Obsessive-Compulsive Disorder (OCD)
Symptoms, Treatment, and Self-Help
It’s normal, on occasion, to go back and double-check that the iron is unplugged or your car is locked. But if you suffer from obsessive-compulsive disorder (OCD), obsessive thoughts and compulsive behaviors become so consuming they interfere with your daily life. No matter what you do, you can’t seem to shake them. But help is available. With treatment and self-help strategies, you can break free of the unwanted thoughts and irrational urges and take back control of your life.
What is obsessive-compulsive disorder (OCD)?
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and ritualized, repetitive behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational—but even so, you feel unable to resist them and break free.
Like a needle getting stuck on an old record, OCD causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it’s really turned off, or wash your hands until they’re scrubbed raw. While you don't derive any sense of pleasure from performing these repetitive behaviors, they may offer some passing relief for the anxiety generated by the obsessive thoughts. You may try to avoid situations that trigger or worsen your symptoms or self-medicate with alcohol or drugs. But while it can seem like there’s no escaping your obsessions and compulsions, there are plenty of things you can do to help yourself and regain control of your thoughts and actions.
OCD obsessions and compulsions
Obsessions are involuntary thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas, but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.
Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away.
For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive rituals and behaviors often end up causing anxiety themselves as they become more demanding and time-consuming. This is the vicious cycle of OCD.
Most people with OCD fall into one of the following categories:
- Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
- Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
- Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.
- Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
- Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don't need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
OCD signs and symptoms
Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time (at least one hour per day), and interfere with your daily life and relationships.
Most people with obsessive-compulsive disorder have both obsessions and compulsions, but some people experience just one or the other.
Common obsessive thoughts in OCD include:
- Fear of being contaminated by germs or dirt or contaminating others
- Fear of losing control and harming yourself or others
- Intrusive sexually explicit or violent thoughts and images
- Excessive focus on religious or moral ideas
- Fear of losing or not having things you might need
- Order and symmetry: the idea that everything must line up “just right”
- Superstitions; excessive attention to something considered lucky or unlucky
Common compulsive behaviors in OCD include:
- Excessive double-checking of things, such as locks, appliances, and switches
- Repeatedly checking in on loved ones to make sure they’re safe
- Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
- Spending a lot of time washing or cleaning
- Ordering or arranging things “just so”
- Praying excessively or engaging in rituals triggered by religious fear
- Accumulating “junk” such as old newspapers or empty food containers
OCD symptoms in children
While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADHD, autism, and Tourette’s syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.
OCD self-help tip 1: Learn how to resist OCD rituals
No matter how overwhelming your OCD symptoms seem, there are many ways you can help yourself. One of the most powerful strategies is to eliminate the compulsive behaviors and rituals that keep your obsessions going.
Don’t avoid your fears. It might seem smart to avoid the situations that trigger your obsessive thoughts, but the more you avoid them, the scarier they feel. Instead, expose yourself to your OCD triggers, then try to resist or delay the urge to complete your relief-seeking compulsive ritual. If resistance gets to be too hard, try to reduce the amount of time you spend on your ritual. Each time you expose yourself to your trigger, your anxiety should lessen and you’ll start to realize that you have more control (and less to fear) than you think.
Anticipate OCD urges. By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.
- Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
- When the urge to check arises later, you will find it easier to re-label it as “just an obsessive thought.”
Refocus your attention. When you're experiencing OCD thoughts and urges, try shifting your attention to something else. You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion.
At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change.
Tip 2: Challenge obsessive thoughts
Everyone has troubling thoughts or worries from time to time. But obsessive-compulsive disorder causes the brain to get stuck on a particular anxiety-provoking thought, causing it to play over and over in your head. The following strategies can help you get unstuck.
Write down your obsessive thoughts or worries. Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.
- Keep writing as the OCD urges continue, aiming to record exactly what you’re thinking, even if you’re repeating the same phrases or the same urges over and over.
- Writing it all down will help you see just how repetitive your obsessions are.
- Writing down the same phrase or urge hundreds of times will help it lose its power.
- Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.
Create an OCD worry period Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.
- Choose one or two 10-minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
- During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
- When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.
- Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period.
Create a tape of your OCD obsessionsFocus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.
- Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
- Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.
- By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.
Four Steps for Conquering Obsessive Thoughts
Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, offers the following four steps for dealing with obsessive thoughts:
- RELABEL – Recognize that the intrusive obsessive thoughts and urges are the result of OCD. For example, train yourself to say, "I don’t think or feel that my hands are dirty. I’m having an obsession that my hands are dirty." Or, "I don’t feel that I have the need to wash my hands. I’m having a compulsive urge to perform the compulsion of washing my hands."
- REATTRIBUTE – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain. Tell yourself, "It’s not me—it’s my OCD," to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
- REFOCUS – Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior. Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior."
- REVALUE – Do not take the OCD thought at face value. It is not significant in itself. Tell yourself, "That's just my stupid obsession. It has no meaning. That's just my brain. There's no need to pay attention to it." Remember: You can't make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behavior.
Source: Westwood Institute for Anxiety Disorders
Tip 3: Make lifestyle changes to ease OCD
A healthy, balanced lifestyle plays a big role in easing anxiety and keeping OCD compulsions, fears, and worry at bay.
Exercise regularly. Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise. For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Ten minutes several times a day can be as effective as one longer period especially if you pay mindful attention to the movement process.
Get enough sleep. Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.
Avoid alcohol and nicotine. Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Similarly, while it may seem that cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety and OCD symptoms.
Practice relaxation techniques. While stress doesn't cause OCD, it can trigger symptoms or make them worse. Mindful meditation, yoga, deep breathing, and other relaxation techniques can help lower your overall stress and tension levels and help you manage your urges. For best results, practice a relaxation technique regularly.
Tip 4: Reach out for support
OCD can get worse when you feel powerless and alone, so it’s important to build a strong support system. The more connected you are to other people, the less vulnerable you’ll feel. Just talking about your worries and urges can make them seem less threatening.
Stay connected to family and friends. Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation will aggravate your OCD symptoms. It’s important to invest in relating to family and friends. Talking face-to-face about your worries and urges can make them feel less real and less threatening.
Join an OCD support group. You’re not alone in your struggle with OCD, and participating in a support group can be an effective reminder of that. OCD support groups enable you to both share your own experiences and learn from others who are facing the same problems. For a searchable database of OCD support groups, see the Resources and References section below.
Treatment for OCD
Cognitive-behavioral therapy is the most effective treatment for obsessive-compulsive disorder and involves two components: 1) exposure and response prevention, and 2) cognitive therapy.
Exposure and response prevention requires repeated exposure to the source of your obsession. You are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety.
- For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing up. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you learn that you don’t need the ritual to get rid of your anxiety—that you have some control over your obsessive thoughts and compulsive behaviors.
- Studies show that exposure and response prevention can actually “retrain” the brain, permanently reducing the occurrence of OCD symptoms.
Cognitive therapy focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.
Other OCD treatments
In addition to cognitive-behavioral therapy, the following treatments are also used for OCD:
Medication. Antidepressants are sometimes used in conjunction with therapy for the treatment of obsessive-compulsive disorder. However, medication alone is rarely effective in relieving the symptoms.
Family Therapy. Since OCD often causes problems in family life and social adjustment, family therapy can help promote understanding of the disorder and reduce family conflicts. It can also motivate family members and teach them how to help their loved one with OCD.
Group Therapy. Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.
Is unresolved trauma playing a role in your OCD?
In some people, OCD symptoms such as compulsive washing or hoarding are ways of coping with trauma. If you have post-traumatic OCD, cognitive approaches may not be effective until underlying traumatic issues are resolved.
Helping someone with OCD
The way you react to your loved one’s OCD symptoms can have a big impact on their outlook and recovery. Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment.
Avoid making personal criticisms. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
Don’t scold someone with OCD or tell them to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse.
Be as kind and patient as possible. Each sufferer needs to overcome problems at their own pace. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person’s life.
Do not play along with your loved one’s rituals. Helping with rituals will only reinforce the behavior. Support the person, not their rituals.
Keep communication positive and clear. Communication is important so you can find a balance between supporting your loved one and standing up to the OCD symptoms and not further distressing your loved one.
Find the humor. Laughing together over the funny side and absurdity of some OCD symptoms can help your loved one become more detached from the disorder. Just make sure your loved one feels respected and in on the joke.
Don’t let OCD take over family life. Sit down as a family and decide how you will work together to tackle your loved one’s symptoms. Try to keep family life as normal as possible and the home a low-stress environment.
Resources and references
Anxiety and Stress Disorders: A guide to managing panic attacks, phobias, PTSD, OCD, social anxiety disorder, and related conditions – Harvard Medical School Special Health Report
What You Need to Know About Obsessive Compulsive Disorder (PDF) – International OCD Foundation
Obsessive-Compulsive Disorder in Children – KidsHealth
How to Find the Right Therapist – International OCD Foundation