You always take a deep breath, hold it, then count to 10 before exhaling and walking into your office at work. You’re afraid of germs that might filter into your house when you fetch the mail, so you wipe down packages before opening them. It’s possible you’re experiencing signs of obsessive-compulsive disorder.
What is OCD?
Obsessive-compulsive disorder (OCD) is a disorder where someone has recurring, unwelcome thoughts, notions, or sensations (known as obsessions) that force them to do something repeatedly (known as compulsions). Repetitive actions, like hand washing, verifying something, or cleaning repeatedly, can significantly inhibit a person’s daily life and social relations. But people without OCD can also have distressing thoughts and behaviors, mostly happening occasionally and resolving themselves without causing significant problems.
Causes and Risk Factors
Like other anxiety disorders, obsessive-compulsive disorder can have multiple causes and risk factors. Knowing each can inform diagnosis and treatment.
Causes may include:
- Changes in your daily life, like relocating to a new town, marriage or divorce, or starting a new job or school
- Death of someone you love or other emotional suffering
- History of abuse
- Certain Illnesses like the flu, in which case you may begin obsessively washing your hands because you’re afraid of germs
- Low stores of serotonin, a naturally occurring substance in the brain that promotes mental balance
- Hyperactivity in areas of the brain, like the orbitofrontal cortex, the anterior cingulate cortex, and the head of the caudate nucleus
- Problems with relationships at work, school, or elsewhere
There are other risk factors to be aware of, some you can control, and others you can’t:
- Your family history. If your biological parents or other family members have the disorder, then you’re at a higher risk of getting OCD.
- Life stressors. If you’ve lived through traumatic or worrying events, your risk can go up. This could, for some reason, activate the intrusive thoughts, rites, and emotional distress typical of OCD.
- Other mental health problems. Some people with OCD may have other related mental health ailments, like other anxiety disorders, depression, substance use disorder, or tic disorders.
How to Identify OCD as an Anxiety Disorder
Obsessive-compulsive disorder is one of the five major anxiety disorders, but is rare, affecting only about 2 million adults in the United States. But there are ways to identify OCD, giving patients and healthcare providers insight into effective treatment options. People experiencing an anxiety disorder can’t always self-diagnose what’s happening to them, but the symptoms are always based on obsessions and compulsions.
Obsessions are repeated and persistent thoughts, desires, or mental images which trigger distressing emotions like anxiety or disgust. Some people with OCD know that the feelings, impulses, or images are created by their mind and are extreme or unreasonable. But the pain caused by such intrusive thoughts can’t be solved through logic or reasoning. Instead, most people who experience OCD try to reduce the anguish of the obsessions through compulsions, ignoring or suppressing the obsessions, or keeping themselves busy with other activities.
Obsessions may include:
- Fear of becoming polluted by people or the environment
- Disturbing thoughts or images
- Fear of shouting out vulgarities or insults
- Extreme concern with order, exactness, or symmetry
- Recurring intrusive thoughts of images, numbers, words, or sounds
- Fear of losing or getting rid of something of value
If you have obsessions, compulsions are repetitive behaviors or mental acts that you do in response. The behaviors typically stop or lower someone’s distress linked to an obsession. Compulsions can be excessive actions that are linked to an obsession (like washing your hands excessively because you’re afraid of germs), or actions that aren’t related at all. In the most extreme instances, a constant recurrence of rituals can occupy your day, making the possible seem impossible.
Compulsions may include:
- Extreme or ritualized hand washing, bathing, brushing teeth, or other personal hygiene chores
- Recurring cleaning of household items
- Ordering or arranging items in a specific way
- Repeatedly checking wearables or appliances
- Constantly seeking validation or reassurance
- Recurrent counting to a specific number
Diagnosis & Treatment
Arriving at a diagnosis may involve:
- Psychological assessment to discuss your thoughts, feelings, symptoms, and behavior patterns, and whether they involve obsessions or compulsive behaviors.
- Comparing your symptoms to criteria in the Diagnostic and Statistical Manual of Mental Disorders.
- A physical exam to see if there’s an underlying cause for symptoms.
In most cases, symptoms of obsessive-compulsive disorder can be managed with time and proper care. Effective treatment options include counseling, certain medicines, self-care, or ketamine therapy.