Obsessive-Compulsive Disorder (OCD)

Overview

Obsessive-compulsive disorder (OCD) is a long-lasting mental illness in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both. Obsessive-compulsive disorder symptoms are often time-consuming and can cause significant distress or interfere with daily life.

It is common for people with obsessive-compulsive disorder also to have a diagnosed mood or anxiety disorder. Although there is no cure for obsessive-compulsive disorder, available treatments can help people manage their symptoms, participate in day-to-day activities, and improve their quality of life.

Signs and Symptoms

People with obsessive-compulsive disorder may have obsessions, compulsions, or both. Obsessions are repeated thoughts, urges, or mental images that are intrusive, unwanted, and make most people anxious.

Common obsessions include:

• Fear of germs or contamination
• Fear of forgetting, losing, or misplacing something
• Fear of losing control over one’s behavior
• Aggressive thoughts toward others or oneself
• Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
• Desire to have things symmetrical or in perfect order

Compulsions are repetitive behaviors a person feels the urge to do, often in response to an obsession.

Common compulsions include:

• Excessive cleaning or handwashing
• Ordering or arranging items in a particular, precise way
• Repeatedly checking things, such as making sure the door is locked or the oven is off
• Compulsive counting
• Repeating words silently

Everyone rethinks or double-checks things sometimes—not all repeated thoughts are obsessions, and not all rituals or habits are compulsions. However, people with obsessive-compulsive disorder generally:

• Cannot control their obsessions or compulsions, even when they know they are excessive
• Spend more than 1 hour a day on their obsessions or compulsions
• Do not get pleasure from their compulsions but may feel temporary relief from their anxiety
• Experience significant problems in daily life due to these thoughts or behaviors

The symptoms of obsessive-compulsive disorder usually follow a “waxing and waning” course: symptoms may start slowly and can go away for a while or worsen as time passes. During times of stress, the symptoms often get worse. A person’s obsessions and compulsions may also change over time.

People with obsessive-compulsive disorder might go far out of their way to avoid situations that trigger their symptoms or use drugs or alcohol to cope. Many adults with obsessive-compulsive disorder recognize that their compulsive behaviors do not make sense. However, children may not realize that their behavior is out of the ordinary and they often fear that something terrible will happen if they do not perform certain compulsive rituals. Parents or teachers are typically the first to recognize obsessive-compulsive disorder symptoms in children.

If you think you or your child may have obsessive-compulsive disorder, talk to a healthcare provider. If left untreated, obsessive-compulsive disorder symptoms can become severe and interfere with daily life.

Related Health Effects

It is common for people with obsessive-compulsive disorder to also have a diagnosed mood disorder (such as depression) or anxiety disorder (such as social anxiety disorder or panic disorder). Some people with obsessive-compulsive disorder also have a tic disorder involving repetitive movements or sounds. Motor tics are sudden, brief, repetitive movements—such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Vocal tics include things like repetitive throat-clearing, sniffing, or grunting sounds.

Several other conditions involving compulsive behaviors, including trichotillomania (hair pulling), compulsive gambling, and compulsive shopping, are often considered part of an “obsessive-compulsive disorder spectrum,” with treatment approaches similar to those for obsessive-compulsive disorder.

Causes and Risk Factors

Although the exact causes of obsessive-compulsive disorder are unknown, various risk factors increase the chances of developing the disorder.

• Genetics: Studies have shown that having a first-degree relative (parent or sibling) with obsessive-compulsive disorder is associated with an increased chance of developing the disorder. Scientists have not identified any one gene or set of genes that definitively leads to obsessive-compulsive disorder, but studies exploring the connection between genetics and obsessive-compulsive disorder are ongoing.
• Biology: Brain imaging studies have shown that people with obsessive-compulsive disorder often have differences in the frontal cortex and subcortical structures of the brain—areas that impact the ability to control behavior and emotional responses. Researchers have also found that several brain areas, brain networks, and biological processes play a key role in obsessive thoughts, compulsive behavior, and associated fear and anxiety.
• Temperament: Some research has found that people who exhibit more reserved behaviors, experience negative emotions, and show symptoms of anxiety and depression as children are more likely to develop obsessive-compulsive disorder.
• Childhood trauma: Some studies have reported an association between childhood trauma and obsessive-compulsive symptoms. More research is needed to understand this relationship.

Diagnosis

Obsessive-compulsive disorder symptoms may emerge any time, but they usually start between late childhood and young adulthood, and they often start at a younger age in boys than in girls. Most people with obsessive-compulsive disorder are diagnosed as young adults. Diagnosing obsessive-compulsive disorder can be difficult because symptoms such as worry, anxiety, and low mood—which are often people’s most distressing concerns—can be similar to those of other mental illnesses. Also, people with OCD may not tell their healthcare provider about their obsessions and compulsions out of fear of judgment.

If you are experiencing symptoms, the first thing you should do is speak with a healthcare provider, such as a primary care physician. They will examine you and ask about your health history to ensure other illnesses or conditions are not causing your symptoms. A healthcare provider may refer you to a mental health professional for further evaluation or treatment. Learn more about how to talk with a doctor or healthcare practitioner about mental health.

Treatment and Management

Treatment helps many people, even those with the most severe forms of obsessive-compulsive disorder. Mental health professionals treat obsessive-compulsive disorder with medicines, psychotherapy, or a combination of treatments. Although there is no cure for obsessive-compulsive disorder, treatments can help people manage their symptoms, engage in day-to-day activities, and lead full, active lives.

Following a treatment plan is important because psychotherapy and medicine can take some time to work.

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with obsessive-compulsive disorder. Research shows that certain types of psychotherapy, including cognitive behavioral therapy (CBT) and other related therapies, can be as effective as medicine for many people. For others, psychotherapy may be most effective when combined with medicine.

• Cognitive behavioral therapy (CBT): Cognitive behavioral therapy is a type of talk therapy that helps people recognize harmful or untrue ways of thinking so they can more clearly view and respond to challenging situations. Cognitive behavioral therapy works best when customized to treat the unique characteristics of specific mental disorders, including obsessive-compulsive disorder.
• Exposure and response prevention therapy (ERP): Research shows that exposure and response prevention therapy, a specific type of cognitive behavioral therapy, effectively reduces compulsive behaviors, even for people who do not respond well to medicine. With exposure and response prevention therapy, often considered the “gold standard” treatment for obsessive-compulsive disorder, people spend time in a safe environment that gradually exposes them to situations that trigger their obsession, such as touching dirty objects, and prevent them from engaging in their typical compulsive behavior, such as handwashing. Although this approach may initially cause anxiety, creating a risk of dropping out of treatment prematurely, compulsions decrease for most people as they continue treatment.

Children with obsessive-compulsive disorder may need additional help from family members and healthcare providers to recognize and manage their obsessive-compulsive disorder symptoms. Mental health professionals can work with young children to identify strategies for managing stress and increasing support so they can control their obsessive-compulsive disorder symptoms.

Medicine

Healthcare providers may prescribe medicine to help treat obsessive-compulsive disorder. The most common medicines prescribed for obsessive-compulsive disorder are antidepressants that target serotonin, a chemical messenger in the brain involved in depression and obsessive-compulsive disorder. These antidepressants are called selective serotonin reuptake inhibitors (SSRIs), and these can be effective for obsessive-compulsive disorder even in the absence of depression. One older antidepressant, clomipramine, is approved by the U.S. Food and Drug Administration (FDA) only for the treatment of obsessive-compulsive disorder—in adults and children ages 10 and up—because of its very strong effects on the serotonin system. Clomipramine is generally not a first-line treatment for obsessive-compulsive disorder because it has more side effects than the newer SSRIs, ranging from minor problems of dry mouth and constipation to more serious risks of seizures and slowed cardiac conduction.

Antidepressant treatment can take 8–12 weeks before symptoms begin to improve, and treatment for obsessive-compulsive disorder may require higher doses than are typically used to treat depression. For some people, these medicines may cause side effects such as headaches, nausea, or difficulty sleeping. Do not stop taking your medicine without first talking to your healthcare provider.

Read the most up-to-date information on medicines, side effects, and warnings on the FDA website.

Other Treatments

In 2018, the FDA approved using a form of repetitive transcranial magnetic stimulation (TMS) along with medicine, psychotherapy, or a combination of both, to treat people with severe obsessive-compulsive disorder who did not respond to other treatments. In 2022, this approval was extended to standard transcranial magnetic stimulation devices.

Most commonly used to treat depression, transcranial magnetic stimulation is a noninvasive therapy that uses a magnet to deliver repeated low-intensity pulses to stimulate a particular part of the brain. Unlike most other available treatments, it can target specific brain areas associated with obsessive-compulsive disorder. Another advantage of transcranial magnetic stimulation is that it requires no anesthesia or other medicine.

Deep brain stimulation is a surgical procedure in which a brain stimulation device is implanted to directly stimulate sites in the brain. Healthcare providers may use deep brain stimulation to treat people with severe obsessive-compulsive disorder when other, less-invasive treatments have not worked. However, this therapy is considered experimental. The FDA has approved using deep brain stimulation to treat severe cases of obsessive-compulsive disorder under a Humanitarian Device Exemption.

Living With Obsessive-Compulsive Disorder

You can do several things to manage the stress and anxiety associated with obsessive-compulsive disorder:

• Create a consistent sleep schedule.
• Make regular exercise a part of your routine.
• Eat a healthy, balanced diet.
• Seek support from trusted family and friends.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on obsessive-compulsive disorder.

Find Treatment

If you have concerns about your mental health, talk to a primary care provider. They can refer you to a qualified mental health professional, such as a psychologist, psychiatrist, or clinical social worker, who can help figure out the next steps.

You can also learn about finding support and locating mental health services in your area on the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Community Support

• The National Alliance on Mental Illness (NAMI) offers support groups and family education programs for people with a mental health condition and their loved ones. The NAMI HelpLine can connect you with the NAMI office in your state and help you find programs close to home.
• Mental Health America is the nation’s leading nonprofit dedicated to the promotion of mental health, well-being, and condition prevention. They provide resources for understanding your mental health, helping loved ones, or accessing information for personal, academic, or professional purposes.
• Additionally, the International OCD Foundation website can help you find a healthcare provider who may be knowledgeable about obsessive-compulsive disorder and related conditions.

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH. 

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH funds and conducts research to better understand who is at risk for developing obsessive-compulsive disorder. This includes research into genetics, biology, temperament, and childhood trauma, as well as studies of obsessive-compulsive disorder in children and adults. NIH supports research to improve existing treatments for obsessive-compulsive disorder, including psychotherapy, medicine, and brain stimulation therapy. NIH also funds research investigating new treatments, particularly for people with treatment-resistant obsessive-compulsive disorder whose symptoms have not improved after trying multiple treatment options.

Research is underway to better understand the connection between OCD symptoms and parts of the brain. This knowledge can help researchers develop and adapt treatments targeted to specific brain locations.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.