Understanding and Dealing with Obsessive Compulsive Disorder

By: Michael G. Conner, Psy.D

Revised: May 21, 2014

Obsessive compulsive disorder (OCD) is a relatively common psychiatric condition and is responsive to treatment. An obsession is a recurrent and intrusive thought, feeling, idea or sensation. A compulsion is a conscious, standardized, recurrent thought or behavior such as counting, repeating, checking, or avoiding. In general, obsessions increase a person’s anxiety, whereas compulsions reduce a person's anxiety. When a person resists carrying out a compulsion, their anxiety and a "pressure" to act in a compulsive manner increases. OCD can develop gradually or very quickly. The disorder can progress to the point that it can become disabling and interfere with school, relationships, social activities and work.

There is good reason to be concerned if you have any symptoms of OCD. The disorder tends to become stronger with time and more difficult to treat. Understanding the physical, emotional and psychological symptoms of anxiety and panic can help you deal with these conditions and help you seek help from qualified mental health professionals.

Symptoms of an Obsession

  • Recurrent, persistent, intrusive and excessive thoughts, impulses or images.

  • The person attempts to ignore, reduce or eliminate their obsession with other thoughts or actions.

  • There is increasing anxiety or depression when the person is unable to make these thoughts, impulses and images stop.

  • The obsession is excessive and interferes with a normal life

Symptoms of a Compulsion

  • Repeated behaviors such as

- cleaning, hand washing, showers, etc
- counting
- organizing objects
- checking windows, doors, locks, stoves, etc…
- avoiding objects, people, animals, physical touch, germs, etc…

  • Ritual movements or actions that have no particular purpose except to relieve an obsession.
  • Repeated mental acts such as

- praying
- counting
- repeating words silently
- repeating a mental activity

  • Compulsive behavior is excessive and interferes with a normal life

Serious and Critical Symptoms

  • An obsession is distracting to the point of being unsafe

  • A compulsive behavior that is dangerous or causing physical harm

  • Symptoms are interfering with good judgment that is necessary to solve problems

  • Thoughts of suicide, violence or destructive behavior

  • Following and watching another person repeatedly


OCD occurs in 3 to 4 percent of the population. It usually occurs in a person's 20's, but can occur in late childhood or early teens. OCD tends to occur more frequently in families where the disorder is present in blood relatives. However the disorder is not necessarily inherited. Studies of identical twins have shown that the disorder may occur with one but not the other. There are individuals who acquire OCD purely on the basis of psychological, social and environmental influences. This means of acquiring the disorder is quite rare. There are also individuals who acquire OCD based entirely on a biological abnormality in the brain which may be seen with brain scanning technology. This too is rare. More often, an individual carries a biological predisposition for anxiety and repetitive behavior. Situational stress or psychological trauma associated with loss, separation or abuse can lead to worry, rumination, and obsessive thinking. Social and psychological stress over time can reinforce obsessive compulsive behavior in a person who was at risk.

In many, but not all cases, the brains of people with OCD appear to be different from people who do not have OCD. Images obtained from brain scans have found increased activity in the frontal lobes, the basal ganglia (especially the caudate), and the cingulum of patients with OCD. The areas are located near the center of the brain. The basal ganglia is commonly considered the principle culprit in generating or supporting symptoms of OCD. Basal ganglia are involved in evaluation, feedback and regulation which corrects behavior or movement as it happens. A problem in this process has been hypothesized to explain the intrusive and repetitive tendencies found in OCD. Behavioral and pharmacological treatment tends to reverse these abnormalities.

In most cases, people with OCD recognize their thoughts and behavior are irrational, unusual, and serve no real purpose. OCD is also associated with symptoms of depression that usually occur at the same time. Exercising will-power alone by an individual to resist acting on a compulsion has not been found to be a successful form of treatment or self-help. Stress, anxiety or exhaustion increase the frequency and intensity of obsessive compulsive behavior. Failed attempts to gain control over compulsive behavior can lead to an increasing experience of helplessness and hopelessness with increasing symptoms of anxiety and depression. Reducing the level of exhaustion, stress and anxiety has been found to reduce or eliminate symptoms of OCD. Anxiety and depression can be a consequence of OCD or a cause of the disorder.

In general, behavioral therapy and treatment with medication are equally effective approaches. However, the beneficial effects of therapy are longer lasting than medication. Effective therapy must include evaluation of the patients entire biological, psychological, social and cultural background. A treatment plan based on a thorough evaluation is essential. In most cases, there must be changes in the patient’s environment and social support system for treatment of a patient to be successful. Families of people affected by OCD often fail to see how they reinforce the disorder. They are often resistant to change despite expressed dedication of support and a desire do whatever is necessary. Embarrassing or punishing a person will only make the disorder worse. There are effective and ineffective therapies. While some professionals prefer to emphasize that psychotherapy is effective, it is worth recognizing that effective therapies can be used incorrectly by well intended therapists. Competence, commitment as well as outstanding interpersonal qualities in a therapist are crucial for treatment to be successful.

Treatment with medication will often produce physical and psychological side effects that must be monitored and considered in contrast to the benefits gained. Many of these side effects can contribute to new symptoms, entirely new problems and more stress.   However, for may people, medications are effective and a welcome solution.   Psychological and behavioral therapy requires significant commitment whereas treatment of OCD with medication requires less effort. Use of medication will typically requires a life long reliance on medication. Psychotherapy is almost always the first treatment of choice except in cases where OCD is so severe that relief as soon as possible is necessary to restore functioning and to prevent severe consequences. Medication is usually the second choice after a comprehensive and competent trial of psychotherapy. Combined use of medications and psychotherapy at the onset of treatment may in some cases confound the evaluation of treatment effectiveness and the observed source of change. It is harder for a psychotherapist involved in a combined medication and therapy approach to know which approach is or is not helping and how much it is helping.

Psychotherapy, or the psychotherapist, can generally be considered ineffective if a trial of 3 months has not produced a measurable and noticeable improvement. A decision to change therapists or to start a medication may be necessary at this point. Several trials of psychotherapy or medications may be necessary to successfully manage and treat OCD. Keep in mind that a failed attempt that is the result of working with an inexperienced or incompetent psychotherapist can lead to discouragement, self-blame and an increasing sense of helplessness and hopelessness.

Information And Steps You Can Take

  • Seek advice and consultation from a qualified mental health professional if you have symptoms of OCD.
  • Recognize the biological effects of alcohol use.  Avoid or minimize alcohol use. Alcohol is a depressant in which prolonged or excessive use will increase and deepen symptoms. Withdrawal from alcohol and certain drugs can produce symptoms of anxiety and panic.
  • Avoid drugs that are not medically appropriate or approved by your physician.
  • Maintain regular or routine physical activity. Exercise is an effective way to relieve symptoms and build strength to resist stress.
  • Do not isolate and withdraw from society.
  • It is important to resist acting on symptoms, but will power alone is not a solution.
  • Do not punish or shame yourself. This will only make things worse.
  • Do not focus or dwell on how it might get worse. Negative predictions can result in anxiety, panic and depression. This can make OCD worse.
  • Sometimes it can help to focus on and perform simple manageable tasks that are not compulsive behaviors.
  • Notice if there is a relationship between what you are doing and your symptoms. This can help during an evaluation and in treatment of these disorders.

Copyright 1999 to 2008, Michael G. Conner