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Obsessive Compulsive Disorder (OCD)

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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is obsessive compulsive disorder (OCD), and what are its symptoms?

Obsessive compulsive disorder (OCD) is an anxiety disorder that is characterized by the sufferer experiencing repeated obsessions and/or compulsions that interfere with the person's ability to function socially, occupationally, or educationally, either as a result of the amount of time that is consumed by the symptoms or the marked fear or other distress suffered by the person. Conventional knowledge is that there are four types of OCD: obsessions that are aggressive, sexual, religious or harm-related with checking compulsions; obsessions about symmetry that are accompanied by arranging or repeating compulsions; obsessions of contamination are associated with cleaning compulsions; and symptoms of hoarding.

An obsession is defined as a thought, impulse, or image that either recurs or persists and causes severe anxiety. These thoughts are irresistible to the OCD sufferer despite the person's realizing that these thoughts are irrational. Examples of obsessions include worries about germs/cleanliness or about safety or order. A compulsion is a ritual/behavior that the individual with OCD engages in repeatedly, either because of their obsessions or according to a rigid set of rules. The aforementioned obsessions may result in compulsions like excessive hand washing, skin picking, lock checking, or repeatedly arranging items. Different than compulsions, habits are behaviors that occur with little to no thought, are repeated routinely, are not done in response to an obsession, are not particularly time-consuming, and do not cause stress. Examples of habits include cracking knuckles or storing car keys in a coat pocket.

The diagnosis of OCD has been described in medicine for at least the past 100 years. Statistics on the number of people in the United States who have OCD range from 1%-2%, or more than 2-3 million adults. Interestingly, the frequency with which it occurs and the symptoms with which it presents are remarkably similar, regardless of the culture of the sufferer. The average age of onset of the disorder is 19 years, although it often begins during the childhood or the teenage years and usually develops by 30 years of age. It tends to afflict more males than females.

Individuals with OCD are more likely to also develop chronic hair pulling (trichotillomania), muscle or vocal tics (Tourette's disorder), or an eating disorder like anorexia or bulimia. OCD sufferers are also predisposed to developing other mood problems, like depression, generalized anxiety disorder, and panic disorder. OCD puts its sufferers at a higher risk of having excessive concerns about their bodies (somatoform disorders) like hypochondriasis, which is excessive worry about having a serious illness. People with OCD are more vulnerable to having bipolar disorder, also called manic depression.

Although sometimes confused with OCD, obsessive compulsive personality disorder (OCPD) is defined by perfectionism and an unbending expectation that the individual and others will keep a specific set of rules. OCPD sufferers do not tend to engage in ritualized behaviors (compulsions). However, OCPD tends to occur more often in people with OCD than in those without and therefore can be considered another risk factor for the development of obsessive compulsive disorder.