Symptoms and Causes of Obsessive Compulsive Disorder

Published on: 22 May 2020
Clinically Reviewed by Catherine Richardson
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The term “OCD” (Obsessive Compulsive Disorder) is sometimes used thoughtlessly as a stand in for being focused on organization or tidiness.

For example, if a person likes to keep things clean or always pushes their chairs in a certain way, or likes their desk to be organized in a certain way, then they “must be OCD.” But “OCD” is often used pejoratively, rather than strictly adhering to standard medical definitions, such as those found in the DSM-V. Calling someone OCD can also be hurtful and using it can diminish the seriousness of this disorder that can be extremely destructive to the lives of those who suffer from it.

OCD can be expressed in a variety of ways, such as being afraid of germs or getting sick, cleaning excessively, or repeating patterns to alleviate anxiety. Instead of using OCD as a way to call someone out when they take longer to wash their hands, it’s far better to understand OCD symptoms and how these behaviors affect those who suffer from the disorder.

What are the Symptoms of OCD?

According to the DSM-V, OCD is an anxiety disorder. OCD symptoms are categorized into two behavioral areas: obsessive behaviors and compulsive behaviors. The presence of these behavior-types is what leads to an OCD diagnosis

Here are examples of OCD symptoms, summarized based on the DSM-V classification:

  • Recurrent and persistent thoughts, considered intrusive, that cause marked anxiety or distress (known as obsessions)
  • Ignoring or suppressing obsessions with some thought or action
  • Repetitive behaviors (e.g., hand washing) or mental acts (e.g. counting) that the person feels driven to perform in response to an obsession (known as compulsions).
  • The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation, but are excessive, or not connected in a realistic way with what they are designed to neutralize or prevent
  • The obsessions or compulsions are time consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The disturbances are not better explained by the symptoms of another mental disorder (e.g. generalized anxiety disorder), or substances (e.g. recreational drugs) or prescribed medications.

OCD Symptoms Explained by Medical Professionals

“The core features of OCD include intrusive, repetitive thoughts that intrude on thinking, obsessions, as well as repetitive behaviors that are done in excess, compulsions, used to diminish the anxiety brought on by the obsessions,” says Dr. Rebecca Sinclair, Director of Psychological Services Brooklyn Minds Psychiatry, P.C, “Often, the themes involve danger, risk, and most often a form of intolerance to uncertainty.” The Anxiety and Depression Association of America reports that OCD affects about 2.2 million people in the United States with the average onset for symptoms happening at 19.

Someone with germophobic tendencies may have OCD, but germaphobia is just one of the many ways OCD can manifest itself/ be presented in humans. “Some folks with OCD become fixated on concepts of harm or moral scrupulosity, meaning focuses on being a good or bad person or worries about the potential of hurting themselves or others. Others become untrusting of their memories or senses and become obsessed with making mistakes or forgetting to do something like turning off their stove, and we see them repeating checking behaviors over and over,” says Dr. Sinclair. “Still others become overly focused on superstitious beliefs and find themselves unable to complete other tasks because of focus on needing to complete rituals that may seem nonsensical even to them.”

In any of these cases the distinction between a habit or passing thought and OCD is critical to understanding an individual’s mental health. The key to recognizing this difference is the time spent obsessing.

“Someone has OCD when these activities take up more than an hour per day or start to interfere with a person’s life,” says Dr. Alessandro De Nadai, Assistant Professor of Psychology at Texas State University. “For example, I have worked with patients whose showering routine is so intensive that it often makes them late to work, and they have incurred thousands of dollars in traffic tickets racing to work because this process is making them late.”

Whereas an intrusive thought may only occupy a person’s mind for a few minutes, OCD is much harder to let go of and the thoughts repeatedly return to the forefront of an individual’s mind. As Dr. Sinclair explains, someone without OCD will have an intrusive thought that seems out of line with their typical mindset and be able to dismiss it as an outlier.

On the other hand, if the person has OCD symptoms, they will fixate on the thought, worry about why they had it, and have an incredibly difficult time freeing themselves of the thought.

What Causes OCD?

Unfortunately, there is still little known about why OCD develops and what spurs OCD symptoms. The foremost indicator, like many other disorders, is whether anyone else in your family has experienced OCD symptoms.

It’s likely that genetics and brain physiology play a role. “We also believe that brain functioning plays a large role in OCD, particularly the role of the neurotransmitter serotonin. Of interest is how that impacts the communication between brain structures that notice when something is wrong, as well as part involved in activating emotional responses,” explains Dr. Sinclair.

That’s not to say environmental factors are irrelevant to the way someone experiences or develops OCD. Cultural influences and scary experiences may play a role in the way OCD and OCD symptoms present.

“A person raised in an environment in which non-heterosexuality is devalued may develop sexual-identity focused obsessions because it’s identified as a feared content. Or someone who had a loved one in a car accident may become obsessed with the concept of hit-and-run accidents,” says Dr. Sinclair.

While these external environmental circumstances are not always to blame, obviously, the symptoms of OCD will be the same.

“The brain sends a worry signal to the part of the brain controlling emotion about the thought, and it can become the object of fixation. And the fear and behavior that OCD creates around the thought makes the thought ‘stick,’” says Dr. Sinclair. Experiencing OCD symptoms can reconfirm this association in the brain, further exacerbating the brain and body’s reactions.

How are OCD Symptoms Treated?

Though little is known about how OCD develops, treatment is available to lessen its impact. Like other mental health disorders, seeking help in person or via online therapy can provide relief.

“If the [OCD symptoms]] are impairing, patients should seek treatment called Exposure and Response Prevention (ExRP) provided by a professional,” says Dr. De Nadai. “This treatment involves practicing anxiety-provoking situations related to OCD together with a therapist — with practice over time, the OCD-related situations will make someone less and less anxious.”

For those who experience milder OCD symptoms, Dr. De Nadai recommends getting into the habit of confronting intrusive thoughts and fears directly instead of simply hoping they’ll go away. While ignoring these thoughts can provide relief in the short term, they often come back stronger the next time. Instead, sitting in the discomfort the thoughts arouse can allow a person to become more desensitized to them and be less overwhelmed when they appear.

“When I work with folks with OCD, I often talk about acceptance. Some get very angry or find the term off-putting because it sounds like resignation. When in fact, acceptance of uncertainty is about a willingness to experience the negativity and about the inevitable fact of uncertainty,” says Dr. Sinclair.

While change won’t happen overnight, OCD can go from being a controlling force in your life to just a small part of it.

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