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Mental HealthICD-10: F42Affects 2–3% of the global population; about 1 in 40 adults in the US

Obsessive-Compulsive Disorder

Also known as: OCD

Obsessive-compulsive disorder (OCD) is a chronic mental health condition characterized by recurring, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. OCD can be severely debilitating, consuming hours of a person's day and significantly impairing work, relationships, and quality of life. It affects approximately 2–3% of the population and typically emerges in childhood, adolescence, or early adulthood.

Symptoms

Intrusive, unwanted thoughts, images, or urges (obsessions)
Excessive hand washing or cleaning rituals
Compulsive checking (locks, appliances, stove)
Need for symmetry, order, or exactness
Counting, tapping, or repeating actions a certain number of times
Fear of contamination or germs
Hoarding or difficulty discarding items
Distressing thoughts about harm, religion, or sexuality
Significant anxiety when unable to perform compulsions

Causes

  • Imbalances in serotonin and other neurotransmitters
  • Abnormal activity in the orbitofrontal cortex, anterior cingulate, and basal ganglia
  • Genetic predisposition (higher concordance in identical twins)
  • Environmental factors including childhood trauma or infection (PANDAS)

Risk Factors

  • Family history of OCD or other anxiety disorders
  • Stressful or traumatic life events
  • Other mental health disorders (anxiety, depression, tic disorders)
  • Childhood onset of tics or streptococcal infection (PANDAS)
  • Perfectionist personality traits

Diagnosis

  • Clinical interview using DSM-5 criteria
  • Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for severity assessment
  • Screening for co-occurring conditions (depression, anxiety, tics)
  • Ruling out medical causes (thyroid disorders, neurological conditions)

Treatment

  • Cognitive-behavioral therapy with Exposure and Response Prevention (ERP)
  • Selective serotonin reuptake inhibitors (SSRIs) — fluoxetine, fluvoxamine, sertraline (often at higher doses than for depression)
  • Clomipramine (tricyclic antidepressant) for treatment-resistant OCD
  • Combination of ERP therapy and medication for optimal outcomes
  • Deep brain stimulation or transcranial magnetic stimulation for severe refractory cases

Prevention

  • No known prevention, but early identification and treatment improve outcomes
  • Stress management and healthy coping strategies may reduce severity
  • Education about OCD to reduce stigma and encourage early help-seeking

When to See a Doctor

  • Obsessions or compulsions consuming more than an hour per day
  • Rituals significantly interfering with work, school, or relationships
  • Increasing distress or inability to resist compulsive behaviors
  • Thoughts of self-harm or suicide

Frequently Asked Questions

Related Conditions

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