What is OCD?

To understand obsessive compulsive disorder (OCD), it’s first important to know what it is. As the name may suggest, OCD is a mental health disorder that consists of two parts, and these are the obsessions and the compulsions.

Obsessions are unwanted thoughts, images, or urges that are often intrusive, repetitive, and distressing. They’re also associated with feelings such as fear, doubt, disgust, anxiety, or a feeling that things need to be done ‘just right’. Everyone can have thoughts or feelings like these from time to time. However, what differentiates obsessions in OCD is that they’re persistent and the person is unable to control, get rid of, or ignore them. In addition, they are time-consuming and interfere with the person’s daily activities, whether they be related to work, school, their social life, etc.

Some common obsessions can be found under the categories of contamination, doubting, ordering, violence, religious, and sexual. Contamination relates to a fear of contamination by dirt, diseases and fear of feces, bodily fluids, etc. Doubting can include fearing that the stove hasn’t been turned off, the door hasn’t been locked, or fear that one may make a mistake or do something that could cause harm, etc. Related to this are violent obsessions, which can include the fear of harming others or oneself. Ordering relates to a concern with order, symmetry, exactness, or things being “just right”. Religious obsessions can include fears of blasphemy, of having thoughts that go against one’s religion, and an excessive preoccupation with morality and religious thoughts or images. Finally, sexual obsessions are related to unwanted or forbidden sexual thoughts, images, etc. However, it’s important to note that these are only a small portion of the types of obsessions people with OCD can have

People with obsessive thoughts often try to reduce the associated distress by performing certain actions or rituals, which are the compulsions. And often, compulsions are closely related to obsessions; for instance repeatedly checking the stove for a set number of times to ensure that it has been turned off.

Compulsions are repetitive behaviors or mental acts a person feels driven to perform in response to their obsession. As mentioned above, compulsions are often intended to reduce the distress caused by obsessions or to neutralize them, avoid them, or make them go away. And they may be helpful in the short-term but not in the long-term. In addition, similar to obsessions, compulsions are time-consuming and interfere with a person’s daily activities to varying degrees. What differentiates compulsions from normal rituals or repetitive behaviors is that people with OCD find it very difficult and nearly impossible not to do them. Another differentiating factor is that, for example, unlike people who like having their things neatly ordered and enjoying making them so, people with OCD are often aware that their compulsions are senseless and would actually prefer not to perform them.

Some common compulsions are cleaning, washing, checking, ordering or arranging, mental rituals such as counting and repeating certain thoughts or phrases, constantly seeking approval or reassurance, etc. It’s also important to note that, while obsessions and compulsions often occur together, some people may have one and not the other.

What Causes OCD?

Experts haven’t fully understood what’s behind OCD. However, most agree that there’s no single cause of OCD and that it instead results from a combination of biological, genetic, and psychological factors.

The biological cause of OCD relates to changes in brain chemistry and brain activity. The brain chemistry aspect relates to neurotransmitters, which are chemicals in the brain that help transmit signals from one neuron to another neuron or to other types of cells. One neurotransmitter that’s been liked to OCD is serotonin. Serotonin is a neurotransmitter that is involved with mood regulation and impulse control and also affects memory and learning processes. Decreased levels of serotonin are what have been associated with OCD. The medications used to treat OCD, such as SRIs (serotonin reuptake inhibitors), work by raising the available levels of this neurotransmitter. Dopamine, which is related to the reward systems in the brain, is another neurotransmitter that’s been associated with OCD. Medications that affect dopamine can therefore also be helpful.

Serotonin and dopamine are the two major neurotransmitters that have been implicated as possible causes for OCD. They’re also what most OCD medications target. However, researchers are also looking into glutamate, another major neurotransmitter, as a possible cause. They’ve found that people with OCD have higher levels of glutamate compared to those who don’t have OCD. There is a possibility that these high levels are a result or consequence of OCD instead of its cause but other genetic findings have indicated that this is probably not the case. So, researchers are now looking into various medications that reduce high levels of glutamate as a possible treatment for OCD.

The second aspect of the biological causes behind OCD, as mentioned above, is changes in brain activity. Researchers can study the levels of brain activity or metabolism in an individual with advanced imaging techniques and such studies have shown that individuals with OCD have increased levels of activity in certain areas of the brain. One such area is the caudate nucleus, which is a structure found in the basal ganglia. It’s a structure that screens messages it receives from other areas of the brain and regulates habitual and repetitive behaviors, such as the ones seen in OCD. In addition, the treatment of OCD has been associated with brain activity in this region returning to normal levels.

Another region of the brain that’s been associated with OCD is the prefrontal cortex, which regulates appropriate social behavior. High brain activity in this region may therefore be related to the increased worry about social and moral concerns (like meticulousness, cleanliness, and fear of impropriety) that is one aspect of OCD. High levels of brain activity have also been recorded in the cingulate gyrus. This structure helps regulate emotion and takes part in predicting and avoiding negative outcomes as well as recognizing errors. It may therefore be behind the emotions associated with obsessive thoughts and the obsession of fearing making mistakes. It’s also interesting to note that the cingulate gyrus is well connected to the prefrontal cortex and the basal ganglia, the brain structures mentioned above, through many brain circuits. Increases and decreases in grey matter (the part of the brain which contains nerve-cell bodies and nerve fibers and is where most “processing” is done) have also been recorded in different parts of the brain.

The second in the combination of factors that can cause OCD is genetics. Most experts agree that OCD runs in families. It must therefore have a genetic component. However, the specific genes responsible for the condition haven’t yet been identified. The genes involved with the regulation of serotonin and other neurotransmitters in the brain are possible suspects though.

Psychological factors may also play a role. One example of this is that obsessions and compulsions can sometimes be learned from family members or other close individuals. Obsessions and/or compulsions also seem to be related to the things that a person values. An example given by the department of psychiatry at Sunnybrook is that obsessive thoughts about harming one’s baby are common among new parents with OCD. Research on OCD in different cultural groups suggests that there are no big differences across cultures, ages, or genders.

There are some risk factors that can make one more susceptible to OCD. Family history of OCD, as mentioned above, is one such factor. Stressful events, the nervous system disorder known as Tourette’s syndrome (TS), and mental health disorders such as anxiety and depression are other factors that are associated with OCD. There’s also a link between OCD and substance abuse. More specifically, OCD has been associated with higher rates of substance abuse. The link between these two conditions can also work the other way around as, whatever its initial cause was, substance abuse may interfere with a person’s treatment for and recovery from OCD on top of the negative consequences it has on its own.

Diagnosis

As was mentioned in previous sections, there are many normal and day-to-day thoughts or activities that could be confused with OCD. This is why only trained professionals can diagnose OCD. Some of the primary differentiation factors are the degree of distress, the level of impairment or interference, and the amount of time spent. More specifically, more than one hour per day must be occupied by obsessions and/or compulsions for them to qualify as OCD. Other causes of confusion in the diagnosis of OCD are related to the fact that the person’s symptoms may be better accounted for by other disorders or that OCD can occur at the same time as other disorders. So, mental health professionals use various interview strategies and questionnaires to make these differentiations and accurately diagnose OCD.

How to help those who have OCD?

The best way to help those with OCD or the first step towards doing so is educating oneself about the condition. It’s also important to know what attitudes or responses to avoid. One such response is accommodation, which involves helping the person perform their rituals or other compulsions. One example would be helping with cleaning or checking compulsions. While stemming from good intentions, this may enable the continuation of symptoms and slow down recovery. The best way to avoid this is learning to recognize accommodation and reducing it. Telling the person that their behavior is “silly” or “ridiculous” is another response to avoid. Similarly, comparing the person’s situation to normal everyday manifestations of certain obsessive thoughts should also be avoided. This is because, while it may be an attempt to empathize with the person, it may make them feel as though their experience is being played down.

As mentioned above, getting educated about OCD is the first step towards helping those who’re suffering from it. Another way to help is to provide validation. This can be done by showing understanding and acknowledgment that what they’re going through is difficult, which also helps create a supportive environment. However, it’s also important to give them space and not be with them every moment of the day as, like everyone else, they need some alone time as well.

Another very important thing to do would be to help them seek professional help. There are also various types and combinations of treatment so helping them find the right one is vital. Once they’ve started on a specific course of treatment, another way to help would be to encourage them and let them know that even small improvements are significant, which they are. And if they experience setbacks, reminding them that they always have tomorrow to try again is something else to do.

How to help yourself?

The biggest step to helping oneself is to seek professional help. As mentioned above, there are various types of treatment options. Psychological treatment, and more specifically cognitive behavioral therapy (CBT), is believed to be very effective. A form of CBT called Exposure and Response Prevention (ERP), where the person will expose themselves to a situation that triggers their anxiety and will then try to keep from carrying out their usual response or their compulsion, is most commonly used. Various types of medications may also be used either in tandem with CBT or on their own. Selective serotonin reuptake inhibitors (SSRIs), clomipramine, and serotonin and norepinephrine reuptake inhibitors (SNRIs), which all belong to the bigger group of serotonin reuptake inhibitors (SRI) medication, are commonly used. Each also has their own advantages and side effects.

However, there’s no complete cure for OCD. Instead, the goal of these different treatment options is to reduce symptoms as much as possible and to help the person live a full life. So, while undergoing treatment, it’d be helpful to learn some strategies to aid recovery. Exercising mindful meditation, which is also sometimes taught as part of the treatment for OCD as Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive therapy (MBCT), is a very helpful tool. Asking one’s healthcare provider any and all questions and talking to family, friends, as well as other loved ones can also be helpful. In addition, with both medication and CBT, it’ll likely take some time to see changes. So, it’s important to be patient and not give up. There’s also a chance of relapse. It may therefore be very helpful to make a plan for how to respond in case this happens.

Last Updated: May 25 2022