Obsessive-

Compulsive
Disorder:
When Unwanted Thoughts or
Repetitive Behaviors Take Over

National Institute
of Mental Health
People who are distressed by recurring, unwanted, and
uncontrollable thoughts or who feel driven to repeat
specific behaviors may have obsessive-compulsive
disorder (OCD). The thoughts and behaviors that
characterize OCD can interfere with daily life, but
treatment can help people manage their symptoms.

What is OCD?
OCD is a common, long-lasting disorder characterized by uncontrollable,
recurring thoughts (obsessions) that can lead people to engage in
repetitive behaviors (compulsions).
Although everyone worries or feels the need to double-check things on
occasion, the symptoms associated with OCD are severe and persistent.
These symptoms can cause distress and lead to behaviors that interfere with
day-to-day activities. People with OCD may feel the urge to check things
repeatedly or perform routines for more than an hour each day as a way of
achieving temporary relief from anxiety. If OCD symptoms are not treated,
these behaviors can disrupt work, school, and personal relationships and
can cause feelings of distress.
OCD symptoms tend to emerge in childhood, around age 10, or in young
adulthood, around age 20 to 21, and they often appear earlier in boys than
in girls. Most people are diagnosed with OCD by the time they reach
young adulthood.

What are the signs and symptoms of OCD?

People with OCD may have obsessions, compulsions, or both.
Obsessions are repeated thoughts, urges, or mental images that cause
anxiety. Common obsessions include:
⊲ Fear of germs or contamination
⊲ Fear of forgetting, losing, or misplacing something
⊲ Fear of losing control over one’s behavior
⊲ Aggressive thoughts toward others or oneself
⊲ Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
⊲ Desire to have things symmetrical or in perfect order
Compulsions are repetitive behaviors that a person feels the urge to do in
response to an obsessive thought. Common compulsions include:
⊲ Excessive cleaning or handwashing
⊲ Ordering or arranging items in a particular, precise way
⊲ Repeatedly checking things, such as that the door is locked or the oven
is off
⊲ Compulsive counting

How do I know if it’s OCD?

Not all rituals or habits are compulsions. Everyone double-checks
things sometimes. In general, people with OCD:
⊲ Can’t control their obsessive thoughts or compulsive behaviors,
even when they recognize those thoughts or behaviors as excessive
⊲ Spend at least 1 hour a day on these obsessive thoughts or
compulsive behaviors
⊲ Don’t get pleasure when performing compulsive behaviors or
rituals, but may feel brief relief from the anxiety brought on by
obsessive thoughts
⊲ Experience significant problems in daily life due to these
thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden,
brief, repetitive movements, such as eye blinking and other eye movements,
facial grimacing, shoulder shrugging, and head or shoulder jerking. Common
vocal tics include repetitive throat-clearing, sniffing, or grunting sounds. It
is common for people with OCD also to have a diagnosed mood disorder
or anxiety disorder.
Symptoms of OCD may come and go, ease over time, or worsen. People
with OCD may try to help themselves by avoiding situations that trigger
their obsessions, or they may use alcohol or drugs to calm themselves.
Although most adults with OCD recognize that their compulsive behaviors
don’t make sense, some adults and most children may not realize that their
behavior is out of the ordinary. Parents or teachers typically recognize OCD
symptoms in children.
If you think you or your child may have OCD, talk to a health care provider
about the possible symptoms. If left untreated, OCD can interfere in all
aspects of life.
What causes OCD?
The exact causes of OCD aren’t known; however, a variety of factors are
associated with an increased chance of developing the disorder.
Genetics is one factor associated with OCD. Studies have shown that having
a first-degree relative (parent, sibling, or child) with OCD is associated with
an increased chance of developing the disorder. Scientists have not
identified any one gene or set of genes that definitively lead to OCD, but
studies exploring the connection between genetics and OCD are ongoing.
In addition to genetics, other biological factors may play a role. Brain
imaging studies have shown that people with OCD often have differences
in the frontal cortex and subcortical structures of the brain, areas of the
brain that underlie the ability to control behavior and emotional responses.
Researchers also have found that several brain areas, brain networks, and
biological processes play a key role in obsessive thoughts, compulsive
behavior, and associated fear and anxiety. Research is underway to better
understand the connection between OCD symptoms and parts of the brain.
Some studies have reported an association between childhood trauma and
obsessive-compulsive symptoms. More research is needed to understand
this relationship.
Children who develop a sudden onset or worsening of OCD symptoms
after a streptococcal infection may be diagnosed with a condition called
Pediatric Autoimmune Neuropsychiatric Disorders Associated with
Streptococcal Infections (PANDAS). You can learn more about PANDAS at
www.nimh.nih.gov/pandas.

How is OCD treated?

The first step is to talk with your health care provider about your symptoms.
Asking questions and providing information to your health care provider
can improve your care.
Your health care provider will perform a physical exam and ask you about
your health history to make sure that your symptoms are not caused by
other illnesses or conditions. Your health care provider may refer you to a
mental health professional, such as a psychiatrist, psychologist, social
worker, or counselor, for further evaluation or treatment.
Treatment for OCD typically includes specific types of psychotherapy (such
as cognitive behavioral therapy), medication, or a combination of the two. A
mental health professional can talk about the benefits and risks associated
with different treatment options and help identify the best treatment for you.
Sometimes people with OCD also have other mental illnesses, such as anxiety,
depression, and body dysmorphic disorder, a disorder in which someone
mistakenly believes that a part of their body is abnormal. It is important to
consider these other disorders when making decisions about treatment.
It is important to follow your treatment plan because both psychotherapy
and medication can take some time to work. Although there is no cure for
OCD, current treatments help many people with the disorder manage their
symptoms, engage in day-to-day activities, and lead full, active lives.

For tips on how to talk to your health care provider about your
mental health and get the most out of your visit, read the National
Institute of Mental Health (NIMH) fact sheet, Taking Control of Your
Mental Health: Tips for Talking With Your Health Care Provider,
available at www.nimh.nih.gov/talkingtips.

You can learn more about psychotherapies, including CBT, at

www.nimh.nih.gov/psychotherapies.
Medication
Your health care provider may prescribe medication to help treat OCD.
Serotonin reuptake inhibitors (SRIs) are the most common type of
medication prescribed for the treatment of OCD.
SRIs, including selective serotonin reuptake inhibitors (SSRIs), are often
used to treat depression, and they also are helpful for treating symptoms
of OCD. With SRI treatment, it may take up to 8 to 12 weeks before
symptoms begin to improve, and treatment for OCD may require higher
SRI doses than are typically used in treating depression. For some people,
these medications may cause side effects such as headaches, nausea, or
difficulty sleeping.
People respond to medication in different ways, but most people with OCD
find that medication, often in combination with psychotherapy, can help
them manage their symptoms.
Your health care provider can adjust medication doses over time to
minimize any side effects or withdrawal symptoms. Do not stop taking
your medication without talking to your health care provider first. Your
health care provider will work with you to monitor your health and can
adjust the treatment plan in a safe and effective way.
The most up-to-date information on medications, side effects, and
warnings is available on the U.S. Food and Drug Administration (FDA)
website at www.fda.gov/drugsatfda.

Other Treatments
In 2018, FDA approved the use of transcranial magnetic stimulation (TMS),
most commonly used in treating depression, as an add-on treatment for
adults with OCD. You can learn more about brain stimulation therapies,
including TMS, on the NIMH website at www.nimh.nih.gov/braintherapies.

Beyond Treatment: Things You Can Do

There are several important things you can do to manage stress and
anxiety associated with OCD.
⊲ Create a consistent sleep schedule.
⊲ Make regular exercise a part of your routine.
⊲ Eat a healthy, balanced diet.
⊲ Seek support from trusted family and friends.
Where can I go for help?
If you’re not sure where to get help, your health care provider is a good
place to start. Your health care provider can refer you to a qualified mental
health professional, such as a psychiatrist or psychologist, who has
experience treating OCD and can evaluate your symptoms.
You can learn more about getting help and finding a health care provider
on the NIMH website at www.nimh.nih.gov/findhelp. The Substance Abuse
and Mental Health Services Administration (SAMHSA) has an online tool at
https://findtreatment.samhsa.gov to help you find mental health services
in your area.

I know someone who is in crisis. What do I do?

If you or someone you know is having thoughts about wanting to die or is
thinking about hurting themselves or someone else, get help quickly.
⊲ Do not leave a person who is in crisis alone.
⊲ Call 911 or go to the nearest hospital emergency room.
⊲ Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK
(8255) or the toll-free TTY number at 1-800-799-4TTY (4889). You also
can text the Crisis Text Line (text HELLO to 741741) or go to the National
Suicide Prevention Lifeline website at https://suicidepreventionlifeline.org.
These services are confidential, free, and available 24/7.

Participating in Clinical Research

Clinical trials are research studies that look at new ways to prevent, detect,
or treat diseases and conditions. Although individuals may benefit from
being part of a clinical trial, participants should be aware that the primary
purpose of a clinical trial is to gain new scientific knowledge so that others
may be better helped in the future.
Researchers at NIMH and around the country conduct many studies with
patients and healthy volunteers. Talk to your health care provider about
clinical trials, their benefits and risks, and whether one is right for you. For
more information, visit: www.nimh.nih.gov/clinicaltrials.
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Information Resource Center at 1-866-615-6464, email [email protected],
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For More Information

NIMH website
www.nimh.nih.gov
MedlinePlus (National Library of Medicine)
https://medlineplus.gov
(En Español: https://medlineplus.gov/spanish)
ClinicalTrials.gov
www.clinicaltrials.gov
(En Español: https://salud.nih.gov/investigacion-clinica)

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National Institute
of Mental Health

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health
NIH Publication No. 20-MH-4676
Revised 2020