Obsessive-Compulsive Disorder (OCD): Symptoms, Causes & Treatments

Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects 1 to 3 per cent of the global population. According to a recent study, it is the 4th most common mental health disorder in the world. 

You might have heard of terms like “Oh, I am so OCD” thrown around casually. While OCD has become a popular term, the casual definition of OCD differs from its actual definition. 

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is defined as a disorder in which an individual experiences obsessions and compulsive behaviours or both. Obsessions are recurring, unwanted and uncontrollable thoughts. Compulsions are repetitive behaviours such as washing hands multiple times, compulsive counting and others. 

Now that we know what OCD is, let us look into its impact on people’s lives. 

The Impact of OCD on Daily Life

OCD’s impact on daily life can be significant, especially if it's left unmanaged. Its effects differ from person to person. It can affect all important areas of life such as occupation, education, relationships, mental health etc. An Indian study of 100 patients showed that the severity of symptoms and OCD stigma hurt the quality of life.

OCD’s primary mental health effect is that it causes intense feelings of distress or anxiety. The uncontrollable thoughts can lead to shame, guilt, and sadness. People can dwell on trying to understand why such thoughts are coming to them or on the content of the thoughts.

OCD makes daily functioning difficult. For example, spending an excessive amount of time on compulsions can lead to missing out on important tasks. Some compulsions such as pulling out hair or skin picking can have bad effects on the body. OCD is seen to impact sleep causing poorer sleep quality and more disturbed sleep. 

OCD can negatively impact relationships. It may lead to isolation and withdrawal from loved ones. People also struggle with unwanted or intrusive thoughts about loved ones. These can be thoughts about a loved one’s health, doubts about the relationships or obsessions revolving around loved ones. People struggling with OCD need more care and reassurance. Supporting loved ones with OCD can be difficult, especially if you don’t have the right resources or don’t know how.

Common Symptoms of OCD

Obsession Symptoms

Symptoms of OCD are divided into obsessions and compulsions.  According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), obsessions in OCD are thoughts, images or urges that are recurrent and persistent. They are also unwanted, intrusive and in most cases accompanied by distress or anxiety.

Some examples of common obsessions in OCD are:

• Fear of contamination or germs
• Need for symmetry or order 
• Intrusive thoughts about self and others such as harming others and self, both by choice and by mistake 
• Intrusive thoughts related to sex, aggression or religion 
• Distressing and recurring doubts about everyday tasks such as locking the door, switching off an appliance etc. 

Compulsion Symptoms

According to DSM-5, compulsions in OCD are behaviours or mental acts that an individual is compelled to do as a reaction to an obsession. They are aimed at relieving anxiety caused by obsessive symptoms. They also aim to eliminate occurrences or situations feared by obsessive symptoms. 

They relieve distress in the short run. Compulsions, in reality, are not connected to obsessions in any way nor can they cancel out fears and they are repeated enormously. 

Some of the most common repetitive OCD behaviours are:

• Repetitive cleaning
• Excessive checking and rechecking
• Counting or repeating phrases
• Handwashing multiple times
• Hoarding 
• Arranging things in a particular way 
• Asking for reassurance 

Severity of OCD Symptoms

Individuals experience different levels of OCD severity. Varying symptoms of OCD are seen throughout their lives. Symptoms usually start during adolescence or young adulthood. Some people can also experience the beginning of OCD in their childhood. Severity varies throughout life depending on external factors such as stress and family support.

When to See a Doctor for OCD

When to seek help for OCD? If your symptoms of OCD are interfering with your day-to-day life and capacity to function, it is best to seek professional help. For example, if you spend a lot of time on obsessions or compulsions or if you have difficulty completing tasks due to the symptoms. Having an OCD medical diagnosis is helpful as it opens up various options for treatment.  

What Causes OCD?

While we are still searching for an exact answer to what causes OCD, much research has been done over the years. 

Research points to genetic, environmental, and biological factors. According to research, OCD tends to have a hereditary component. Studies on twins and families suggest that there is a genetic basis for at least some forms of OCD, where having a first-degree relative or a sibling increases the risk.

Several genes — even hundreds — influence the risk of the disorder. With the presence of more genetic variants, one is more prone to OCD.  SLC1A1, DLGAP1, and PTPRD are some of the genetic variants seen to have a connection to OCD.

Another primary causes of obsessive-compulsive disorder are environmental factors such as trauma and stress. According to one study, 34% of the participants experienced trauma and 61.2% had experienced stress before the development of OCD. Streptococcal infections or illnesses can also cause OCD among the age group 3 to 12.

Neurobiological factors such as serotonin levels have been associated with OCD. Medicines like serotonin reuptake inhibitors (SSRIs) have been shown to reduce the symptoms. OCD has been associated with structural and functional abnormalities in some brain circuits associated with reward value, and decision-making related to rewards and emotions.

Risk Factors for OCD

Some people are more prone to getting diagnosed with OCD than others. Who gets OCD depends on many factors. 

Here are some common risk factors for OCD:

• Family history 
• Traumatic or stressful life events
• Childhood trauma
• Co-occurring mental health conditions such as depression, tic disorders, substance use or anxiety

Complications of OCD

Living with OCD has many challenges as it tends to impact daily functioning. 

Here are summon OCD complications:

• Reduced quality of life
• Strained relationships
• Negative impact on work or academic performance 
• Isolation 
• Physical issues from compulsions such as damage to skin due to excessive washing
• Use of substances 
• Excessive time spent on compulsions
• Causing or worsening anxiety or depression symptoms

Diagnosis of OCD

Now that we have a comprehensive understanding of OCD, let’s see how OCD is diagnosed. 

Free-form and structured clinical interviews are used to evaluate OCD. Clinicians use criteria from the Diagnostic and Statistical Manual of  Mental Illnesses (DSM-5), scales and psychological assessments to aid the process. 

Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) is used to understand the prevalence and severity of OCD by checking for 10 symptoms of obsessions and compulsions. The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is used for children. 

Treatment Options for OCD

Medication for OCD

Selective serotonin reuptake inhibitors (SSRIs)  or SSRIs are the most commonly prescribed OCD medications. They are used to increase serotonin levels. Serotonin is a chemical messenger in the brain associated with sleep, mood, memory and emotions. Higher doses of SSRIs for OCD are linked to higher effectiveness. They are shown to have a 40 to 60 per cent symptom reduction rate. 

If these are not working after 10 to 12 weeks, they are augmented with antipsychotic meds, which means that antipsychotics are prescribed along with SSRIs. 

Cognitive-behavioural therapy (CBT) for OCD

It is possible to manage and overcome OCD without medications if the symptoms are mild. The most well-known therapy for OCD is Cognitive-Behavioral Therapy, especially Exposure and Response Prevention (ERP).

CBT for OCD helps in bringing awareness to and changing thinking patterns that are contributing to the symptoms. ERP is used to treat OCD by helping individuals face their fears or obsessions for long periods, without indulging in compulsions. 

Mindfulness-Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Mindfulness Exercises are the other therapies beneficial in treating OCD. 

Neurostimulation and Alternative Therapies

Alternative OCD treatments include Transcranial direct current stimulation (tDCS), Transcranial magnetic stimulation(TMS) and Deep brain stimulation (DBS).

Transcranial Direct Current Stimulation (tDCS) is a non-invasive treatment option that is shown to be safe and effective for treatment-resistant cases of OCD. In tDCS, a small device is used to send low-intensity current to specific areas of the brain. The aim is to regulate neural activity to improve symptoms. 

TMS is another technique of neurostimulation for OCD. It is a non-invasive treatment that uses electromagnetic impulses to stimulate nerve cells in the brain.

DBS, on the other hand, is a surgical procedure in which electrodes are implanted in certain brain regions. They produce electrical impulses that are controlled by a device implanted under the skin, near the collarbone.  This is used for treatment-resistant severe cases of OCD. know more about tDCS devices for OCD.

Managing OCD: Practical Tips for Everyday Life

Managing OCD in daily life is a challenging experience. 

Here are some tips on how to manage OCD in real-life

• Sticking to your treatment plans
• Practising mindfulness techniques
• Recognizing triggers and minimizing them 
• Adhering to a healthy diet and exercise
• Asking for support 
• Being compassionate towards yourself 

The Chronic Nature of OCD

OCD is a chronic illness, which means that symptoms are present life-long. The severity of symptoms can vary from time to time and they can come and go. Although OCD is a long-term condition, it can be managed well with proper treatment and one can go on to live a successful life. 

OCD and Co-Occurring Conditions

OCD can co-occur with other mental health conditions. For example, a person can have OCD and anxiety disorders or OCD and depression. While these are the most common coexisting conditions, OCD can also coexist with ADHD, Autism, Eating difficulties and disorders, Body Dysmorphic Disorder and others. With co-occurring conditions, people will have symptoms of both, which might complicate the treatment process. 

First of all, diagnosing the right disorders will be hard with coexisting conditions. Symptoms might overlap or intertwine, which needs to be addressed carefully in therapy. Complications can be present in terms of medications too, about side effects and dosages.

Psychosocial Impact of OCD

OCD can have a profound impact on a person’s life There is still a stigma attached to mental health conditions. OCD can lead to feelings of low shame, low self-esteem and embarrassment. OCD causes social isolation and strain on relationships due to difficulties in fully participating in relationships and social life. 

OCD vs. Other Mental Health Conditions

OCD vs. Generalized Anxiety Disorder (GAD)

Although OCD and  GAD can have similar features, there are important distinctions between them.

A major difference when it comes to OCD vs GAD is that in GAD the thoughts are around excessive worry. For example, “ I am going to get fired.” In OCD, the thoughts are around obsessions or specific fears. For example, “I need to check again” or “If I don’t repeat this phrase, something bad will happen.” When it comes to OCD vs anxiety, a definitive contrast is that rituals or specific behaviours are performed to alleviate anxiety in OCD, while such behaviours are not present in GAD. 

OCD vs. Borderline Personality Disorder (BPD)

OCD and BPD can coexist and have some commonalities such as anxiety and distress related to intrusive thoughts. BPD is a personality disorder and can cause intense emotional instability and rapid mood fluctuations. BPD is characterized by fear of abandonment, impulsive or risky behaviours, and difficulty in self-image and relationships.

A key difference when it comes to OCD vs BPD is in terms of emotional regulation. People with OCD engage in compulsive behaviours to regulate emotions, primarily anxiety. They have pre-decided rituals that they do to reduce distress. People with BPD face challenges in emotional regulation and tend to use impulsive behaviours to alleviate distress. 

OCD vs borderline personality disorder are also dissimilar in their behavioural patterns. In OCD, individuals perform various rituals or compulsions. For example, when there is an obsessive thought related to a relationship, one may engage in a ritual.  In BPD, individuals' behaviours are impulsive. For example, when there is an intrusive fear related to a relationship, an individual may seek reassurance, react emotionally or engage in some impulsive behaviour.  

FAQs About OCD

What are the early signs of OCD?

Early signs of OCD may include intrusive thoughts, preoccupation with fears, spending time in compulsive behaviours or repeating behaviours. 

How does OCD differ from perfectionism?

OCD vs perfectionism are different because the former is mostly a personality trait while the latter is a diagnosable condition.  OCD is driven by fear while perfectionism might be motivated by other factors such as having a high standard for oneself. However, someone struggling with perfectionism might also have OCD or OCPD. In such cases, it is important to go to a professional. 

Can OCD be cured?

OCD is a lifelong condition, which means that there is no cure for OCD. However, symptoms can be managed well with treatment. 

Can OCD go away without treatment?

If left untreated, OCD can seriously impair life and functioning. It cannot go away without treatment. It is important to look into various treatment options for OCD and go ahead with the one that suits your needs the best. 

Is OCD genetic or environmental?

OCD has genetic and environmental causes. OCD tends to be hereditary while environmental causes such as stress, and trauma also play a role in causing the condition.

Conclusion

Living with OCD is challenging and it can throw some serious hurdles into life.  It is important to remember that with treatment options such as therapy or medications, not only managing OCD is possible but also you can thrive in life.  OCD treatment can help you in bettering your quality of life. If you or someone you know struggles with symptoms, do not hesitate to reach out for professional help.  Seeking support from a mental health professional is a crucial step in overcoming OCD and a journey towards a more rewarding life. 

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