Obsessive-compulsive disorder (OCD) is a mental health condition characterised by obsessions, compulsions or both. OCD is not classified as a “neurosis” in current diagnostic practice, and it does not define a person's identity.
Obsessions and compulsions
- Obsessions are recurring unwanted thoughts, images or urges that cause anxiety or marked discomfort. Examples include fear of contamination, persistent doubts about safety, or an intrusive fear of harming someone.
- Compulsions are repetitive actions or mental rituals that a person feels driven to perform in response to an obsession. Examples include excessive washing, checking, counting or repeating particular words.
Rituals may reduce anxiety briefly but maintain the OCD cycle. They can consume considerable time and interfere with education, work, relationships and everyday activities. Insight into whether the fears are excessive varies, so limited insight does not rule out OCD.
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Causes and risk factors
OCD has no single established cause. Its development is associated with a combination of genetic, neurobiological, psychological and environmental factors. Stressful or traumatic events may affect the onset or severity of symptoms in vulnerable people, but strict parenting, high standards or control are not considered direct causes of OCD. Explaining the condition solely as a “serotonin imbalance” is also an oversimplification.
Diagnosis of OCD
A professional makes the diagnosis after assessing obsessions and compulsions, their duration and their effect on the person's life. OCD needs to be distinguished from ordinary habits, generalised anxiety, depression and other conditions. A person is not responsible for the content of involuntary intrusive thoughts, and having such a thought does not mean that they intend to act on it.
Treatment of OCD
A principal psychological treatment is cognitive behavioural therapy with exposure and response prevention (CBT with ERP). During ERP, the person gradually encounters triggers with professional support while refraining from the compulsive ritual. Its purpose is not to force distress but to build the ability to tolerate anxiety safely without performing rituals.
Depending on symptom severity, functional impact and the person's preferences, a clinician may offer a selective serotonin reuptake inhibitor (SSRI). For severe OCD, combined CBT with ERP and an SSRI may be recommended. Medication should be taken and discontinued only in consultation with the prescribing clinician.
OCD is treatable. Professional support is advisable when intrusive thoughts or rituals consume significant time, cause distress or restrict everyday life.