Obsessive-Compulsive Disorder (OCD)

16th October 2023

Signs, Symptoms, and Treatment Options

Obsessive-compulsive disorder (OCD) is characterized by repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome.

This page has been professionally reviewed and edited by a practicing mental health professional with a PsyD in psychology.

Compulsive hand-washing is one way OCD manifests itself.

Obsessions involve persistent and recurrent intrusive thoughts, images, or impulses that can be disturbing and inappropriate.

Compulsions can involve over-repetitive behavior or more covert mental acts. This is often in response to an obsession, and it is behavior that is often times rigid as to how it should be performed. The goal can be to prevent or reduce distress or prevent some dreaded event or situation.

NIMH’s Definition of Obsessive-Compulsive Disorder
"An anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand-washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called 'rituals,' however, provides only temporary relief, and not performing them markedly increases anxiety." http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

Characteristics of Obsessive-Compulsive Disorder OCD

Cognitive: Obsessions, Ruminations, Cognitive

Obsessions are defined as recurrent, persistent ideas, thoughts, images, or impulses involuntarily coming to awareness.

Ruminations are forced preoccupation with thoughts about a particular topic, associated with brooding, doubting, and inconclusive speculation. (Ex. Worrying several hours a day if a former lover will establish contact).

Cognitive rituals are often elaborate series of mental acts that one feels compelled to complete. Ending performance of the ritual can only take place, for those with OCD, if the ritual is properly performed or carried out completely.

Motor: Compulsive, Avoidances

Compulsive motor rituals can be elaborate, time-consuming activities that are often associated with common, everyday activities such as eating, washing, toileting, grooming, dressing, and sexual activity. (Ex. repetitive hand-washing, compulsive counting, or "checking" of objects)

Compulsive avoidances involve substitute actions performed instead of appropriate anxiety causing-behavior. (Ex. Distracting oneself before exams with elaborate avoidance activities to avoid having to study for the test; an action with potential anxiety.)

Signs and Symptoms of Obsessive-Compulsive Disorders

The Medical Director of the New York State Office of Mental Health, Lloyd Sederer, MD, explains the difference between signs and symptoms when diagnosing mental health disorders using Obsessive Compulsive Disorder as an example. Obsessions are considered to be symptoms involving thoughts or impulses, whereas compulsions are signs involving visible actions.

"Obsessions are symptoms, such as thoughts or impulses, which gnaw away at someone's mind even though the sufferer knows that the thoughts are unreasonable. Obsessions are more than just worries like: “Did I remember to leave a note for friend who is staying at my apartment?” Another symptom of the condition is anxiety that manifests as anxious thoughts, such as: “Did I turn off the stove (after checking it 25 times)?” “Will I be exposed to infection if I touch any surface in the classroom?”

Compulsions are signs: they are visible, repetitive actions by a person in response to a particular anxiety-provoking idea (despite knowing that these are irrational and foolish behaviors). Some examples of compulsions are: “I will count to thirty forty times, and only then can I leave the house safely;” “If I touch my index and thumb fingers while saying the Lord's Prayer, then nothing bad will happen to my children;” or “I must wash my hands just one more time (this after ten minutes of scrubbing hands that are already chapped from previous washings) then I can return to work" (Sederer, L., Erlich, M., 2012).

Who is Affected with Obsessive-Compulsive Disorder (OCD)?

OCD can range from mild to severe. One reference says that OCD affects 2% of people in the US. Divorced or separated individuals and unemployed people are somewhat overrepresented. There seems to be little gender difference in OCD, markedly different from that of depression and other anxiety disorders.

It is stated that 67% of those with OCD may also experience major depression at some time in their lives, and there can be other comorbid personality problems or disorders. According to the A.D.A.M. Medical Encyclopedia, most who develop OCD do so by the age of 30.

The Psychodynamics of OCD - Overcoming Perfectionist Thinking

There are different schools of thought with regards to OCD and its causes. From a psychodynamic viewpoint displacement, substituting one activity for another activity can be a causal factor; a person who has thoughts of hurting a child displaces those thoughts with other compulsive behaviors. A person might be seeking forgiveness for some real or imagined transgression, and try to find that in a "formula" of compulsive behavior in an attempt to "undo" such thoughts or past actions.

In this aspect of OCD, helping a person past an "all or nothing" viewpoint of life, to realize that we are acceptable despite our imperfections and that perfection is not expected or demanded, can be important psychological and spiritual lessons to learn — in both acknowledging such, and making it a part of one's psyche. Some religions teach a very strict view of sin. Some fundamentalist religions might stress obedience through fear. Others may have been raised by overly demanding parents, or parents who were abusive or who never gave approval. These thought patterns formed through the years are not easy to erase. This type of thinking, then, can contribute to the thought patterns that lead to obsessive thoughts.

From the role of a psychologist or that of a pastor or other counselor, a person needs aid to realize that perfection is not expected of them, that God does not expect perfection, and that God is forgiving, especially if a person continues to make efforts in a positive direction. Accepting mercy for oneself and realizing that each one has worth can be something of value to change the thinking that can lead to obsessive thoughts.

The Behavioral Model for OCD is said to be very helpful for many who experience such compulsions. In the therapy involved, a person would be exposed to a situation that leads to obsessive-compulsive behavior, and then will be helped through the situation. Repeated success in controlling the compulsion or overcoming unreasonable fears helps a person gain mastery of the situation and confidence.

Antidepressant Use in Treating OCD

Antidepressants are the most common form of treating OCD, despite the fact that relief from symptoms is usually temporary, short-term, and lasts only as long as the drug is taken. There is some anecdotal evidence that there is some benefit to antidepressants as an adjunctive rather than primary therapy. As far as clinical evidence goes, there seem to be only two short-term clinical studies measuring the effectiveness of antidepressants for OCD that provide some support for modest improvement in symptoms (reduction of symptoms by approximately one-third) of OCD with antidepressant use.

Why, then, has prescribing antidepressants become the most common way of treating OCD, despite the fact that there are more effective treatments? The answer lies in the fact that prescribing an antidepressant is simple and convenient. Also, antidepressant use has become an accepted part of treatment for depression, and depression accompanies signs and symptoms of OCD in the majority of sufferers (over 70%, according to some studies).

An examination of clinical studies that support antidepressant treatment for OCD will not reveal the origin of said studies, or who sponsored or conducted them. This indicates that the research was most likely sponsored by the pharmaceutical company who manufactures the antidepressants used in treatment. Because of the likely lack of objectivity with studies sponsored by manufacturers of the drug being tested, it seems that more testing would be necessary before one could conclude that antidepressants are effective treatment, albeit in most cases, conjunctive, for OCD. In others words, we can be a little skeptical about clinical studies sponsored by pharmaceutical companies. There can be bias in the way the study is designed, conducted, and interpreted, considering the fact that the doctors performing the studies are being paid to conduct the tests, making it a lucrative source of income for doctors.

Additionally, while it is possible that there may be some short-term benefit for use of antidepressants, it has also been concluded that there is a higher-than-usual relapse rate for OCD treated with drugs in the long-term. "Once a person stops taking [antidepressants for OCD], in most cases the OCD symptoms return" (Grohl, M., PSYD, June 27, 2012).

Bradley C. Riemann, PhD, states in Psychiatric Times, "While medications can reduce symptoms of OCD by about one-third, this is seldom sufficient to adequately control the disorder."

Dr. Riemann continues, "Patients with OCD generally respond best to cognitive-behavioral therapy (CBT)." For this and other reasons, Cognitive Behavioral Therapy, then, is a preferred method of treatment for OCD that addresses not only the symptoms, but also the thought patterns associated with the behavior.

Psychosurgery and OCD

For approximately ten percent of those with OCD, the disorder seems to be intractable. For some of those who find no relief from symptoms through various non-invasive therapies, neurosurgery techniques have been suggested. This site does not recommend neurosurgery, however. Before anyone resorts to neurosurgery in addition to behavioral and cognitive therapies, one should also consider some of the other suggestions found on this site, like the
16 Keys to good mental health that can assist one to overcome problems associated with OCD. Cognitive-behavioral therapy is also recommended.

Films and Television - Violence and Disturbing Content - Psychological Affect
- Prevention and Possible Media Influences

Obsessive-Compulsive Disorder is considered to be a form of anxiety disorder. As such, it is reasonable to conclude that avoiding external stimuli that contributes to unnecessary anxiety can be one area of prevention in self-help for OCD.

Because watching fast-paced television and movies can contribute to higher anxiety levels, it is possible that watching certain types of television and films on a regular basis may contribute to an increase in symptoms of OCD in some. Suspenseful thrillers or pseudo-news programs exploring hidden crimes or conspiracies may can contribute to the type of thinking that is evident in OCD, as examples. These types of films and TV programs, when watched on a regular basis, can contribute to irrational fears that contribute to the thought processes involved with OCD. As this thinking is reinforced over time, symptoms of OCD can be reinforced likewise strengthened.

Another hypothesis is that excessive time with television and devotion to watching movies as a form of recreation can have the effect of locking the mind in a passive mode that is being constantly directed by external sources. The mind or will can become weak and open to suggestion. The only thing that the passive viewer has full control over are those associated with obsessive-compulsive rituals.

In one study conducted in Israel of 237 adults, television clips of terrorism and political violence reported higher levels of anxiety (Hamblen, J., Ph.D.). Watching television, including the news and sensational news programs, then, may increase levels of stress and anxiety for some individuals. Watching television excessively as a way of life does affect one's mind processes, and for some may contribute to "circular thinking," a way of thinking contributing towards obsessions and compulsions.

The same might be said for many films that feature violence or distressing situations. Viewing films with macabre themes or scenes/themes with deep emotions on a regular basis can also put some in a disturbed emotional state, which can contribute to, along with other factors, irrational thinking leading to some symptoms of OCD.

Persons with OCD might consider doing without television and movies/films, or cutting back on the number of intense films that one might watch in a given week or month.

Television Habits and Sports Obsessions

Similarly, watching sports on television, such as baseball and basketball, can become something of an obsession for some; the statistics and numbers involved with baseball can lend itself well, for some, to the type of thinking associated with OCD. Not to say that playing sports might lead to such thinking, but the passive obsession of following teams and statistics might be one factor for some people that contributes to the mental patterns that lead to OCD.

Baseball is also known as a sport where superstitious thinking is most common among players and coaches as well as fans, and it is that type or pattern of thinking that, for a few, might also lead to obsessions and compulsions (Stadler, M., 2006).


There may be certain types of music that reinforce mental patterns contributing to patterns involved with OCD. Overindulgence in intense music may contribute to mental health difficulties. Self-examination in this area can be beneficial, and switching from intense and powerful music to music which is less taxing on the mind might benefit some.

Cognitive Behavioral Therapy for OCD

Behavioral and cognitive therapies are effective because the results are more enduring; new skills are learned and reinforced, and new ways of thinking are developed.

People who benefitted from CBT usually saw their OCD symptoms reduced by 60-80% (International OCD Foundation). The International OCD Foundation states that one of the most effective types of cognitive behavioral therapies used for OCD is one that is called Exposure and Response Prevention, or ERP. "Exposure" in ERP refers to confronting the thoughts, images, objects, and situations that make a person with OCD anxious.

"Response Prevention" refers to making a deliberate choice not to perform a certain compulsive behavior after coming into contact with the things that trigger a compulsive response.

Both actions and thought patterns need to be changed with OCD. The compulsive way of thinking can develop in certain mental environments. Cognitive behavioral therapy can be effective because it addresses both actions and thought patterns.

Solutions and Self-help for OCD

Art is an excellent therapy for OCD, both as a hobby and as a professional therapy. Art can calm and soothe the mind. The temporary mental retreat of creating art, the satisfaction of creating something new, as well as the soothing nature of creating artwork, can make obsessions and rituals less compelling, and can assist individuals with OCD to break free from them.

Reading the news rather than watching it on television can also be of benefit for some. The news, for some, might contribute to fears that can lead to irrational obsessions. Reading the news is less impactful, and requires more deliberate choice in what articles one will read. It requires more mental energy and strength to read the news rather than to watch it, and if reading becomes a way of life, it can serve the purpose of strengthening the mind. This in turn can help some gain ground on certain types of mental health disorders.

Finding quiet time with nature, or green therapy, is also of value as a therapeutic activity for OCD. Other forms of therapeutic behavior are prayer, attention to spiritual needs, as well as the avoidance of any type of pornography (which can set up patterns of thinking of obsessions, compulsions, and guilt).

There is much that can be done through self-help and non-pharmaceutical professional therapy to overcome the thought processes that lead to obsessive-compulsive disorder, so it need not be a lifetime difficulty.

Natural Therapies for OCD - (on-site links)

Cognitive Behavioral Therapy

Art Therapy

Attention to Spiritual Needs

Green Therapy

Relaxing and Soothing Music (rather than intense music)

References for Obsessive-Compulsive Disorder (OCD) - Signs, Symptoms, and Treatment Options

1. Cognitive Behavior Therapy (CBT). (2010). International OCD Foundation. http://www.ocfoundation.org/CBT.aspx

2. Grohl, M., (2012, June 27). OCD Is Most Often Treated with Antidepressants. PsychCentral. http://psychcentral.com/blog/archives/2012/04/07/ocd-is-most-often-treated-with-antidepressants/

3. Hamblen, J., Ph.D. The Effects of Media Coverage of Terrorist Attacks on Viewers. National Center for PTSD Fact Sheet. Retrieved July 28, 2012. http://www.au.af.mil/au/awc/awcgate/va/fs_media_disaster.htm

4. Obsessive-compulsive disorder - Obsessive-compulsive neurosis; OCD. (2012, March 7). A.D.A.M. Medical Encyclopedia. PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001926/

5. Riemann, B. C., PhD, (2006, August 1). Cognitive Behavioral Treatment for Obsessive-Compulsive Disorder. Psychiatric Times. http://www.psychiatrictimes.com/ocd/content/article/10168/51891

6. Sederer, L., Erlich, M. (2012). How Thoughts Become a Psychiatric Diagnosis. The Atlantic. http://www.theatlantic.com/health/archive/2012/07/how-thoughts-become-a-psychiatric-diagnosis/260012/

7. Stadler, M., (2008). The Psychology of Baseball. New York: Gotham.