What is obsessive compulsive disorder (OCD)?

Dr. Wayne K. Goodman, MD
Psychiatrist (Therapist)

Obsessive compulsive disorder, or OCD, is simple to define, but often hard to diagnose, says Wayne Goodman, MD, chairman of the Department of Psychiatry at the Mount Sinai School of Medicine. Watch Goodman explain the basics of OCD in this video.

Obsessive compulsive disorder (OCD) is an illness, like asthma or diabetes. An obsession is a worrying thought. A compulsion is an action that the OCD makes people do, even if they know it’s silly. And disorder means problem.

OCD is something that happens in a part of the brain called the basal ganglia. When people encounter something dangerous, the basal ganglia sends a message to other parts of the brain to alert them that something is wrong. In people with OCD, the basal ganglia keeps sending them the "something is wrong" message even when there isn’t any danger.

Dr. Alice Domar
Psychology Specialist

People with OCD become preoccupied with certain persistent thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. For example, if you’re obsessed with germs, you may develop a compulsion to sanitize the kitchen counter over and over again. If you’re obsessed with neat handwriting, you may copy a letter over many times before being satisfied with the results. People with OCD sometimes feel the need to repeatedly touch, count, or check things (such as the kitchen stove, to make sure it’s turned off). Their obsessive thoughts and rituals may interfere with their daily lives.

Be Happy Without Being Perfect: How to Worry Less and Enjoy Life More

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Donna Hill Howes, RN
Family Practitioner

Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with OCD feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life.

The frequent upsetting thoughts are called obsessions. To try to control them, a person will feel an overwhelming urge to repeat certain rituals or behaviors called compulsions. People with OCD can't control these obsessions and compulsions.

For many people, OCD starts during childhood or the teen years. Most people are diagnosed by about age 19. Symptoms of OCD may come and go and be better or worse at different times.

Dr. Michael J. Mufson, MD
Psychiatrist (Therapist)

Obsessive-compulsive disorder (OCD) is characterized by obsessions (distressing and intrusive thoughts, worries, or urges that are involuntary and occur repeatedly) and compulsions (ritual behaviors that a person uses in an attempt to feel safe and decrease anxiety). The most common obsessions involve persistent thoughts of becoming contaminated, having neglected to do something (such as turn off the oven), having done something terrible (such as harm someone), or needing to have objects in a particular order. Aggressive impulses and pornographic thoughts are also common. Compulsions can include handwashing, repeatedly checking something (for example, that the door is locked or that the stove is off), or mental acts such as praying, counting, or repeating words.

People with OCD have obsessions, compulsions, or both for more than an hour a day. These thoughts or actions often cause significant distress and can interfere with the individual's ability to function at work, in relationships, or in any normal routine. Unlike children, many adults with OCD eventually realize that their obsessions or compulsions are unreasonable. But their attempts to eliminate the compulsive behavior usually fail because doing so causes unbearable anxiety. Obsessions and compulsions can be so distracting that an individual can't concentrate on normal tasks. Although the symptoms are driven by a desire to do something perfectly, their force often derails the person's ability to even complete a task.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Obsessive Compulsive Disorder (OCD) is a twofold disorder that consists of:

  1. Obsessions: Involuntary thoughts, ideas, images, or impulses that become disturbing or distracting and won't go away. Examples include a preoccupation with dirt or germs; fear or worry of accidentally harming people; or an extreme need for order and symmetry. Some people with OCD harbor obsessions around sexual, religious, or violent images that they find disturbing or repugnant, but cannot stop.
  2. Compulsions: Behaviors or rituals one feels compelled to act out again and again. Excessive hand washing or cleaning; double-checking of locks, appliances or switches; and ordering or arranging things "just so" are common types of compulsive behavior. Rituals such a praying, counting, or tapping before simple everyday acts like shaking hands or driving to the supermarket can also be symptoms of OCD. These repetitive behavioral patterns are performed to create a sense of control, help the person feel safe, and neutralize the anxiety created by the obsession.

The symptoms for OCD can range from mild to severe. While OCD sufferers know their behavior is irrational, they often can't stop it on their own. Also, they're often ashamed or unaware they even have a treatable disorder. Unfortunately, OCD can be easily mistaken for another mental health issue such as depression, bipolar disorder, or attention deficit hyperactivity disorder (ADHD), making it all the more difficult to diagnose, or resulting in the wrong treatment.

The onset of this crippling anxiety disorder generally happens in adults around age 21 and can inflict children near age 10. Typically, there is a significant delay between symptom onset and treatment due to the patient's own embarrassment and the long-held but false belief that little can be done about OCD.

Quality of life for the OCD sufferer is greatly compromised because of shame, distress, and time spent carrying out compulsive behaviors. One study found that 13% of OCD patients have attempted suicide.

A person with the diagnosis of obsessive-compulsive disorder has an unreasonable thought, fear, or worry that he or she tries to manage through a ritualized activity to reduce the anxiety. Frequently occurring disturbing thoughts or images are called obsessions, and the rituals performed to try to prevent or dispel them are called compulsions.

People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce; most of the time, the rituals end up controlling them. For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed.

Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts to people they dislike, or having thoughts that are prohibited by religious beliefs.

While healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house, people with OCD perform their rituals even though doing so interferes with daily life. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.