What is Obsessive Compulsive Disorder?

Obsessive compulsive disorder, or OCD, is a mental illness that affects people of all ages, genders and ethnicities, although research suggests that women are more likely to report having OCD to their medical team. An estimated 1% of the American population, or 2 million adults, has obsessive compulsive disorder, according to the Anxiety and Depression Association of America.

Obsessive compulsive disorder is characterized by repetitive thoughts or actions. These intrusive and disruptive thoughts are considered to be obsessions, while the resulting actions are identified as compulsions. Compulsive behavior is often an attempt to relieve or escape the obsessions and decrease the distress associated with the obsessions.

When left untreated, OCD can be debilitating. Obsessions or compulsions can escalate throughout life, becoming so extreme that people have difficulty functioning normally at school or work. In the workplace, for example, a person with OCD may insist on having everything on their desk precisely arranged before they can begin a task or attend a meeting. They may become overwhelmed by troubling thoughts and have to step away to calm themselves. Co-workers may not understand the behavior, causing misunderstandings and other difficulties. People living with OCD may avoid social events or may not be able to leave the house without completing a specific set of steps.

Some men and women with OCD work hard to hide their symptoms, which may be a source of embarrassment since they feel unable to control their thoughts and behavior. But, usually OCD symptoms directly affect the person’s quality of life or lifestyle.

What are Obsessive Compulsive Disorder Signs and Symptoms?

As with many mental health conditions, OCD can look different in each individual living with it. However, there are certain hallmarks of the disorder that can be easy to identify.

While the typical onset of initial symptoms is around age 19, children may develop OCD. In fact, up to half of all adults with OCD say their symptoms started when they were children.

Obsessions are intrusive and unwanted thoughts, images or urges that can cause a feeling of sadness, worry, or dread. These obsessions often lead to compulsions, or actions that the person thinks will prevent harm or protect them in some way.

Common obsessions can include thinking surfaces are not clean and have too many unsafe germs. A compulsion that could follow this obsession is washing hands multiple times per day with scalding water. This is different than a person who recognizes that it’s good to wash their hands after touching surfaces that have lots of germs or before eating. An individual living with OCD finds thoughts about germs and unclean hands to be intrusive and disruptive to daily life. He or she cannot function until their hands are washed, and often get caught in a cycle of not being able to stop washing their hands.

Other OCD symptoms of obsessions or compulsions can include thinking a certain number is unlucky, needing to say the same phrase a certain number of times before moving on in conversation, or feeling the need to do something over and over again.


Common OCD Symptoms and Signs are:

  • Repetitive thoughts, images, or urges.
  • Awareness that these thoughts and feelings are a problem, but feeling unable to control or get rid of them.
  • Having disturbing and potentially irrational thoughts.
  • Feeling fearful that things won’t be done right and something bad will happen as a result.
  • Spending significant time everyday thinking about and acting on obsessions, that interfere with relationships, social life and work life.

OCD Obsessions and Compulsions

Obsessions and compulsions can take numerous forms and are unique to each individual. Below are a few common examples.


  • Fear of contamination, including body fluids, germs, and dirt, which may be related to fear of disease, illness, or death.
  • Fear of harming a loved one or others due to carelessness.
  • Fear of purposefully hurting someone. People with these fears may have no history of aggression and no desire to hurt others, but they obsess about losing control and acting impulsively (i.e. stabbing someone with a kitchen knife for no reason or pushing someone they know or a stranger into an oncoming train).
  • Sexual obsessions, including a fear about sexual orientation or unwanted sexual thoughts about family members, animals or other taboo subjects.
  • Religious obsessions, including excessive concern about committing a sin or blasphemy, also called scrupulosity.
  • Symmetry and exactness, often related to the way items are arranged or ordered. People with these obsessions may believe that something bad will happen if something is uneven or out of order.


Washing and cleaning– People with contamination fears may engage in excessive washing to remove dirt or germs or to feel clean. Wearing gloves or repeated hand washing, including cleaning each finger and under each fingernail, is common. People may also shower, bathe, brush their teeth or do other self-grooming rituals to the point of damaging their skin. They may also spend an inordinate amount of time cleaning their house, cell phone, or shoes and even avoid touching surfaces like doorknobs.

Checking – Stemming from a fear of being responsible for someone being hurt, people with OCD may repeatedly check appliances, doors and windows for signs of being unlocked, damaged, leaking, and so on. Checking may extend to people – they may check their own bodies for signs of disease or injury, or constantly scan their environment for signs of reassurance that they haven’t caused harm to others.

Repeating – Repeating behaviors such as going in and out of a door multiple times, rereading the same passage in a book to make sure they didn’t miss anything, or feeling the need to say the same word again and again, are all types of repetitive behavior associated with OCD. Repeating body movements can include tapping, touching or blinking.

Ordering, arranging and counting – Instilling order and exactness to objects, or obsessively counting steps or floor tiles when walking, either out loud or internally, are signs of OCD. People may also have fears of certain numbers, such as a number on a clock or an address on a building. This is more than feeling a bit superstitious about Friday the 13th or deciding “8” is your lucky number. Number obsessions lead people to believe terrible things will happen if they don’t obey their rules about numbers –for example, if they don’t eat at a certain time or wash a certain body part a set number of times, they feel extreme anxiety that something bad will happen.

According to the National Alliance on Mental Illness, people living with OCD have obsessions and compulsions that last more than one hour per day. Further, their need to perform certain compulsions lead to disruption of daily life. Finally, the act of completing the compulsions do not give the person pleasure. Instead, performing the compulsions offers a brief reprieve from the anxiety associated with the obsessions.

The intensity of these intrusive and unwanted thoughts as well as the feeling of needing to act out certain rituals or behaviors in order to cope can cause people to experience suicidal thoughts or compulsions regarding self-harm.

What are the Causes of Obsessive
Compulsive Disorder?

The root causes of OCD are unknown. However, researchers widely agree that OCD has both biological and environmental contributors.

In the brain, serotonin is a chemical that is vital to mood regulation, sleep, memory, and even social behavior. There are multiple theories that suggest those living with OCD symptoms have abnormalities in the brain related to production or use of serotonin. Researchers have also discovered that OCD has strong genetic ties. For example, individuals with an immediate family member with OCD have a 25% higher chance of experiencing the disorder.

Obsessive compulsive disorder has also been linked to other mental health disorders, such as anxiety and depression. In some people, OCD becomes a coping skill for dealing with anxiety or depression, though certainly not a healthy one. Therefore, it is important to note that OCD is not a voluntary decision. The obsessions and compulsions are very much unwanted by the person living with the disorder.

OCD and the Link to Anxiety and Depression

OCD often doesn’t exist on its own. Many people with OCD also have underlying depression or an anxiety disorder, including generalized anxiety disorder (GAD). The reasons for the connection aren’t fully understood, although it’s believed that there could be biological and environmental triggers that are common to each condition.

The obsessive thoughts and compulsive behavior that accompany OCD often cause individuals to feel anxious, worried and a sense of dread. Many people with OCD understand that their OCD behavior is unreasonable and not normal, but they feel powerless to stop. Trying to resist the urge to engage in repetitive behavior or ignore their obsessive thoughts compounds their anxiety and stress. This, in turn, can make anxiety disorders worse.

Obsessive compulsive disorder is also often linked to depression. A study published in the Journal of Clinical Psychiatry found that one-third of people diagnosed with OCD were also depressed. Depression symptoms often emerge after the start of OCD symptoms, suggesting that the emotional distress may trigger depression symptoms. Research also indicates that the link between OCD and depression could also result from similar biological, psychological and environmental triggers for both conditions.

Physical Effects of OCD

OCD can lead to mental exhaustion. The individual may spend hours a day tending to their compulsions, which can interfere with their relationships, their ability to perform well at work, and their willpower to let go and have fun with friends and family. The mental stress of feeling the need to perform certain rituals many times a day can lead to fatigue, digestive issues and other stress-related problems. Excessive hand washing can lead to skin problems and infection. Excessive hair washing causes problems with the scalp.


For many people living with obsessive compulsive disorder, finding a set of coping skills that give relief to the unwanted thoughts or cycle of compulsions is difficult. Unfortunately, there is a connection between OCD and substance abuse in that people with OCD often turn to substance abuse to find the solace and peace they seek.

A study published in the Journal of Anxiety Disorders found that 27% of people living with OCD had a substance use disorder. One question is whether OCD contributes to people using alcohol and drugs to self-medicate their symptoms, such as calming their fears or anxieties. The study found that the OCD preceded the substance abuse onset by about one year in 70% of those studied.

Since the study shows that obsessive compulsive disorder symptoms arrived first, it also provides evidence that alcohol or drug use can be an unhealthy habit and coping mechanism that develops as a way to deal with the intrusive thoughts or compulsions.

There can be other reasons that people with OCD are more likely to abuse alcohol or drugs. People living with OCD may have a tendency to withdraw from social situations due to their compulsions, or their compulsions may make others less likely to seek out their friendship or companionship. Addictive behavior can go easily unchecked due to isolation that accompanies the disease. People who live with OCD often find themselves choosing a solitary lifestyle due to compulsions or ritual seeking behaviors. Without friends nearby to notice their overuse of alcohol or other drugs, addictive behavior can escalate.

Obsessive Compulsive Disorder Treatment

Although OCD can have serious implications on quality of life, medications and therapy have both been shown to help people overcome their obsessive compulsive tendencies and find relief from the fears, anxiety and shame that often accompanies them.

Bluff’s psychiatric providers and licensed therapists work with each patient to come up with the right combination of OCD treatments. Prescription medications can also be a component in a treatment plan for OCD. For many people living with OCD, antidepressants such as SSRIs and anti-anxiety medications work well in helping to reduce symptoms.

For OCD treatment, medications work best when combined with psychotherapy techniques such as cognitive behavior therapy (CBT). In CBT, individuals confront the unhelpful thoughts and beliefs and challenge their need to act on them. They develop strategies for taking their mind off the distressing or anxiety-provoking thoughts, calming the mind, and developing a tolerance for the feelings associated with the obsessive thoughts.

Exposure and response therapy (ERT) is a form of CBT that can be life changing for those seeking OCD treatment. In a controlled and safe environment, a therapist works to introduce the patient to situations or things that can make the patient feel uncomfortable. For example, if the patient has obsessions with germs, the therapist may try to have the patient hold an object that has been sitting on a table. The therapist introduces the situations in small bursts, showing the patient that they don’t have to react to their intrusive thoughts. This also gives the patient a chance to practice any coping skills and to talk themselves out of compulsions that may follow an obsessive thought.

ERT takes a lot of work and dedication from both the patient and the therapist. However, if the two share a relationship of trust, they can emerge on the other side of the experience feeling confident and armed with a wide array of coping skills.

Treating OCD in Drug and Alcohol Rehab

People with OCD are often depicted as simply quirky or humorous in TV and movies. But OCD can be debilitating, and the fear and anxiety associated with their obsessions can lead people to use drugs and alcohol in order to escape their persistent, uncomfortable thoughts. OCD can also complicate treatment for substance use disorders, because intrusive thoughts can make it difficult to focus on individual and group therapy, a critical component in the healing process.

That’s why it’s essential to choose a drug and alcohol rehab that offers OCD treatment alongside substance use treatment. Bluff has highly trained and experienced addiction medicine specialists, psychiatric providers and licensed therapists who are dedicated to helping patients with OCD find the right medications to alleviate symptoms, understand how to avoid triggers, develop healthier coping skills to deal with stress and anxiety, and recover from drug and alcohol addiction.


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