Obsessive-Compulsive Disorder

What is obsessive-compulsive disorder (OCD)?

From: MedlinePlus, National Library of Medicine

Obsessive-compulsive disorder (OCD) is a mental disorder in which you have thoughts (obsessions) and behaviors (compulsions) that occur over and over. They interfere with your life, but you cannot control or stop them.

It’s a myth that OCD just means being neat. Cleaning can be one symptom, but OCD more often involves getting stuck on a particular action you feel compelled to repeat, rather than simply staying organized. These obsessions and compulsions can shift over time.

What causes obsessive-compulsive disorder (OCD)?

From: MedlinePlus, National Library of Medicine

The cause of OCD is unknown. Factors such as genetics, brain biology and chemistry, and your environment may play a role.

Who is more likely to develop obsessive-compulsive disorder (OCD)?

From: MedlinePlus, National Library of Medicine

OCD usually begins when you are a teen or young adult. Boys are often diagnosed at a younger age than girls.

Risk factors for OCD include:

• Family history. People with a first-degree relative (such as a parent, sibling, or child) who has OCD are at higher risk. This is especially true if the relative developed OCD as a child or teen.
• Brain structure and functioning. Imaging studies have shown that people with OCD have differences in certain parts of the brain. Researchers need to do more studies to understand the connection between the brain differences and OCD.
• Childhood trauma, such as child abuse. Some studies have found a link between trauma in childhood and OCD. More research is needed to understand this relationship better.
• Temperament. Other studies found that people who are shy, often unhappy, or anxious and depressed as children may be more likely to develop OCD.

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection. This is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

What are the symptoms of obsessive-compulsive disorder (OCD)?

From: MedlinePlus, National Library of Medicine

People with OCD may have symptoms of obsessions, compulsions, or both:

• Obsessions are repeated thoughts, urges, or mental images that cause anxiety. They may involve things such as Fear of germs or contamination Fear of forgetting, losing or misplacing something Fear of losing control over your behavior Worries about harm coming towards yourself or others Unwanted forbidden thoughts involving sex or religion Aggressive thoughts towards yourself or others Needing things lined up exactly or arranged in a particular, precise way
• Compulsions are behaviors that you feel like you need to do over and over to try to reduce your anxiety or stop the obsessive thoughts. Some common compulsions include Excessive cleaning and/or handwashing Repeatedly checking on things, such as whether the door is locked or the oven is off Compulsive counting Ordering and arranging things in a particular, precise way

Some people with OCD also have Tourette syndrome or another tic disorder. Tics are sudden twitches, movements, or sounds that people do over and over. People who have tics cannot stop their body from doing these things.

How is obsessive-compulsive disorder (OCD) diagnosed?

From: MedlinePlus, National Library of Medicine

The first step is to talk with your health care provider about your symptoms. Your provider will do a physical exam and ask about your medical history to rule out other health problems. If your symptoms do not seem to be caused by a physical problem, your provider may do an OCD test or may refer you to a mental health specialist for further evaluation or treatment.

Obsessive-compulsive disorder (OCD) can sometimes be hard to diagnose. Its symptoms are like those of other mental disorders, such as anxiety disorders. It is also possible to have both OCD and another mental disorder.

Not everyone who has obsessions or compulsions has OCD. Your symptoms would usually be considered OCD when you:

• Can't control your thoughts or behaviors, even when you know that they are excessive
• Spend at least 1 hour a day on these thoughts or behaviors
• Don't get pleasure when performing the behaviors. But doing them may briefly give you relief from the anxiety.
• Have significant problems in your daily life because of these thoughts or behaviors

What are the treatments for obsessive-compulsive disorder (OCD)?

From: MedlinePlus, National Library of Medicine

The main treatments for obsessive-compulsive disorder (OCD) are cognitive behavioral therapy, medicines, or both:

• Cognitive behavioral therapy (CBT) is a type of psychotherapy. It teaches you different ways of thinking, behaving, and reacting to your obsessions and compulsions. Exposure and Response Prevention (ERP) is a specific type of CBT. ERP involves gradually exposing you to your fears or obsessions. You learn healthy ways to deal with the anxiety they cause.
• Medicines for OCD include certain types of antidepressants. If those don't work for you, your provider may suggest taking some other type of psychiatric medicine.

If you have severe OCD that does not get better with these treatments, your provider may suggest a treatment called repetitive transcranial magnetic stimulation (rTMS). It is a brain stimulation procedure that uses magnetic pulses. It can target specific brain areas associated with OCD.

Genetic causes described in the linked summary

From: MedlinePlus Genetics

The cause of OCD is unknown. Researchers are investigating whether the condition might involve changes in the brain's response to chemical messengers (neurotransmitters) such as serotonin or dopamine. Problems with regulating the activity of and interaction between various parts of the brain are also thought to contribute to the condition.

Variations in certain genes that provide instructions for proteins that react to or transport serotonin have been associated with an increased risk of OCD. Variations in other genes involved in communication in the brain may also be associated with the condition. However, not all people with OCD have an associated variation, and not all people with the variations will develop OCD.

In addition to genetic factors, researchers are studying environmental factors that might contribute to OCD, including complications during pregnancy or childbirth and stressful life events. However, none have been conclusively associated with this disorder. It seems likely that environmental conditions interact with genetic factors to determine the overall risk of developing OCD.

Inheritance described in the linked summary

From: MedlinePlus Genetics

The inheritance pattern of OCD is unclear. Overall, the risk of developing this condition is greater for first-degree relatives of affected individuals (such as siblings or children) as compared to the general public. For unknown reasons, the risk of inheriting the disorder appears to be higher in some families than in others. However, most people who have a close relative with OCD will not develop the condition themselves.

Which doctor should you see?

The suggested department for discussing Obsessive-Compulsive Disorder is Psychiatry, with a psychiatrist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

Additional services that may be relevant, depending on the findings, include: Clinical Genetics.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• How are symptoms affecting safety, sleep, relationships and everyday function?
• What roles could psychological treatment, medicines or support services have?
• Who should be contacted if safety or functioning deteriorates?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.