Obsessive-Compulsive Disorder (OCD): What It Is

OCD is not about a perfectly organized shelf and not about a habit of rechecking the iron. It is a mental disorder in which intrusive thoughts and repetitive actions take over the day. Below — calmly and to the point: what the word "obsession" means, how the syndrome differs from neatness, and what the diagnosis looks like.

What obsessive-compulsive disorder is

OCD is a mental disorder in which thoughts and actions repeat again and again, and the person cannot stop them. Another name is obsessive-compulsive neurosis. The course can be chronic, progressive, or episodic. People with OCD are fully aware of how distressing their experiences are — unlike people with schizophrenia.

Obsession and compulsion: what these words mean

An obsession is an intrusive thought, urge, or image that causes anxiety. It comes on its own, unbidden. A compulsion is a behavior that a person repeats in order to make the anxiety less or to make the thoughts go away. The ritual gives brief relief, and then everything returns. The set of obsessions and compulsions can change over time.

How OCD manifests: intrusive thoughts and repetitive actions

Obsessions most often concern several themes.

• fear of germs and contamination;
• fear of forgetting, losing, or misplacing an item;
• fear of losing control over one's behavior;
• unwanted thoughts about sex or religion;
• the need to arrange things in a strictly defined way.

Compulsions look like excessive handwashing and cleaning, repeated checks — whether the door is closed, whether the stove is off — counting, and arranging things in an exact order. Sometimes OCD occurs together with Tourette syndrome or another tic disorder.

Why OCD occurs

The exact cause is unknown. Genetics, biology and brain chemistry, and the environment are discussed. The risk is higher if a parent, brother or sister, or child has OCD — especially when the relative's OCD began in childhood or adolescence. Brain scans of people with OCD show differences in certain areas. Among the factors cited are childhood trauma, including abuse, and temperament: shyness, frequent low mood, and anxiety in childhood. In some cases, children develop symptoms after a streptococcal infection — this is PANDAS.

OCD most often begins at age 10–30. Prevalence is approximately 1–3% in adults and 1 case per 200–500 children and adolescents. Clinically recognized cases are fewer: 0.05–1%.

How OCD differs from ordinary anxiety and perfectionism

The first myth is that OCD equals neatness. Cleaning can be a symptom, but more often the person gets stuck on an action they feel obliged to repeat. The doctor looks at four signs: the thoughts and behavior are beyond control, even though you understand they are excessive; they take up at least an hour a day; the actions themselves bring no pleasure, only brief relief from anxiety; and they cause noticeable problems in ordinary life. OCD symptoms resemble other disorders, such as anxiety disorders — and the two can co-occur.

How OCD is diagnosed and when to see a doctor

The first step is to tell the doctor about the symptoms. They perform an examination and ask about medical history to rule out other causes. If no physical causes are found, an OCD test or a referral to a psychiatrist is possible. The Yale-Brown scale is used in assessment. Up to 7.5 years can pass between the onset of the disorder and the first consultation with a psychiatrist: people most often present at age 25–35.

OCD by itself is not a reason to call emergency services. 103 or 112 — if there is a threat to life (a life-threatening emergency).

The text is for reference and does not replace a doctor's consultation — questions about your specific case are decided by a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer