Obsessive-compulsive disorder (OCD) is a chronic mental health condition that involves obsessions, compulsions, or both. In the United States, around 2 to 3 percent of people have this condition, according to the American Psychiatric Association.
People living with OCD typically experience obsessions, or repetitive unwanted thoughts that prompt an extreme urge to repeat a specific behavior. They then act out that urge, or compulsion, to help relieve the obsessive thought.
Plenty of people double-check to make sure they’ve locked the front door or turned off the stove. It’s also very common to have a superstition or two, like knocking on wood or wearing your team’s jersey when they play. These habits might help you feel more secure, but they don’t automatically suggest OCD.
For people living with OCD, these rituals aren’t a matter of personal choice. Rather, they complicate and disrupt everyday life. Many people with OCD recognize the thoughts and beliefs fueling their compulsions as illogical, or at least highly unlikely. Still, they act on them to:
- relieve the distress caused by intrusive obsessive thoughts
- prevent persistent fears from becoming reality
OCD involves two main types of symptoms: obsessions and compulsions. Many people living with OCD experience both obsessions and compulsions, but some people only experience one or the other.
These symptoms aren’t just fleeting or short-lived. Even milder symptoms can take up at least an hour each day and significantly affect your day-to-day activities.
Obsessions or compulsions might affect your ability to pay attention at school or complete tasks at work. They could even keep you from going to school or work, or anywhere else.
You might realize the obsessive thoughts aren’t true, or know the compulsive behaviors won’t actually do anything to prevent them. Yet they often feel uncontrollable, all the same.
The content of obsessive thoughts can vary widely, but a few common themes include:
- worries about germs, dirt, or illness
- fears of harming yourself or someone else
- fears of saying something offensive or obscene
- a need to have your possessions aligned, orderly, or symmetrical
- explicit sexual or violent thoughts
- worries about throwing things away
- questioning your sexual desires or orientation
- worries about the health and safety of yourself or your loved ones
- intrusive images, words, or sounds
These unwanted and intrusive thoughts keep coming back, no matter how hard you try to ignore or suppress them. Their very persistence can lead to an even stronger conviction that they might be true, or might come true, if you don’t take steps to prevent them.
Examples of compulsive behaviors in OCD include:
- washing your hands, objects, or body
- organizing or aligning objects in a specific way
- counting or repeating specific phrases
- touching something a set number of times
- seeking reassurance from others
- collecting certain objects or buying several of the same item
- hiding objects you could use to hurt yourself or someone else
- mentally going over your actions to make sure you haven’t harmed anyone else
You can think of compulsions as a response to obsessions. Once an obsession surfaces, you might feel compelled to take action in order to relieve the anxiety and distress it causes or to keep that obsessive thought from coming true.
You might feel the need to repeat these actions a specific number of times, or until things seem “just right.” If you make a mistake during the ritual, you might feel that it won’t work unless you start from the beginning and finish it perfectly.
Experts don’t know exactly what causes OCD, but a family history of the condition may play a large part. If you have a close family member with OCD, you have a higher chance of also having the condition.
Irregular development and impairment in certain areas of the brain have also been linked to the condition, according to the
Risk factors for OCD
If you’re genetically more likely to develop OCD, other factors can also increase your chances of developing the condition.
- Stress or trauma. Significant stress at home, school, work, or in personal relationships can raise your chances of developing OCD or worsen existing symptoms.
- Personality. Certain personality traits, including difficulty handling uncertainty, heightened feelings of responsibility, or perfectionism, may factor into OCD. However, there’s some debate over whether these are actually fixed traits or more flexible learned responses that can change.
- Abuse in childhood. Children who experience abuse or other traumatic childhood experiences, like bullying or severe neglect, have a higher chance of developing the condition.
- Childhood acute neuropsychiatric symptoms (CANS). For some children, OCD begins suddenly after an infection. After a streptococcal infection, this syndrome is known as PANDAS, which stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcus. But other infections or diseases can also cause symptoms.
- Traumatic brain injury. According to a 2021 study, symptoms of OCD may appear for the first time following a head injury.
Keep in mind, though, that it’s possible to have a family history of OCD, along with other risk factors, and still never develop the condition yourself. What’s more, people without any known risk factors can still have OCD.
OCD often occurs with other mental health conditions, including:
- attention deficit hyperactivity disorder (ADHD)
- Tourette syndrome
- major depressive disorder
- social anxiety disorder
- eating disorders
If you experience obsessions or compulsions, a trained mental health professional can help you get a diagnosis and explore the best treatment options.
Symptoms of OCD appear first in childhood for
Talking about OCD symptoms can feel difficult, especially if you’ve already tried and been brushed off.
Maybe you shared an obsessive thought with a parent. They laughed, hugged you, and said, “Don’t worry, that’s not going to happen.” But their loving dismissal did nothing to ease the thought.
Or perhaps you tried explaining to a co-worker who frequently borrowed office supplies that you have to keep the items on your desk aligned in a certain way. When they picked up a stapler to borrow it and set it back in the wrong place, you felt intensely uncomfortable until you put it where it belonged. Later, you heard them in the hallway, talking to someone else about how “strange” you were.
A mental health professional won’t laugh or judge you — they’ll listen to your symptoms with compassion and help you begin to address them.
They’ll start by asking questions about obsessions or compulsions you experience, including:
- how much time they take up each day
- what you do to try and ignore or suppress them
- whether the OCD-related beliefs feel true to you
- what effects obsessions and compulsions have on your relationships and daily life
They’ll also ask about medications you’re taking and any other mental health or medical symptoms you experience to help rule out medication side effects or other conditions.
Other mental health conditions can involve symptoms that resemble OCD:
- Body dysmorphic disorder can involve fixated thoughts or repetitive behaviors that relate to your physical appearance.
- Trichotillomania involves persistent urges to pull your own hair out.
- Depression can involve looping unwanted thoughts, but these thoughts generally don’t lead to compulsive behaviors.
- Hoarding disorder involves collecting an excess of unneeded objects and having difficulty throwing things away, but these possessions don’t trigger distress. People with OCD might only collect or save items due to a compulsion to complete a set, or because they believe not saving those items might lead to harm.
- Generalized anxiety disorder also involves frequent and persistent worries. These concerns often relate to everyday life, though. While they might lead you to avoid certain people or situations, they generally don’t lead to compulsive actions.
- Tics, or sudden, repeated movements, can happen with OCD. It’s not uncommon for people with OCD to also have a tic disorder, such as Tourette syndrome. But you can also have a tic disorder without having OCD.
A mental health professional will use all the information they gather to determine whether OCD is the most accurate diagnosis and explore other diagnoses, if needed.
Connecting with a therapist who has experience treating OCD is a good first step toward exploring helpful treatment options.
Usually, treatment for OCD will include both psychotherapy and medication.
A few different psychotropic medications can help reduce OCD symptoms.
A psychiatrist or other prescribing clinician might prescribe:
- selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft)
- the tricyclic antidepressant clomipramine (Anafranil), though this medication generally won’t be prescribed as a first-line treatment
- antipsychotics like aripiprazole (Abilify) or risperidone (Risperdal), which can enhance the effects of SSRIs
- memantine (Namenda), an NMDA receptor antagonist, which can also enhance the effects of SSRIs
It can sometimes take 8 to 12 weeks before SSRIs take effect, so keep taking your medication as directed even if you don’t notice improvement immediately.
Some side effects are possible, so you’ll always want to let your care team know about any unwanted symptoms you experience while taking medication. If these side effects outweigh the medication’s benefits, your psychiatrist may recommend another treatment approach.
Mental health professionals typically recommend therapy as part of a combined approach to treatment.
Medication can often help relieve symptoms, but by working with a therapist, you can also learn:
- tools to manage unwanted thoughts and change unhelpful patterns of behavior
- strategies to improve relaxation and cope with emotional distress
Therapy approaches recommended for OCD include:
- Cognitive behavioral therapy (CBT). CBT can help you learn to identify and reframe patterns of unwanted or negative thoughts and behaviors.
- Exposure and response prevention (ERP). This is a type of CBT that involves gradual exposure to feared situations, or the concerns at the root of obsessions or compulsions. The goal of ERP is to learn to manage the distress obsessions cause without engaging in compulsive behaviors.
- Mindfulness-based cognitive therapy. This involves learning mindfulness skills to cope with distress triggered by obsessive thoughts.
Not sure how to start your search for a therapist? Our guide can help.
Some limited evidence also supports brain stimulation for OCD symptoms.
- Deep brain stimulation. This involves delivering electrical pulses, directly into areas of the brain associated with OCD, through a thin electrode. This procedure requires surgery, so your care team will likely only recommend it for very severe symptoms that don’t improve with other treatments.
- Transcranial magnetic stimulation (TMS). TMS involves magnetic pulses, delivered to your brain via magnetic coil. Experts believe the magnetic pulses help ease OCD symptoms by stimulating associated areas of the brain. This noninvasive procedure doesn’t require surgery and is often used along with medication and therapy.
There’s no formal classification of different types of OCD, but experts commonly separate symptoms into several subtypes:
- contamination and cleaning
- fear of harm and checking
- symmetry, perfectionism, and ordering
- intrusive sexual, violent, or other taboo thoughts
- collecting or hoarding
Your symptoms could mainly align with one of these subtypes, or fall into multiple categories. The fact that symptoms often don’t fit neatly into one category may help explain why these subtypes remain unofficial.
These aren’t the only suggested subtypes of OCD, either. Other unofficial “types” of OCD include:
- Scrupulosity, or religious OCD, involves obsessions and compulsions centered around religious beliefs. If you have a thought you consider blasphemous, you might feel compelled to pray a certain number of times, count to a certain number, or touch several objects in order to cancel it out.
- Relationship OCD involves frequent doubts, questions, and intrusive thoughts about your relationship.
- Pure O (obsession) involves sexual, religious, or violent intrusive thoughts and obsessions but no apparent compulsions. Pure O might still involve compulsions — they just might take place as mental rituals rather than physical actions.
Again, around half of people with OCD first noticed symptoms during childhood.
Children may not always show symptoms of OCD in the same ways as adults. For example:
- They may not realize their obsessions or compulsions are excessive.
- They might believe everyone has similar thoughts and urges.
- Obsessions may seem less obvious. Certain thought patterns, such as magical thinking or fears of bad things happening to loved ones, may also seem like a typical part of child development.
- Tics tend to develop more often with childhood-onset OCD, according to a
- They more commonly have symptoms from multiple categories.
Treatment for children generally involves therapy, medication, or both, as it does for adults.
If you believe your child could have OCD, reaching out to a therapist who specializes in working with children is a good next step.
Despite the similarity in their names, obsessive-compulsive disorder and obsessive-compulsive personality disorder (OCPD) are completely different conditions.
OCPD is characterized by an extreme need for orderliness, perfection, and control, including within relationships. It doesn’t involve obsessions or compulsions.
Key symptoms of OCPD include:
- preoccupation with details, order, rules, and schedules
- perfectionism that gets in the way of completing tasks or assignments
- spending so much time on work that no time remains for personal interests or relationships
- an inflexible or overly conscientious attitude toward ethical or moral concerns
- extreme difficulty discarding objects
- trouble delegating responsibility or working with others
- a tendency to avoid spending money whenever possible
- a rigid or stubborn attitude
Personality disorders like OCPD involve fixed, persistent traits that can disrupt relationships and everyday life. People living with personality disorders often don’t recognize these traits as problematic, but simply accept them as part of their personality.
Still, compared to people living with other personality disorders, those with OCPD are more likely to seek treatment. Compared to other personality disorders, OCPD can often be treated more effectively.
People with OCD, on the other hand, may be more likely to seek help because their symptoms do cause distress.
It’s possible, of course, to have both conditions, but a mental health professional will diagnose them separately. OCPD may also involve different approaches to treatment, including psychodynamic therapy.
While there’s no cure for OCD, professional treatment and a range of coping strategies can help you manage your symptoms and minimize, or even eliminate, their impact on your day-to-day life.
Getting help from a therapist who has experience treating OCD can go a long way toward easing feelings of stress and improving your quality of life overall.
With professional support, it’s often possible to learn new strategies to manage OCD symptoms and challenge patterns of unwanted thoughts. Therapists can also offer guidance with other helpful coping strategies, including:
- breathing exercises
- meditation and mindfulness techniques
- creating a self-care routine
- opening up to loved ones
It might feel difficult to talk about OCD with the people in your life, and nothing says you have to share your diagnosis until you feel ready to do so. That said, isolating yourself usually only makes matters worse.
Reaching out to family, friends, and other loved ones can make it easier to get emotional support, plus any other type of support you might need — which can, in turn, lead to improved well-being overall.
Joining an OCD support group can be another great way to connect with people who understand what you’re experiencing.