Obsessive-Compulsive Disorder
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a mental health disorder that causes a recurrent pattern of unwanted thoughts (obsessions) that lead to repetitive behaviours (compulsions). Obsessive thoughts are uncontrollable and intrusive fears, ideas, sensations, or impulses that trigger extreme distress. Some individuals with OCD suspect that these obsessions are unrealistic, whereas others may believe them to be true. Compulsive behaviours are then carried out to try to control and reduce this distress and prevent feared ideas. Obsessions and compulsions may seem strange and unnecessary, such as worrying about being ‘contaminated’ and so needing to wash your hands seven times after touching something, but also seem out of your control. These repetitive behaviours can cause problems and significant interference in your daily life, such as washing your hands till they are chapped or so much that you are late for a plan. Many people may experience distressing thoughts or conduct repetitive behaviours, but this alone does not mean you have OCD. OCD results in a persistent and extreme cycle of obsessions and compulsions that consume a great amount of time every day, become rigid and uncontrollable, impair work or social functioning, and disrupt daily life. If you try to ignore your obsessions and do not perform the compulsions, it will in-turn increase your distress until you are urged to conduct the compulsive behaviour. Over time, these failed attempts of trying to end these urges and acts lead to more ritualistic behaviour as your mind constantly relies on this to relax, resulting in an endless cycle. Because of this, it is crucial to get professional help so you can get past the obsessive thoughts and detach them from the compulsive activities; the longer you wait the harder it gets. OCD impacts around 2% of the global population, and almost equally affects people of all ages, genders, races, and socioeconomic backgrounds.
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Symptoms
Most people with OCD experience symptoms of both obsessions and compulsions, but it is possible to experience only one or the other. Symptoms typically begin to appear in late childhood, adolescence, or early adulthood; the average age of onset is 19. Symptoms of OCD can come and go, and get better or worse with time. They can interfere in all areas of life such as work, school, leisure, and personal relationships. You may or may not recognize your symptoms and acknowledge your thoughts and behaviours to be excessive or unreasonable.
Symptoms of OCD include:
Inability to control your obsessive thoughts and compulsive behaviours, even if you know they are unnecessary
Spending at least an hour a day on these thoughts and behaviours
Experiencing significant problems and interferences in daily life due to these thoughts and behaviours
Only feeling brief relief from the distress caused by obsessions and not experiencing any pleasure when performing behaviours
Obsessions
Obsessions are persistent involuntary thoughts, images, or impulses that cause distress and anxiety. Although you may recognize that these thoughts are wrong, a product of your mind, and unreasonable, you may not be able to stop them. They can be extremely disturbing and worrisome and cannot be resolved by logic. Obsessions may typically intrude when you are busy thinking about or trying to do other things.
Examples of obsessive symptoms include:
Fear of germs, dirt, and getting contaminated (from people, objects, and the environment)
Unwanted intrusive thoughts and images involving sex, violence, religion, or harm
Extreme concern with specific order, precision, and symmetry
Worrying about yourself or loved ones getting seriously hurt
Fear of losing important things
Constant doubts and uncertainty (whether you have locked the door, whether you turned off appliances, whether your partner is being faithful or not)
Excessive focus on religious, moral, or superstitious ideas
Aggressive thoughts about losing control and acting inappropriately in public (shouting obscenities, harming others or yourself)
These obsessions then cause you to engage in compulsive ritualistic behaviours. You may try to ignore them or avoid situations that trigger these obsessions but they just cause more distress and anxiety at the back of your mind until you are urged to conduct the compulsion.
Compulsions
Compulsions are repetitive behaviours or mental acts that you feel forced to perform in order to reduce the distress caused by obsessions. They may be responses that are directly related to an obsessive worry or completely unrelated actions that just reduce anxiety. Conducting these rituals repeatedly becomes very demanding and time-consuming, interfering with your daily routines.
Examples of compulsive symptoms include:
Excessive ritualized cleaning, hand washing, teeth-brushing, to a point where your skin/teeth become damaged
Avoiding touching door handles, using public toilets, using public transport, or shaking peoples hands
Ordering and arranging things in a particular way
Repeatedly checking locks, doors, switches, or appliances
Constantly seeking approval and reassurance
Doing tasks in a specific order and a specific number of times
Constantly checking on loved ones to make sure they are okay
Repeatedly counting to a certain number, tapping a specific number of times, and needing to count objects
Repeating certain words, phrases, or prayers
Excessively praying or engaging in rituals linked to religious fear
Although these compulsions are meant to reduce worry and obsessive thoughts, they are not logical and only provide temporary relief and the anxious thoughts tend to come back stronger. The compulsive behaviours and rituals also tend to cause even more stress as they are time-consuming and impact your ability to function and complete important tasks, causing the vicious OCD cycle.
Categories
There are many forms of OCD but most people fall into one of the following general categories:
Checking
If you fall into this group, you tend to repeatedly check things that you may associate with harm, such as locks, stove/oven, electrical appliances, switches, or alarm systems. You may also constantly worry about being pregnant or having another mental health condition, such as schizophrenia. You may have obsessive fears about having to prevent danger, fires, or damage and thus conduct checking compulsions. The checking behaviour is carried out several times, and at times can last over an hour. This can impact your life as it will cause you to be late for work, school, appointments, and other occasions, negatively affecting your grades, employment, and relationships.
Symmetry, Ordering, and Counting
You will be categorized into this group if you find yourself being obsessively concerned with order and symmetry and needing to have things be a certain way. You may need things to be a certain colour, positioned in a precise symmetrical arrangement, and have a specific amount. Numbers and counting to a certain number may also be important to you. Here the obsession is to prevent discomfort and have everything feel ‘right’, thus maintaining a specific order, number, and symmetry that feels ‘right’ to you is the compulsive behaviour. Getting things to be perfectly in order and symmetrical can be excessively time-consuming and cause you to be late for school, work, and other engagements. It can also be mentally and physically draining due to the amount of time and effort needed to have things be so precise. You may avoid letting people into your home or not let family members touch things in order to prevent disruption of the arrangement, which can have a negative impact on your relationships and social interaction.
Cleaning and Contamination
You are a part of this category if you are intensely afraid of being dirty and contaminated, and need to constantly clean, shower, or wash your hands. The obsessive fear stems from worrying about harming yourself or loved ones through infections. Due to this, the compulsive rituals of cleaning and washing aim to kill germs and bacteria and get rid of dirt. Avoiding public places and refraining from touching others is another compulsive behaviour you may display. The fear can also include ‘mental contamination’ where you feel like you have been treated like dirt. The washing or cleaning rituals are often carried out multiple times a day and done so until you ‘feel’ that you or an object is clean. Even if you or the object may be and look clean, you will continue the behaviour. This can take a long time which can cause physical impacts such as having overly dry chapped skin, scrubbing till your hands bleed, and even using bleach on your body. The time required for these rituals can impact your ability to maintain a job or relationships, and you may altogether avoid places and people until they meet your requirement of cleanliness. There is also a large financial cost of the consistent purchase and use of cleaning products.
Rumination and Intrusive thoughts
You will be in this group if you experience disturbing intrusive thoughts or ruminate over a specific line of thought.
Intrusive thoughts are constant unwanted and invasive fears and ideas. These thoughts are repetitive, disturbing, and can be horrific or violent. They can be extremely distressing and unpleasant and can include thoughts of causing harm to yourself or others. They are not fantasies or impulses that you want to act upon and are entirely involuntary thoughts and images. The feelings of experiencing these types of thoughts can be shocking and horrifying. These obsessions don’t involve specific compulsions and you may try hard to avoid them.
Rumination includes having obsessions with a certain line of thought. It involves having prolonged thoughts about specific themes or questions that are aimless and unproductive. Unlike intrusive thoughts, ruminations are not objectionable and can seem realistic, thus they are not resisted and indulged in more. Topics are usually of religious, metaphysical, and philosophical natures. You may question and dwell on questions about your existence, religious beliefs and actions, the afterlife, and more. These ruminations are excessively time-consuming and can be draining as you begin to contemplate and go over everything. You worry that things might be wrong. Ruminations don’t tend to ever lead to a satisfactory solution or conclusion and you may stay mentally preoccupied and detached.
Causes and Risk Factors
The specific causes of obsessive-compulsive disorder are not yet fully understood however many factors have been found to be linked to it. Some risk factors include:
Genetics and Family History - OCD may have a genetic component as you are more likely to develop it if you have a family member with it. There is a 25% chance of you developing symptoms if you have immediate family members with a history of OCD.
Biology - Differences in brain structure, activity, and chemistry have been found to be linked to OCD. Individuals with OCD have differences in the frontal cortex and subcortical structures. Along with this, there are also structural and functional differences in neural circuits. You would also have low levels of serotonin and unusually high brain activity.
Life Events - Stressful and negative life events such as abuse, neglect, bullying, and trauma can trigger OCD. It may also develop after events such as loss and childbirth. These events can increase fearful and intrusive thoughts and cause emotional distress, which then lead to compulsive behaviours. Stress can also make symptoms, especially obsessions, worse.
Infections - Research has found that in some cases children develop OCF following Streptococcal Infections. Infections such as strep throat or scarlet fever can lead to the sudden appearance or worsening of OCD symptoms.
Environment - Watching family members or friends with OCD can cause obsessive fears and compulsive behaviours to be gradually learned and picked up over time.
Personality - Highly conscientious, organized, responsible, and anxious individuals are more likely to develop OCD. High standards, strong responsibility, and fears can lead to obsessions and the need to conduct compulsions. Obsessive-compulsive, borderline, narcissistic, and avoidant personalities are highly comorbid with OCD (72%, 60%, 56%, and 52% respectively).
Other Mental Health Disorders - Mental health conditions such as depression, anxiety disorders, substance-abuse disorders, and tic-disorders are all related to an increased likelihood of also having OCD.
Prevalence
The global lifetime prevalence rates of OCD are around 1.5% for women and 1% for men. Males usually have an earlier onset of OCD than females and are more commonly affected in childhood, whereas females have slightly higher rates in adulthood. 2% of the world’s population has OCD.
Comorbidities
Almost all (90%) of individuals with OCD also have at least one other concurrent psychological condition. Disorders that are commonly comorbid with OCD include:
Anxiety disorders (including post-traumatic stress disorder, panic disorder, and phobias) (76% comorbidity)
Mood disorders (including major depressive disorder and bipolar disorder) (63% comorbidity)
Impulse-control disorders and attention deficit hyperactivity disorder (56% comorbidity)
Substance use disorders (39% comorbidity)
Tic disorder (30% comorbidity)
Eating disorders (15% comorbidity)
Other concurrent OCD-related conditions that can cause specific obsessions include:
Hoarding disorder - Collecting, arranging, and organizing things.
Excoriation - Picking at your skin.
Trichotillomania - Pulling out or eating your hair.
Hypochondriasis - Excessive and unnecessary worry about having an illness.
Body dysmorphic disorder - Excessive concern with perceived physical flaws.
Severity and Complications
Symptoms of OCD begin gradually and can vary in severity over time. The types of obsessions and compulsions can change and worsen with time. Symptoms tend to be more severe if you experience highly stressful situations. If you have an earlier age of onset you are also more likely to display more severe symptoms of OCD and have higher rates of bipolar disorder and ADHD. The severity of these symptoms can range from being mild and manageable to being extreme and overly time-consuming to a point where it becomes disabling. 15% of adults with OCD experience mild impairments, 35% experience moderate impairments, while 50% experience serious impairments. In all cases, it is important to seek help before symptoms get worse or cause further harm.
Complications from living with OCD include:
Difficulty completing your work.
Inability to attend work, school, and social activities (especially on time).
Wasting a large part of your day engaging in ritualistic behaviours.
Troubled relationships.
Poor or inadequate quality of life.
Physical conditions such as contact dermatitis due to excessive hand-washing.
Suicidal thoughts and behaviour.
Diagnosis
You and your therapist will discuss your thoughts, feelings, and behaviours in-depth in order to make a diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)’s criteria for diagnosing someone with OCD includes:
A. The presence of obsessions, compulsions, or both
Obsessions must meet both of the following requirements:
1. They are recurrent and persistent thoughts, images, or impulses that are intrusive and unwanted and cause clear distress or anxiety.
2. You try to ignore them or reduce them by performing a certain action.
Compulsions must meet both of the following requirements:
1. They are mental acts (e.g., praying or counting) or repetitive behaviours (e.g. washing or ordering) with rigid rules, that you feel urged to perform in response to an obsession.
2. They are aimed at reducing or preventing distress and anxiety, or preventing a feared situation. These behaviours or mental acts may be excessive and may not be realistically related to the problems they are trying to neutralize.
B. The obsessions and/or compulsions are time-consuming (they take up more than 1 hour every day), and cause significant problems or impairment in important areas of daily functioning (e.g, work, school, socially).
C. The symptoms are not due to another medical or psychological condition and are not the effects of any substance (drugs/medication)
D. The disturbances are not better explained by any other mental condition (e.g. the excessive distressing intrusive thoughts are not due to generalized anxiety disorder or the repetitive behavioural patterns are not better explained by autism spectrum disorder, etc)
Once diagnosed, the psychologist will additionally specify whether you have good/fair insight (you recognize that the disordered beliefs are not or may not be true), poor insight (you think that the beliefs are probably true), or absent insight/delusional beliefs (you completely consider the beliefs to be true). They will also assess whether you have tic-related OCD or not depending on your history or having verbal or motor tics.
When to seek professional help
Although many people may experience intrusive thoughts and fears, symptoms related to OCD are far more extreme, unrealistic, random, and time-consuming. OCD is also far beyond just perfectionism and being organized, it results in extreme distress and requires repetitive rituals. If you believe you have obsessions or compulsions that are interfering with your functioning and quality of life it is important to see a psychologist before it gets worse.
Treatment
There is no specific way to prevent or ‘cure’ OCD, however, treatment can help you manage symptoms and improve your quality of life. It is important to get treatment as early as possible as OCD and its symptoms can worsen over time and become more disruptive to your life. Treatments have been found to successfully improve functioning and reduce symptoms. It also helps to control symptoms of related disorders such as anxiety and depression. Treatments mainly consist of psychotherapy, medication, or a combination of both, and will be personalized towards your needs. If you have severe OCD it is recommended that you receive both therapy and medication for complete and maximum effectiveness. The length and intensity of the treatment depend on the severity of your OCD.
Psychotherapy
Talk therapies have been proven to be effective treatments for individuals with OCD. Cognitive behavioural therapy and its component exposure and response prevention are the most popular and effective forms of therapy used. If you have mild OCD you may only need around 10 sessions of therapy, whereas if it is more severe you will need more. Your therapist will also give you exercises or homework to do between sessions.
Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP)
CBT works by breaking down your problematic thoughts, feelings, and actions and then works to change them by correcting your thinking and behavioural patterns. ERP encourages you to face your fears and worrisome thoughts by putting you in situations that cause anxiety-inducing obsessions (exposure). You will then learn to lessen the anxiety and control the distress without having to engage in compulsions as a response to the obsessions (response prevention). For example, if you are worried about contamination, you will be exposed to touching dirty objects and prevented from washing your hands. This cycle of exposure and response prevention will be repeated until you are no longer distressed by your obsessions and/or compulsions. Over time you will stop conducting the ritualistic behaviours and will be able to control your thoughts and actions. The situations you will be exposed to will start from ones that cause the least anxiety initially and gradually progress towards more difficult ones. Being in a controlled fear-stimulating situation and seeing that nothing bad will happen if you don’t engage in a compulsive behaviour will make your mind understand that these fears are just irrational thoughts and not reality. Your distress will then decrease and over time you will no longer rely on ritualistic behaviours to cope with fearful thoughts. Your therapist will also use CBT to work on these fearful thinking patterns and help you reduce obsessions. CBT with ERP is an evidence-based, effective, and widely used therapy for OCD, and has been proven to reduce symptoms by 60-80% in patients with OCD. Although it may seem frightening and difficult at first, especially if you have poor absent insight, this form of therapy will help you overcome your symptoms and enjoy a better quality of life.
ERP is commonly used as an add-on or replacement treatment in cases where medications such as selective serotonin reuptake inhibitors (SSRIs) themselves are not effective in reducing the symptoms of OCD.
Medication
Medications such as selective serotonin reuptake inhibitors (SSRIs) are commonly used and effective in the treatment of OCD. They can help you control obsessions and compulsions as well as the anxiety and depressive symptoms linked to OCD by increasing serotonin levels in your brain. Low levels of serotonin can be a risk factor for OCD thus increasing levels can help control it. Studies have found SSRIs to reduce the symptoms and effects of OCD over time in 40-60% of patients. It usually takes around 2-4 months for the medication to start working and become effective. In some cases, antipsychotic medications may be useful when SSRIs do not work.
Self-Care
Relaxation techniques such as yoga, meditation, and massages, as well as maintaining a healthy lifestyle can help you cope with OCD. These techniques will clear and calm your mind and reduce levels of anxiety and distress. This can then control obsessions and lessen the urge to conduct compulsions.
Neurological treatments
In severe cases where psychotherapy and medications have not been able to help, neurological treatments such as deep brain stimulation (DBS) or transcranial magnetic stimulation (TSM) can be done. DBS involves implanting electrodes in your brain to regulate your psychological impulses. TMS is non-invasive and creates a magnetic field around your head to stimulate nerve cells in your brain.
FAQ’s
Is OCD the same as being a perfectionist or germaphobe?
The term ‘OCD’ has become commonly misused in society. OCD is a serious psychological and neurological condition that causes far greater concern and distress than just needing things to be clean and neat. You will have obsessions of unwanted and repetitive thoughts that make you perform excessive compulsive behaviours. These thoughts are obsessive and behaviours may be unrelated and are unnecessary. Being comfortable with a preference of having things be a certain way is a part of your personality and is not OCD.
What are the symptoms of OCD?
OCD causes severe distress and interferes with your daily life and functioning. It causes obsessions, which are intrusive and persistent thoughts, ideas, or images that cause marked anxiety or distress, and compulsions, which are attempts to control these thoughts and neutralize them through repetitive actions.
Examples of obsessions can include: worrying about contamination, needing to have things in a specific order, or experiencing violent or sexual impulses or images.
Examples of compulsions can include: repetitive and excessive hand-washing, organizing things particularly, praying, or counting.
What causes OCD?
Although the specific cause for OCD is not clear, many risk factors can lead to its development. These include genetics and family history, stressful or traumatic life events, streptococcal Infections, environmental learning, personality types, mental health conditions, and brain structure, functioning, or chemistry.
If someone in my family has OCD, will I also develop it?
Research has proven that OCD can be genetic and runs in families. If you have an immediate family member (parent, sibling, child) with OCD, you are 25% more likely to also develop it.
What is the best treatment for OCD?
A combination of both psychotherapy and medication can be the best treatment for OCD. The most effective forms of therapy include cognitive behavioural therapy (CBT) and exposure and response prevention (ERP). The most effective medications are selective serotonin reuptake inhibitors (SSRIs). Relaxation techniques such as yoga, meditation, visualization, and massages can also be useful add-ons.
Are treatments for OCD effective?
SSRI medications have been shown to reduce symptoms of OCD in 40-60% of patients, and therapy such as CBT has been shown to reduce symptoms by 60-80%.
Thrive Specialists in OCD
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Dr. Kate Prozeller is a CDA-licensed psychologist. She holds her PsyD in Counseling Psychology from Saint Mary’s University in the United States. Dr. Kate provides individual therapy to adults, couples therapy, and English-language art, sand, and play therapy to children and adolescents. Prior to relocating to Dubai in 2019, she has worked as a psychologist in the United States, serving a variety of patient populations and across hospitals, private practice, and university settings.
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Jessica Rosslee, M.A.
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Joslin Gracias, M.A.
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Joslin is a CDA-licensed psychologist. She holds an M.A. in Clinical Psychology from S.N.D.T. University in India. Joslin works with adolescents, adults, and couples who are experiencing depression, anxiety, relationship difficulties, trauma, and burnout/stress.
Tuna Bereket, M.A.
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Zuha Zubair, M.Sc.
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Corina Saramet, M.A.
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Corina is a CDA-licensed psychologist specializing in working with adults and adolescents (16+). She obtained her Master’s Degree in Cognitive Behavioral Psychotherapy at the University Titu Maiorescu in Romania. Her areas of expertise include anxiety disorders, depression, grief and loss, trauma, and stress.
Dr. Dana Jammal
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Dr. Dana is a UK-trained HCPC registered Counselling Psychologist who completed her doctorate training at City, University of London. She also holds a Master of Science degree in Mental Health Studies from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and a Bachelor of Science Honors degree in Psychology from McGill University in Canada. Dana has over 10 years experience working with individuals facing a range of mental health difficulties and challenges.
Rita Figueiredo, M.Sc.
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Rita Figueiredo is a Clinical and Health Psychologist with an M.Sc. from the University of Lisbon in Portugal. She is licensed by the DHA and CDA, and also holds a European Certificate in Psychology. Rita enriches her practice with four years of extensive experience. She is driven by a profound passion for understanding relationship dynamics. As a result, Rita pursued specialized training in Couples and Family Therapy. This expertise equips her with the necessary tools to assist clients in navigating complex relationship issues, guiding them towards achieving happiness and relational well-being.
Dr. Ash Shishodia
Consultant Psychiatrist
Dr. Ash Shishodia is a Western-trained General Adult Psychiatrist (Addiction Psychiatry endorsement) and Neuropsychiatrist with over 15 years experiencing working with an ethnoculturally diverse population. I am comfortable working with mild, moderate, and severe cases, including major mental illness, and neurological disorders with mental health.
Dr. Lara Foresi
DHA-Licensed Specialist Psychiatrist
Dr. Lara is a European-trained General Adult Psychiatrist with extensive experience in mood disorders and substance misuses. She is both trained and experienced in working with people from diverse ethnocultural backgrounds. Dr. Lara works with mild, moderate, and severe cases of psychiatric disorders, neurodiversity and mental health..
Michelle Estekantchi, M.Ed.
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Michelle Estekantchi is a Licensed Psychologist with a Master’s degree in Counseling Psychology from Memorial University (Canada). She works with children, adolescents, and adults across a range of issues including anxiety, depression, relationship issues (peer, family), burnout, and self-esteem issues. Michelle also conducts psychoeducational and ADHD assessments.
Our mental health professionals are here to help you, whether you need to heal or want to thrive.
Get in touch to find out how we can help you. Contact us however you feel most comfortable, for example Whatsapp message us, or feel free to call us on +971 56 895 2347. You can also email or simply send us a query via our online form. Instagram message, Facebook chat… whatever works best for you!
Our goal is to make you comfortable.
