People with OCD:
• Have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; violence; hurting loved ones; sexual acts; conflicts with religious beliefs; or being overly neat.
• Do the same rituals over and over such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again.
• Have unwanted thoughts and behaviors they can't control.
• Don't get pleasure from the behaviors or rituals, but get brief relief from the anxiety the thoughts cause.
• Spend at least an hour a day on the thoughts and rituals, which cause distress and get in the way of daily life.
Unwanted repetitive ideas or impulses frequently well up in the mind of the person with OCD. Persistent paranoid fears, an unreasonable concern with becoming contaminated or an excessive need to do things perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." These thoughts are intrusive, unpleasant and produce a high degree of anxiety. Other examples of obsessions are fear of germs, of being hurt or of hurting others, and troubling religious or sexual thoughts.
In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are checking and washing. Other compulsive behaviors include repeating, hoarding, rearranging, counting (often while performing another compulsive action such as lock-checking). Mentally repeating phrases, checking or list making are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals: Performing things the same way each time may give the person with OCD some relief from anxiety, but it is only temporary.
People with OCD show a range of insight into the uselessness of their obsessions. They can sometimes recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Most people with OCD struggle to banish their unwanted thoughts and compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are engaged at school or work. But over time, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives and make it impossible for them to have lives outside the home.
The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.
Obsessive-Compulsive Disorder. Last reviewed 12/31/1969
- Archives of General Psychiatry
- British Journal of Psychiatry Supplement
- Diagnostic and Statistical Manual, Fourth Edition
- National Institutes of Mental Health
- National Library of Medicine
- Psychiatric disorders in America: the Epidemiologic Catchment Area Study
- Psychopharmacology Bulletin