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Popular culture characterizes OCD as simply being super organized, tidy, or clean. But if you’re living with OCD, you know firsthand how devastating it can really be.

Obsessive-compulsive disorder (OCD) is a chronic mental health condition in which uncontrollable obsessions lead to compulsive behaviors.

When this condition becomes severe, it can interfere with relationships and responsibilities and significantly reduce quality of life. It can be debilitating.

OCD is not your fault and you don’t have to deal with it alone. OCD is a treatable illness, even when it feels severe.

Learn more about OCD, how it’s diagnosed, and what your treatment options are.

OCD often begins during the teenage or young adult years. Symptoms can be mild at first, increasing in severity through the years. Stressful events can exacerbate symptoms.

OCD has two characteristic types of symptoms:

  • Obsessions: intrusive and unwanted thoughts
  • Compulsions: behaviors performed in an attempt to relieve stress or anxiety and over which an individual has little or no control to stop

While there’s not an official diagnosis for “severe” OCD, many people may feel their symptoms are severe and that they severely impact their lives. Untreated OCD may also lead to more severe symptoms.

Obsession symptoms

Obsessive thoughts tend to have a theme, such as fear of germs, the need for symmetry, or intrusive thoughts about harming yourself or others.

Signs include:

  • not wanting to touch things others have touched
  • anxiety when objects aren’t placed a certain way
  • always wondering if you locked the door, turned off the lights, etc.
  • unwanted, intrusive images of taboo subject matter
  • repetitive thoughts of doing things you really don’t want to do

Compulsion symptoms

Compulsions are repetitive behaviors you find impossible to ignore. You might think that doing them will relieve stress, but that effect is temporary, leading you to do them again.

Compulsions can also follow a theme, such as counting, washing, or a constant need for reassurance. Signs include:

  • excessive hand washing, even if your skin is already raw
  • arranging objects in a precise way, even when it’s not necessary or you should be doing something else
  • repeatedly checking doors, the stove, or other things to make sure they’re off, even if it means you can’t leave the house
  • silently counting or repeating a word or phrase, even though you want to stop

Other OCD symptoms

Obsessions and compulsions can take up so much time that an individual can’t function and their quality of life is significantly affected, such as:

  • You can’t get to school or work on time, if at all.
  • You’re unable to attend or enjoy social activities.
  • Your relationships are troubled.
  • You have health issues related to OCD. For example, you’ve developed dermatitis from excessive hand washing.
  • You’re riddled with guilt, shame, or self-blame.
  • The more you try to control it, the more anxious you feel.
  • Ignoring a compulsion brings it back stronger than ever.
  • You’ve thought about or attempted self-harm or suicide.

Many people with OCD are fully aware that their thoughts and behaviors are irrational but feel powerless to stop them. Others may experience delusional thinking, believing their obsessions and compulsions are a normal or typical way to protect from a threat they believe to be very real.

OCD is chronic disorder in 60 to 70 percent of cases. When considering lowered quality of life and loss of income, OCD was once one of the top 10 debilitating illnesses worldwide, and anxiety disorders in general remain among the top 10.

In addition to the burden of treatment costs, studies show an average loss of 46 workdays a year due to OCD.

We don’t have a complete understanding of what causes OCD but there are several potential contributing factors:

  • Genetics. Some research indicates a higher risk if you have a first-degree relative with OCD, especially if it developed in childhood. Specific genes have yet to be identified.
  • Brain structure and function. There appears to be a link between OCD and differences in the frontal cortex and subcortical structures of the brain. People with OCD also have a hyperactive neural circuit between the prefrontal cortex, which affects decision making, and the nucleus accumbens, which is part of the brain’s reward system. Hormones such as serotonin, glutamate, and dopamine may also be involved.
  • Environment. OCD may develop as a result of childhood trauma, but more research is needed to fully develop this theory. Children sometimes develop symptoms of OCD following streptococcal infection (PANDAS).

People with OCD can have coexisting mental health disorders such as:

Some people with OCD also develop a tic disorder. This can cause sudden repetitive movements such as blinking, shrugging, throat clearing, or sniffing.

Most people are diagnosed by age 19, though it can occur at any age. This may involve:

  • a physical exam to check for other potential problems
  • blood tests, such as complete blood count (CBC), thyroid functioning, and alcohol and drug screening
  • a psychological evaluation to learn more about thought and behavior patterns
DSM-5 diagnostic criteria for OCD
  • presence of obsessions, compulsions, or both
  • obsessions and compulsions take up more than one hour a day or interfere with daily activities
  • symptoms are unrelated to substance use or physical health conditions
  • symptoms are not caused by other mental health conditions

There are several tests to assess OCD severity. One of these is the Yale-Brown Obsessive-Compulsive Scale. It includes 54 common obsessions and compulsions grouped by theme. There’s also a version specifically for children.

The doctor rates obsessions and compulsions on a scale of 0 to 25 according to severity. A total score of 26 to 34 indicates moderate to severe symptoms and 35 and above indicates severe symptoms.

There are effective treatments for OCD, but they require patience. It can take several weeks to several months to start feeling better.

What doctors may prescribe

When choosing medications, your doctor will start with the lowest possible dose and increase as needed. It may take some trial and error to find the right medication and dosage.

Ask your doctor to explain possible side effects and drug interactions. Report new or worsening symptoms while taking these medications and don’t stop without doctor supervision.

Medications used to treat OCD include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants such as:

What therapists may do

Treatment will be individualized, but you’ll most likely need both medication and therapy.

Cognitive behavioral therapy (CBT) is considered the most effective method of treating OCD.

CBT is a type of psychotherapy that addresses the relationship of thoughts, feelings, and behaviors. A therapist will help you adjust your thoughts to affect your actions.

Exposure and response prevention (ERP or EX/RP) is a type of CBT in which the therapist gradually exposes you to something you fear so you can improve your coping skills. Through increased exposure and practice, you’ll gain more control over how you respond.

If you’re at risk of self-harm, have delusional thoughts, or have psychosis due to other conditions, hospitalization may be beneficial.

What you can do at home

  • Take all medicines as directed, even if you feel better. If you want to stop, your doctor can help you taper off safely.
  • Check with your doctor or pharmacist before taking additional medicines or supplements because they can interfere with your OCD therapy.
  • Be aware of signs that you’re slipping into old, unproductive patterns, and tell your doctor.
  • Practice what you’ve learned in CBT. These new skills can help you for the rest of your life.
  • Find new ways to manage anxiety. Physical exercise, deep breathing, and meditation may help ease stress.
  • Join a support group. You may find it helpful to talk to others who really “get it.”
where to find help

The symptoms of OCD can feel severe and overwhelming. If you or someone you love needs help, these organizations can help:

If you think you may harm yourself, call 911 or go to your nearest ER.

New treatment options

Newer surgical treatments for severe OCD aren’t generally recommended unless all other medications and therapies have been ineffective. They may have significant risks.

Deep brain stimulation is a procedure in which the surgeon implants electrical leads into specific parts of the brain. A neurostimulator then sends signals to regulate abnormal activity. This procedure has been used to treat Parkinson’s disease and essential tremor.

In a procedure called laser ablation, the surgeon makes a tiny hole in the skull. With the help of MRI, a laser beam creates a lesion a few millimeters wide to block overactive circuits in the brain. This surgery has been used to treat epilepsy.

Long-term studies that focus specifically on prognosis for severe OCD are lacking. Factors such as having coexisting mental or developmental issues can affect outlook.

Some research suggests early to middle childhood onset is associated with a high rate of spontaneous remission compared to later onset. Positive family involvement and reactions are also associated with a better outcome.

Your doctor can give you a better idea of what to expect of treatment for severe OCD.

OCD is a chronic, debilitating condition that affects every aspect of your life. Symptoms can sometimes be severe.

A combination of medication and therapy is usually quite effective, but it can take time to work. There are also promising new treatments for severe OCD.

A vital element of successful treatment is good doctor-patient communication. It’s also important to continue practicing what you’ve learned in therapy between sessions.

The bottom line is that you don’t have to remain stuck in place. There’s help for severe OCD. Ask your doctor about the next steps toward managing your condition.