OCD: A fact sheet

Adapted from the Obsessive-Compulsive Foundation website

If you or someone you care about has been diagnosed with obsessive-compulsive disorder, or OCD, you are not alone. About 1 in every 50 adults in the United States has OCD, and many more have had symptoms of OCD at some point in their lives.  Many of these people do not even know that they have OCD.  Fortunately, this disorder is more and more often being recognized by health professionals, and many effective treatments for OCD are now available.

What is OCD?

Worries, doubts, and superstitious beliefs are all very common in everyday life. However, when they become excessive or make no sense, such as hours of hand-washing, checking locks dozens of times, or driving around and around the block to make sure that an accident didn’t occur, then they become OCD.  In this disorder, it is as though the brain gets stuck on a particular thought, fear, or urge, and just can’t let go.  People with OCD often say that it feels like they have “brain hiccups” that won’t go away.  OCD is a medical disorder that causes problems in information processing.  It is not the result of a weak personality or something you or your parents have done wrong.

What are the symptoms of OCD?

OCD usually involves having obsessions and compulsions, although some people have only one or the other.

An obsession is a thought, image, or impulse that occurs over and over again and feels out of your control.  The person usually does not want to have these ideas, finds them intrusive and disturbing, and usually recognizes that they don’t make sense.  Some people even feel that the thoughts don’t belong to them, but come from somewhere else.  People with OCD may worry excessively about dirt and germs and be obsessed with the idea that they are contaminated or may contaminate others.  Or they may have obsessive fears of having accidentally harmed someone else (perhaps while pulling the car out of the driveway), even though they know that this is not realistic.  Or they may have urges to harm themselves or someone else, even though they really don’t want to do it.  Obsessions are accompanied by uncomfortable feelings, such as fear, anxiety, disgust, doubt, or a sensation that things have to be done in a way that is “just so” or “exactly right”.

People with OCD usually try to make their obsessions go away by performing compulsions.  A compulsion is an act that is done over and over again, or according to certain “rules”.  People with obsessions about contamination may wash their hands constantly, to the point where they become raw and painful.  A person may repeatedly check that he or she has turned off the stove because of an obsessive fear of burning the house down.  Sometimes the compulsions don’t make any sense at all.  For example, a person may have to get dressed in a certain way every day, because it has to feel “just right”.  Or he or she may have to touch the telephone six times before hanging up to protect their family from harm.

Unlike compulsive eating, drinking, or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals and compulsions are performed to provide relief from the discomfort caused by anxiety or obsessions.

Other features of OCD:

  • OCD symptoms cause distress, take up a lot of time (usually more than an hour a day), or significantly interfere with a person’s work, social life or relationships.
  • Most people with OCD recognize at some point that their obsessions are coming from within their own minds and are not just excessive worries about real problems, and that the compulsions they perform are excessive and unreasonable. However, this is not always the case. For a few people with OCD, and frequently in children with OCD, the obsessions and compulsions, although uncomfortable, may seem reasonable and appropriate.
  • OCD symptoms tend to wax and wane over time. Sometimes they may be little more than background noise; at other times they may be very distressing and disturbing.
  • OCD can start at any time from preschool age to adulthood (usually by age 40).
  • One third to one half of adults report that their OCD started during childhood.
  • On average, people with OCD see 3 to 4 doctors and spend over 9 years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.
  • OCD is under-diagnosed and under-treated for many reasons. Some people may not have access to treatment resources. People with OCD may be secretive about their symptoms or they may lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Also, people with OCD may come to a healthcare provider complaining about symptoms of depression or another anxiety disorder, which frequently co-occur with OCD. They may not tell their doctor about their OCD symptoms and their doctor may not ask, and the diagnosis of OCD therefore gets missed. This is unfortunate, as early diagnosis and proper treatment can help people avoid the suffering associated with OCD, and lessen the risk of developing other problems, such as depression or marital and work problems.

What causes OCD?    

Although it’s clear that genetics are important in OCD, and that serotonin is also important, there is no lab test for OCD. Rather the diagnosis is made based on an expert assessment of a person’s symptoms.

Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in people whose symptoms improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy.

These brain structures use the chemical messenger serotonin. It is believed that some abnormality in the levels or the regulation of serotonin play a role in OCD. Drugs that help to regulate the levels of serotonin in the brain often improve OCD symptoms.

Research suggests that OCD involves problems in communication between the orbitofrontal cortex in the brain and deeper brain structures such as the basal ganglia.

Although no specific genes for OCD have been identified yet, research suggests that genes play a role in the development of the disorder in some cases. Childhood-onset OCD tends to run in families (sometimes in association with tic disorders, sometimes not). When a parent has OCD, there is an increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the OCD itself that seems to be inherited, not the specific symptoms. Thus, a child may have checking rituals and dressing routines, while his mother washes compulsively.