Obsessive-Compulsive Disorder (OCD)

What Is Obsessive-Compulsive Disorder (OCD)?

People with obsessive-compulsive disorder (OCD) experience obsessions, compulsions (also known as rituals), or both (usually both).

• Obsessions are recurrent and persistent thoughts, urges, or images that are intrusive and unwanted. They usually cause substantial anxiety or distress. People with OCD try to ignore or suppress the thoughts, urges, or images, or to neutralize them by performing a compulsion (also called rituals). Examples of OCD obsessions are intrusive thoughts about harm occurring to someone or worries about becoming contaminated.
• Compulsions (rituals) are excessive repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession. They're intended to decrease anxiety or distress, or to prevent something bad from happening. Examples include excessive handwashing, checking, or counting.

For example, a person with OCD may obsess about becoming contaminated with dirt or germs and wash their hands excessively in response. Or they may worry that the house will burn down so they feel compelled to check the stove 30 times to be sure it’s off before they leave the house.

To be diagnosed with OCD, the obsessions or compulsions must be time-consuming or cause significant distress or significant impairment in functioning.

How Common Is OCD?

OCD is common yet often under-recognized. In any one-year period, it affects about 1% to 2% of the population.

Who Gets OCD?

Anyone can get OCD. This condition occurs around the world. It affects both males and females and people of all ages, races, and ethnicities. OCD often starts during late adolescence.

How Serious Is OCD?

OCD varies in severity and can be quite severe. It can cause substantial suffering and often makes daily activities difficult. However, effective treatments are available.

What Treatments Work for OCD?

1. Medications called serotonin reuptake inhibitors (also known as SRIs, or SSRIs): These non-addicting, widely prescribed medications help stop obsessive thoughts and compulsive behaviors. They also often alleviate depression, anxiety, and other symptoms. They're usually well tolerated and are not habit forming. Often, higher doses are needed than are typically used for other conditions such as depression or anxiety. Other medications may also be helpful when added to an SRI.
   
   The SRI medications are fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), fluvoxamine (Luvox), clomipramine (Anafranil), and citalopram (Celexa). These medications' brand names, which are in parentheses, may differ in different countries.
2. Cognitive-behavioral therapy (CBT): CBT is a "here-and-now" practical treatment that helps change problematic OCD thoughts and behaviors. Exposure and response (ritual) prevention (ERP) is a key component of cognitive-behavioral therapy that focuses on OCD compulsions and avoidance behaviors. It helps people gain better control over their repetitive behaviors (compulsions) and reduce avoidance behaviors. ERP also helps people feel more comfortable when they’re in a situation that usually triggers their obsessions (for example, dirt for someone with contamination obsessions).

Medications and CBT are effective for a majority of people with OCD. These treatments usually improve OCD obsessions and compulsive behaviors, and they also often help people feel less depressed and anxious. Some people improve when they're treated with an SRI alone or with CBT alone, whereas others benefit from receiving both treatments at the same time. For more severe symptoms, treatment with both medication and CBT is usually recommended.

What Causes OCD?

OCD results from a complex combination of genetic predisposition/neurobiologic factors as well as life experiences and sociocultural factors.

Hope for People with OCD

OCD can be severely distressing and impairing. But there is hope for people with OCD! Recommended treatments help a majority of people get better.

For More Information About OCD

Please visit the website of the International OCD Foundation at https://iocdf.org/.

I’ve written many articles and chapters on OCD that have been published in scientific journals, books, and other publications. These articles are listed on my curriculum vitae (resume). You can get some of these articles free of charge on PubMed or Google Scholar. 

I've also published articles about OCD in the Merck Manual. You can read the consumer version here and the professional version here.

You can also find my articles on excoriation (skin-picking) disorder, trichotillomania (hair-pulling disorder), body-focused repetitive behavior disorder, and hoarding disorder by searching for these conditions in the Merck Manual consumer version here and the Merck Manual professional version here.

Contact Me

I've been evaluating and treating people with OCD for more than 30 years. If you'd like to see me for a one-time evaluation so I can give you treatment recommendations, or if you live in New York State Connecticut, or New Jersey and would like to see me for ongoing treatment, please call the Weill Cornell Psychiatry Specialty Center at 646-962-2820, email me at kap9161@med.cornell.edu (all lower case letters), or contact us.