When Unwanted Thoughts Take Over:

Obsessive-Compulsive
Disorder
National Institute of Mental Health

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • National Institutes of Health

 National Institute of Mental Health

Obsessive-Compulsive Disorder

Anxiety Disorders
People with anxiety disorders feel extremely fearful and unsure.

Most people feel anxious about something for a short time now and

again, but people with anxiety disorders feel this way most of the time.

Their fears and worries make it hard for them to do everyday tasks.

About 18% of American adults have anxiety disorders. Children also

may have them.

Treatment is available for people with anxiety disorders. Researchers

are also looking for new treatments that will help relieve symptoms.

This booklet is about one kind of anxiety disorder called obsessive-

compulsive disorder, or OCD. For information about other kinds

of anxiety disorders, please see the end of this booklet.

Obsessive-Compulsive Disorder
Everyone double-checks things sometimes—for example,
checking the stove before leaving the house, to make sure
it’s turned off. But people with OCD feel the need to
check things over and over, or have certain thoughts or
perform routines and rituals over and over.The thoughts
and rituals of OCD cause distress and get in the way of
daily life.

The repeated, upsetting thoughts of OCD are called

obsessions.To try to control them, people with OCD
repeat rituals or behaviors, which are called compulsions.
People with OCD can’t control these thoughts and rituals.

Examples of obsessions are fear of germs, of being hurt

or of hurting others, and troubling religious or sexual
thoughts. Examples of compulsions are repeatedly
counting things, cleaning things, washing the body or
parts of it, or putting things in a certain order, when these
actions are not needed, and checking things over and over.

People with OCD have these thoughts and do these rituals

for at least an hour on most days, often longer.The reason
OCD gets in the way of their lives is that they can’t stop
the thoughts or rituals, so they sometimes miss school,
work, or meetings with friends, for example.

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What are the symptoms of OCD?
People with OCD:
• have repeated thoughts or images about many
different things, such as fear of germs, dirt, or intruders;
violence; hurting loved ones; sexual acts; conflicts with
religious beliefs; or being overly neat.

• do the same rituals over and over such as washing hands,

locking and unlocking doors, counting, keeping unneeded
items, or repeating the same steps again and again.

• have unwanted thoughts and behaviors they can’t

control.
• don’t get pleasure from the behaviors or rituals,
but get brief relief from the anxiety the thoughts cause.

• spend at least an hour a day on the thoughts and

rituals, which cause distress and get in the way of
daily life.

OBSESSIVE-COMPULSIVE DISORDER 3
When does OCD start?
For many people, OCD starts during childhood or the teen years.
Most people are diagnosed at about age 19. Symptoms of OCD
may come and go and be better or worse at different times.

Is there help?
There is help for people with OCD.The first step is to go to a
doctor or health clinic to talk about symptoms. People who think
they have OCD may want to bring this booklet to the doctor,
to help them talk about their symptoms.The doctor will do an
exam to make sure that another physical problem isn’t causing
the symptoms.The doctor may make a referral to a mental health
specialist.

There are different kinds of treatment for OCD. Doctors may ask
people with OCD to seek psychotherapy with a psychologist,
psychiatrist, or licensed social worker. A type of therapy called
behavior therapy is especially useful for treating OCD. It teaches
a person different ways of thinking, behaving, and reacting to
situations that help them feel less anxious and fearful without
having obsessive thoughts or acting compulsively.

Doctors also may prescribe medication to help treat OCD.

It’s important to know that some of these medicines may take
several weeks to start working.The kinds of medicines used
to treat OCD are antidepressants and anti-anxiety medicines.
Some of these medicines are used to treat other problems, such
as depression, but also are helpful for OCD. Although these
medicines often have mild side effects, they are usually not a
problem for most people, especially if the dose starts off low and
is increased slowly over time.

Some people do better with therapy, while others do better with

medicine. Still others do best with a combination of the two.Talk
with your doctor about the best treatment for you.

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Personal story

“I couldn’t touch any doors “At first I was too

or countertops in public embarrassed to get
areas. I knew it didn’t help, but a friend told
make any sense, but I me to call the doctor.
was terrified of getting I’m so glad I did. I took
germs that could kill me. the medicine my doctor
I almost couldn’t go out gave me. I also talked
in public, I was so afraid. with a counselor, in
If I thought I had touched therapy. I learned to
anything, I would have to cope with my fear of
wash myself for hours. germs and to stop
Sometimes I washed so washing so much.”
much that my skin would
get red and raw and
bleed.”

OBSESSIVE-COMPULSIVE DISORDER 5
Who pays for treatment?
Most insurance plans cover treatment for anxiety disorders.
People who are going to have treatment should check with
their own insurance companies to find out about coverage.
For people who don’t have insurance, local city or county
governments may offer treatment at a clinic or health center,
where the cost is based on income. Medicaid plans also may
pay for OCD treatment.

Why do people get OCD?

OCD sometimes runs in families, but no one knows for sure
why some people have it, while others don’t.When chemicals
in the brain are not at a certain level it may result in OCD.
Medications can often help the brain chemicals stay at the
correct levels.

To improve treatment, scientists are studying how well different

medicines and therapies work. In one kind of research, people
with OCD choose to take part in a clinical trial to help doctors
find out what treatments work best for most people, or what
works best for different symptoms. Usually, the treatment is free.
Scientists are learning more about how the brain works, so that
they can discover new treatments.

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Personal story

“I couldn’t do anything something, my parents

without rituals. They were going to die. I’d
invaded every aspect of have these terrible
my life. Counting really thoughts of harming
bogged me down. my parents. That was
I would wash my hair completely irrational,
three times as opposed but the thoughts
to once because three triggered more anxiety
was a good luck number and more senseless
and one wasn’t. It took behavior. Because of
me longer to read the time I spent on
because I’d count the rituals, I was unable to
lines in a paragraph. do a lot of things that
When I set my alarm at were important to me.”
night, I had to set it to
“I knew the rituals didn’t
a number that wouldn’t
make sense, and I was
add up to a ‘bad’ number.”
deeply ashamed of them,
“Getting dressed in the but I couldn’t seem to
morning was tough, overcome them until
because I had a routine, I had therapy.”
and if I didn’t follow the
routine, I’d get anxious
and would have to get
dressed again. I always
worried that if I didn’t do

OBSESSIVE-COMPULSIVE DISORDER 7
For More Information on
Obsessive-Compulsive Disorder

Visit the National Library of Medicine’s

MedlinePlus http://medlineplus.gov
En Español, http://medlineplus.gov/spanish

For Information on
Clinical Trials for Obsessive-Compulsive Disorder

NIMH Clinical Trials Web page

http://www.nimh.nih.gov/health/trials/index.shtml

National Library of Medicine Clinical Trials Database

http://www.clinicaltrials.gov

Information from NIMH is available in multiple formats.

You can browse online, download documents in PDF,

and order paper brochures by mail. You can order NIMH

publications online at http://www.nimh.nih.gov. If you do not

have Internet access, please contact the NIMH Information

Resource Center at the numbers listed below.

For Further Information

National Institute of Mental Health

Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or
1-866-615-NIMH (6464) toll-free
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E-mail: [email protected]
Web site: http://www.nimh.nih.gov

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 09-4676
Reprinted 2009