Diagnostics and Statistics Manual), a manual that mental health professionals use for diagnosis. In addition, the Yale Brown Obsessive Compulsive Scale is another tool that can help elucidate the symptoms of OCD.

To diagnose OCD, someone must have these recurring, non-rational thoughts or images (obsessions) with behaviors that help to reduce the anxiety (compulsions). The symptoms must take up an hour or more a day and cause impairment in daily life.

To meet the criteria for diagnosis of OCD, the DSM-5 indicates that these obsessions and compulsions must not be the result of another disorder. Examples include food rituals that are the result of an eating disorder, disturbing thoughts that are the result of schizophrenia or other psychotic disorders, or excessive worries that are the result of Generalized Anxiety Disorder. In these cases, the individual may not be diagnosed as OCD. While individuals may have milder symptoms that do not meet all criteria for diagnosis of OCD, clients can still get tremendous benefit from treatment for the symptoms they do have.

As with all psychiatric disorders, diagnosis can be tricky and confusing as symptoms can cross over multiple disorders, and it is essential to get a proper evaluation with a licensed clinician.

What causes obsessive compulsive disorder?

No one knows exactly what causes OCD. Although OCD has been researched extensively, and no single cause has been identified.

Like most medical and mental health disorders, there is usually a family pattern of having similar symptoms and there may also be environmental factors that contribute to the development of the disorder. What experts do know is that there are brain structures and chemicals involved in the disorder and that it can be passed down by genes in families.

What types of obsessions are there?

• Contamination: Over-concern of being “contaminated” by germs, chemicals (e.g. from household cleaning products), or environmental chemicals (e.g. from radiation).
• Hypochondriasis or illness anxiety: Irrational fear of having an illness. For example, being preoccupied by a small bump on the skin and thinking it is cancer despite a doctor saying it’s a mosquito bite.
• Scrupulosity: A preoccupation with morality or blasphemy (fear of offending God).
• Losing control: Over concern with “losing your mind” or “going crazy” and harming another or yourself; worries of blurting out obscenities, stealing, or breaking the law; worry about certain images you can’t get out of your mind.
• Harm: Fear that you will cause harm to yourself or others or of being the cause of something terrible happening.
• Perfectionism or “just not right”: Fear of not doing something perfectly or correctly; fear of losing or forgetting things; preoccupation with past mistakes or fears of failure to the extent of preventing the individual from reaching for goals.
• Transformation: Fear of transforming into something or someone else. Worry about taking on the characteristics of someone else. An individual may fear that they have taken on the gestures or behaviors of a friend or even a stranger and that they are copying them, although they do not want to.
• Sexualized: Knowing one’s sexual preferences and desires, yet constantly and obsessively checking to make sure that they are right. Worrying that you might be a pedophile or might sexually assault someone.
• Magical thinking: Being obsessed about lucky numbers and/or letters.

What types of compulsions are there?

• Skin picking (dermatillomania): Continual picking at hangnails, scalp, scabs, blemishes, freckles, chest, shoulders, etc even after bleeding or pain occurs.
• Hair pulling (trichotillomania): Pulling out lashes or eyebrows or hair from the scalp and other body parts.
• Cleaning: Excessive hand washing, showering, or cleaning.
• Checking: Performing multiple physical checks, for example to see if the stove is turned off, or mental checks, for example to see if you have harmed someone.
• Mental rituals: For example, review of events to make sure nothing bad happened or repeated self-reassurance.
• Repeating thoughts, words, or behaviors: Such as repeating out loud the word “green” five times every time you pass your best friend’s house to protect the best friend.
• Canceling: For example, saying “cancel that thought” multiple times to get rid of the unwanted thought.
• Ritualized eating: For example, eating food in a certain order or in a certain pattern to avoid something bad happening.
• Ordering / symmetry : For example, feeling the need to have pencils on a table in exactly 90 degree angles.
• Hoarding: Inability to part with objects and items, even if the object is broken or is considered by most to be trash; experiencing great distress in parting with objects to the point that the individual may go to great lengths to retrieve the items.
• Confessing: Feeling the need to confess something the individual feels irrationally guilty about; for example, confessing to your boss out of guilt that you went to the bathroom two times, despite the fact that you are allowed to go the bathroom.
• Reassurance seeking: Obsessively questioning one’s decisions; for example, having to ask multiple people at the store repeatedly times whether or not the individual should purchase a certain item.
• Repetitive behaviors: Repeatedly touching, tapping, or rubbing self or items; for example feeling the need to open and close the kitchen cabinets nine times before making coffee in the morning; or feeling the need to tap the desk three times every time you read another sentence in a book.
• Self-damaging behaviors: Self-injurious behaviors such as obsessively and repeatedly hitting oneself; note this is different from non-suicidal self harm or suicidal behaviors.

These behaviors are considered compulsions because they help to decrease the severe worry that comes with the distressing thoughts or images. They may not be similar (worrying about germs may not have a compulsive ritual involving cleaning -- it could be counting, reassurance seeking, lock checking or other behaviors).  

For example, counting sheep to fall asleep at night isn’t a compulsion unless you must do it every night in a certain way at a certain time and if you “mess up” you have to start over again or an intrusive thought or image may continue. Checking the stove before you leave for work isn’t a compulsion but checking and rechecking to the point of not being able to leave for hours, is.