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by Rosenblum LB

Obsessive-Compulsive Disorder: When You Cannot Stop Intrusive Thoughts and Rituals

OCD Since his early twenties, Joe was often plagued by seemingly senseless fears. For awhile, he had been terrified of getting sick and spent several hours a day washing his hands to be sure they were germ-free. The washing took a lot of time and made his hands red and raw. But he felt too embarrassed to tell anyone.
Joe, a high school English teacher praised by students and colleagues alike, finally decided to confide in his doctor when his thoughts became more frightening. He was constantly afraid that he had run someone over in his car. His heightened anxiety and the pressing need to return to the site of the "accident" to check if the person was okay was making him late for work. He was also unable to focus on his teaching. The doctor suspected Joe had obsessive-compulsive disorder (OCD). A psychiatrist confirmed the diagnosis and started Joe on treatment that has significantly reduced his fears and enabled him to return to his successful teaching career.

How Do You Know It Is OCD?

Most people occasionally get stuck in a thought, worry over and over about a particular problem, get totally preoccupied with something they are doing, or triple-check to make sure they locked their house or car door. However, that is not OCD. The hallmark of OCD is becoming so stuck in an unwanted thought or repetitive action that your daily life is disrupted. Other symptoms that suggest OCD are if the preoccupations or compulsions add up to an hour or more each day and are very distressing.
OCD is a condition that is characterized by intrusive, unwanted, recurrent, and unpleasant thoughts (obsessions) that cause anxiety and repetitive, ritualistic behaviors (compulsions). Victims feel driven to carry out these obsessions to reduce their anxiety, but the compulsions only provide short-term and often incomplete relief before an obsession strikes again.
Although the thoughts and behaviors in OCD may seem "crazy," people with OCD are not "crazy." They are aware that their obsessions and compulsions are excessive and senseless. They do not want to act them out, but they have little or no control. As a result, they may feel embarrassed, hide their symptoms, and remain alone and unsupported with their disorder.

Are There "Typical" Obsessions and Compulsions?

People with OCD may have many or just a few typical obsessions and compulsions. The specific ones and their severity tend to change over time. Most people have both obsessions and compulsions, but a small percentage just have obsessions.

Common Obsessions

  • Fears related to contamination from items such as dirt, germs, bodily wastes, and chemicals
  • Fears about causing harm to someone else, such as killing a beloved family member or running over a pedestrian
  • Fears of having done something wrong even when you know you have done it right
  • Intense need to have things in a certain order, place, or position
  • Disturbing thoughts that may involve religious or sexual behaviors, and fears of acting on them

Common Compulsions

  • Excessive washing or cleaning, particularly hand washing or bathing
  • Repeatedly checking, such as making sure the door is locked or that the stove is turned off
  • Arranging or organizing things in a certain order
  • Collecting things like newspapers or mail to the point of filling your home
  • Repetitive actions, such as touching something over and over
  • Mental compulsions, such as repeatedly counting to a certain number or counting all the books in a bookcase

What Causes OCD?

Although the exact causes of OCD are not known, researchers believe that OCD may be caused by a chemical imbalance in the brain. Problems with different functional signalling pathways, as well as social and genetic factors, may also be involved.

Are There Related or Simultaneous Disorders?

Some people may experience other disorders, such as depression, eating disorders, attention deficit disorder (ADD), or other anxiety disorders along with OCD. This may make diagnosis of OCD more complicated. There has also been a link between symptoms of OCD and tic disorders. For example, OCD is often present in people who suffer from Tourette syndrome. Other illnesses, such as trichotillomania (the repeated urge to pull out scalp and other body hair), body dysmorphic disorder (preoccupation with, or distorted image of, the body), and hypochondriasis (fear of serious illness, even when testing proves negative), may also be related to OCD.

What Is the Treatment?

Treatment can help most people with OCD experience significant improvement. Working with a therapist and taking medication are the two primary approaches.
Behavior therapy is a common treatment that covers a number of techniques designed to change behaviors. Exposure and response prevention has been shown to be effective in treating OCD. People with OCD learn to confront their fears and decrease their anxiety (exposure) without doing the compulsive rituals (response prevention). Cognitive therapy, which can help you change your behaviors about fears and anxiety, is sometimes used along with exposure and response prevention.
Medications called serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat OCD. SSRIs are antidepressants, but they have also shown to be helpful in reducing obsessive thoughts and compulsions.
For some with OCD, therapy alone may be the best treatment. Others may find it helpful to work with a therapist and take medication.
OCD may be chronic condition for many of those that have it. That is, your symptoms may regress and reappear. It is possible that treatment will help you manage OCD, but not cure it.

Getting Help

If you suspect you might have OCD, remember that are you are not alone. You do not need to keep your frightening thoughts and ritualistic behaviors a secret. Seek out diagnosis and treatment from a professional experienced in treating OCD. Consider joining a support group for people with OCD. If you know someone who may have the condition and is not diagnosed or receiving treatment, encourage them to get professional help. Remember that OCD deserves the same treatment and consideration that you would give to any other medical condition.


National Institute of Mental Health
Obsessive-Compulsive Foundation


Canadian Psychiatric Association
Canadian Psychological Association


Obsessive compulsive disorder. National Alliance on Mental Illness website. Available at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-Compulsive-Disorder. Accessed December 22, 2015.
Obsessive compulsive disorder (OCD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 19, 2015. Accessed December 22, 2015.
Obsessive compulsive disorder (OCD). Mental Health America website. Available at: http://www.nmha.org/go/ocd. Accessed December 22, 2015.
Obessions and compulsions. The International OCD Foundation website. Available at: https://iocdf.org/about-ocd/#Common%5FObsessions. Accessed December 22, 2015.
Understanding obsessive-compulsive and related disorders. Stanford School of Medicine website. Available at: http://ocd.stanford.edu/about/understanding.html. Accessed December 22, 2015.
Obsessive-compulsive disorder: When unwanted thoughts take over. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over/index.shtml. Updated 2013. Accessed December 22, 2015.

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