Obsessive-Compulsive Disorder

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a mental health condition in which you have repeated thoughts (obsessions) and rituals (compulsions). They interfere with your life, but you cannot control or stop them.

What causes OCD?

The cause of OCD is unknown. Genetics, brain biology and chemistry, and your environment may all play a role.

Who is at risk for OCD?

OCD usually begins in the teen years or young adulthood. Boys often develop OCD at a younger age than girls.

Risk factors for OCD include:

• Family history. A first-degree relative (parent, sibling, or child) with OCD raises your risk — especially if the relative developed OCD as a child or teen.
• Brain structure and function. Imaging studies show differences in certain brain areas in people with OCD, though research continues.
• Childhood trauma, such as abuse. Some studies have linked childhood trauma to OCD.

In some children, OCD symptoms can appear after a streptococcal (strep) infection. This is known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections).

What are the symptoms of OCD?

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

• Obsessions are repeated thoughts, urges, or mental images that cause anxiety — such as fear of germs or contamination, fear of losing something, worries about harm, unwanted forbidden thoughts (about sex or religion), aggressive thoughts, or a need for things to be arranged in a specific way.
• Compulsions are behaviours you feel you have to do over and over to try to reduce anxiety — such as excessive cleaning or handwashing, repeatedly checking things (locks, the gas stove), compulsive counting, or arranging things in a precise way.

Some people with OCD also have Tourette syndrome or another tic disorder — sudden movements or sounds that happen repeatedly and can't be controlled.

How is OCD diagnosed?

The first step is to talk to a doctor about your symptoms. It is important to rule out physical causes, so your doctor will do an examination and ask about your medical history. If no physical problem explains your symptoms, your doctor may use an OCD questionnaire or refer you to a mental health specialist.

OCD can be hard to diagnose. Its symptoms overlap with other mental disorders such as anxiety, and it is also possible to have OCD alongside another condition.

Not everyone with obsessions or compulsions has OCD. The symptoms would typically be considered OCD when you:

• Can't control the thoughts or behaviours, even when you know they are excessive
• Spend at least 1 hour a day on them
• Don't get pleasure from the behaviours — they only briefly relieve anxiety
• Have significant problems in daily life because of them

What are the treatments for OCD?

The main treatments are cognitive behavioural therapy, medicines, or both:

• Cognitive behavioural therapy (CBT) teaches you different ways of thinking, behaving, and reacting to your obsessions and compulsions. Exposure and Response Prevention (ERP) is a specific form of CBT that gradually exposes you to your fears, teaching you healthy ways to deal with the anxiety.
• Medicines for OCD include certain antidepressants. If those don't work, your doctor may suggest another type of psychiatric medicine.

For severe OCD that does not improve with these treatments, your doctor may suggest repetitive transcranial magnetic stimulation (rTMS) — a brain stimulation procedure that uses magnetic waves to target specific brain areas. It is available at select centres in India.