Obsessive-compulsive disorder

Obsessive-Compulsive Disorder Diagnosis and Treatment

Learn about the details, causes, symptoms, and treatment options for obsessive-compulsive disorder.

Table of Contents

Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder, or OCD, is a mental health condition that can cause intrusive thoughts and compulsive behaviors. While the specific symptoms vary from person to person, OCD can be extremely disruptive and impairing. If you or someone you know is struggling with OCD, it is essential to get help. Many effective treatment options are available, so don’t hesitate to reach out.

In the United States, approximately 1.2% of adults were diagnosed with obsessive-compulsive disorder. About 50% of these adults had an OCD diagnosis classified as serious. OCD is a long-lasting mental health disorder that involves reoccurring behaviors and thoughts.

Overview of OCD

Obsessive-compulsive disorder is a chronic condition based on obsessions and compulsions. Obsessions are repetitive and continuous thoughts, while compulsions are reoccurring behaviors. An individual with OCD may have obsessions, compulsions, or both.

Different Types of OCD

Obsessive-compulsive disorders typically fall into one of the following four main categories; however, there can be some overlap between the categories:

Checking
If a person with OCD is excessively checking things, they are demonstrating a compulsion. This fear-based obsession may be surrounding memories, door locks, house alarms, stoves, water taps, fires, electrical appliances, re-reading texts, or checking valuable items. Checking is a repetitive compulsion that can last upwards of an hour in some cases. For people with OCD, checking may significantly impact the person’s school, social, or work obligations.

Contamination
If a person fears contamination or the feeling of being dirty, they are displaying an obsessional worry. Typically, a person obsessing over contamination believes it might harm them or their loved ones. Related compulsion behaviors can include hours of cleaning after sexual intercourse, showering after exposure to outside air, and excessive tooth brushing.

Symmetry and Ordering
Orderliness and symmetry constitute the third category of OCD types. This type of OCD involves having everything just right to prevent something bad from happening or feelings of discomfort. Facing items the same way, keeping everything neat at all times, and having everything spotless are all examples of this type of OCD. Symmetry and ordering can be highly time-consuming and physically and mentally draining for the person.

Ruminations and Intrusive Thoughts
For someone with OCD, rumination is defined as a “train of prolonged thinking about a question or theme that is undirected and unproductive.” Ruminations can involve religion, philosophy, morality, and what happens after death. Although everyone experiences positive and negative intrusive thoughts, people with OCD typically experience unpleasant and repetitive intrusive thoughts. A few examples of intrusive thoughts include constantly seeking reassurance from one’s significant other, violently harming someone, and dwelling on superstitious beliefs.

Causes and Symptoms

The following sections explore various causes, signs, and symptoms associated with obsessive-compulsive disorder.

Causes of OCD

Although extensive research has been conducted, the exact cause(s) of OCD is still unknown. Nonetheless, research has suggested that biology, genetics, learning, and brain structure play a role.



  • Genetics: OCD has been found to run in families. Therefore, researchers believe that genetics are partially responsible for causing the disorder.
  • Brain Structure and Functioning: Researchers believe that OCD involves communication breakages between the front of a person’s brain and the deeper structures in the brain.
  • Biology: Current research does suggest that OCD is a biological disease. Brain imaging studies have shown hyperactivity in specific brain regions when individuals have OCD.
  • Learning: According to the Learning Theory, some researchers believe that OCD results from an individual’s learned behavior patterns and negative thoughts.

Signs and Symptoms

Signs and OCD symptoms are classified as obsessions and compulsions. The following sections will provide definitions and examples of these two terms.



Obsessions Symptoms

Reoccurring thoughts, mental images, and urges that cause anxiety are obsessions. Common obsession symptoms are aggressive thoughts, having things in perfect order, fear of germs, and unwanted thoughts involving sex, religion, or violence.



Compulsions Symptoms

A person with OCD has the urge to perform repetitive behaviors in response to their obsessive thoughts. Examples of compulsions are excessive handwashing, ordering things a particular way, checking on things repetitively, and compulsively counting.

How to Diagnose Obsessive-Compulsive Disorder

Trained mental health professionals are the only individuals that can provide an obsessive-compulsive disorder diagnosis. Licensed professionals have the credentials and experience to distinguish between a clinical diagnosis and regular habits everyone experiences from time to time.

Psychological Evaluation

A mental health professional uses clear-cut diagnostic criteria during a psychological evaluation to determine whether the person has obsessive-compulsive disorder symptoms.

Diagnostic Criteria for OCD

In general, to meet diagnostic criteria for obsessive-compulsive disorder, an individual must present obsessions or compulsions. The person must have at least one compulsion or obsession that is considered excessive or unreasonable, causing distress or significantly interfering with the person’s life.

Physical Exam

During an assessment for obsessive-compulsive disorder, the provider may administer a physical exam and order lab testing to rule out other causes such as medications or mental illness.

Diagnostic Challenges

OCD symptoms are often paired with feelings of shame or secrecy. Obsessive-compulsive disorder symptoms can also present in a complex way. These factors can lead to diagnostic challenges and delays in care.

Treatment Options for Obsessive-Compulsive Disorder

Treatment for OCD symptoms is available in many formats, including psychotherapy, intensive outpatient therapy, residential treatment, medication management, and more. The following sections will explore these forms of OCD treatment.

Psychotherapy

Psychotherapy is an effective form of OCD treatment for people of all ages. In many cases, psychotherapy, including cognitive-behavior therapy (CBT) and habit reversal treatment, can be equally as effective as medication for OCD.

Intensive Outpatient and Residential Treatment Programs

OCD treatment is available in traditional outpatient, intensive outpatient, and residential levels of care. Depending on the necessary level of care, individuals in obsessive-compulsive disorder treatment could attend outpatient once a week or several days per week. In contrast, residential OCD treatment programs are live-in, voluntary programs.10 

Deep Brain Stimulation (DBS)

DBS is FDA-approved as a Humanitarian Device Exemption (HDE) for OCD treatment. DBS is an intervention involving electrodes and the brain. This method is typically only used for treatment-resistant OCD.11 

Transcranial Magnetic Stimulation (TMS)

TMS is FDA-approved to treat obsessive-compulsive disorder symptoms in adults. Transcranial magnetic stimulation is a non-invasive therapy that uses magnetic fields to stimulate the brain.

Medication

OCD medications are comprised of serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs). Medication for OCD typically takes about eight to twelve weeks to start working. Here is a list of the common medications used to treat OCD:12 

  • Citalopram (Celexa): Citalopram is a common antidepressant prescribed to treat OCD symptoms.
  • Escitalopram (Lexapro): Escitalopram is an OCD medication used alongside therapy.
  • Fluoxetine (Prozac): Obsessive-compulsive disorder treatment providers often prescribe fluoxetine for clients.
  • Fluvoxamine (Luvox): Fluvoxamine or Luvox is used to treat individuals with obsessive-compulsive disorder symptoms.
  • Paroxetine (Paxil): Medication management providers often prescribe paroxetine to patients diagnosed with OCD.
  • Sertraline (Zoloft): Sertraline is a common antidepressant approved for use as an OCD medication.

Neuromodulation

Neuromodulatory approaches include deep brain stimulation (DBS), electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and magnetic seizure therapy. In OCD therapy, neuromodulation techniques are becoming more common.13 

Lifestyle and Home Remedies

Obsessive-compulsive disorder
Although managing OCD can be a lifelong challenge, lifestyle and home remedies can make a significant impact.

  • Learn About OCD: As with any medical diagnosis, knowledge and education are key to making empowered decisions for one’s health. People should never be afraid to ask questions or seek help if they are experiencing OCD-related symptoms.
  • Practice What Is Learned: A crucial part of therapy is completing the homework assignments and doing the work every day.
  • Take Medications as Directed: Medication for OCD and treatment plans are excellent resources for managing OCD. Be sure to take medications as prescribed and discuss desired changes with a doctor before making any changes.
  • Stick With Regular Activities: Routine is essential for completing homework assigned by a counselor. Taking medications, therapy appointments, and self-care are all other crucial components of keeping a routine.
  • Find Healthy Outlets: Healthy outlets, including hobbies, exercise, social activities, and self-help groups, are necessary for managing obsessive-compulsive disorder.