Obsessive-compulsive disorder
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder, or OCD, is a relatively common mental health condition that consists of two parts - "obsessions" and "compulsions."
Obsessions are recurrent intrusive or unwanted thoughts, images, or urges that cause anxiety, disgust, fear, just-not-right experiences, or other forms of distress
Compulsions are repetitive behaviors that people do to feel safer or get rid of the distress caused by intrusive thoughts
Everyone has intrusive thoughts from time to time as well as certain rituals or repetitive behaviors, but we only consider someone to have OCD or obsessive-compulsive disorder when these thoughts and behaviors cause a great deal of distress, cause problems in people's lives, or take up a lot of time in their day-to-day life. You often hear people saying things like "I'm so OCD about my closet being clean," but we would only consider someone having true OCD if this concern led to a lot of distress or problems in their life (for example, if they were getting stuck in their closet when getting ready for the day making sure everything is perfect).
What causes OCD?
There are many factors that contribute to a person developing OCD. Although the causes of OCD will be unique to each person, there has been a lot of research on what factors maintain the OCD cycle. These factors include a person's psychology, biology, as well as and social and environmental factors.
The leading psychological explanations point to the cycle of obsessions and compulsions as maintaining symptoms. Everyone experience intrusive or unpleasant thoughts from time to time, but people with OCD might be more likely to believe these thoughts really matter or even are dangerous. When someone experiences an intrusive thought, it brings up anxiety, fear, disgust, shame, a sense of things not being "just right," or other difficult emotions. To escape from this discomfort, people with OCD use compulsions to help themselves feel better. This can bring relief from these difficult thoughts and emotions, but it is only temporary, as compulsions are quick fixes that do not let a person find out how scary or meaningful their intrusive thoughts really are.
Another important part of psychological models is avoidance. People with OCD often avoid triggers for their obsessions because of how dangerous these situations feel or how distressing they can be. Although avoidance also helps manage distress in the short term, just like compulsions, avoiding triggers does not let a person test out how scary or realistic their intrusive thoughts really are.
Biologically, there has been lots of research suggesting that problems with the way specific brain circuits or "loops" work are associated with obsessions and compulsions. These loops involve communication between different parts of the brain that are responsible for critical thinking and decision making (certain parts of the frontal cortex) and deeper parts of the brain that are responsible for understanding sensory inputs, learning, motor control, and other functions (for example, the thamalus and striatum). When there is an imbalance in the "go" and "stop" signals between these parts of the brain, it is believed people can get stuck on repetitive obsessive thoughts or compulsive behaviors.
Environmentally, trauma and stressful life circumstances also often contribute to the development of OCD. People with OCD are more likely to have traumatic experiences, which may or may not be directly linked to the content of their obsessions and compulsions.
What are the most common types of obsessions and compulsions?
There are four commonly identified OCD domains:
Contamination: obsessions about dirt, germs, contamination, and disgust, as well as washing and cleaning compulsions.
Symmetry and incompleteness: obsessions about things needing to be ordered, symmetrical, or done in "just-right" way, which are often paired with ordering, arranging, repeating, and aligning compulsions (among many others).
Harm: obsessions about harm coming to the self or others, which come along with checking, reassurance-seeking, and mental compulsions
Taboo or forbidden thoughts: These often involve intrusive thoughts tied to morality, religion, sexuality, or violence, and are often paired with reassurance-seeking, excessive praying, checking, and other compulsions.
In addition to these four domains, people can develop obsessions and compulsions about nearly any topic. These often change with the times. For example, I see more people now with obsessions about harming the environment or being "canceled" for a past mistake that could be discovered.
What is the recommended psychotherapy for people with OCD?
The gold-standard treatment for people with OCD is a specific type of cognitive behavioral therapy called "exposure and response prevention," or "ERP."
My/my child's OCD is not related to contamination or symmetry. Will treatment still help?
Yes! Many studies have investigated this question, and the majority show that treatment is effective regardless of the type of symptom a person experiences, including people with intrusive thoughts related to religion, morality, sexuality, and other topics.
When does OCD tend to start?
It is believed that there are two peak time periods when OCD tends to begin - one just before puberty (about 8-10), and another peak in later adolescence/early adulthood.
How common is OCD?
About 1-2% of children and adolescents experience OCD and about 2-3% of adults.