While often used in a joking manner to describe individuals with rigid standards for cleanliness or order, obsessive-compulsive disorder (OCD) is a real, common, and chronic mental disorder that affects people of all ages and genders.

Parents and teachers often recognize OCD symptoms in children, and most people are diagnosed by age 19, although onset after 35 happens. Boys may develop OCD earlier than girls.

A person with OCD will have uncontrollable and recurring thoughts (obsessions) and sometimes also behaviors that they feel the urge to repeat over and over (compulsions). The symptoms might interfere with personal relationships, work, or school. While symptoms can come or go, persons with OCD may self-medicate with alcohol or other substances or may try to avoid triggering situations. Untreated OCD can make daily life, work, and relationships difficult.

Obsessions are repeated mental images or thoughts that cause anxiety, common obsessions are:

• Needing things to be in perfect or symmetrical order
• Aggressive thoughts toward self or others
• Fear of contamination or germs
• Unwanted forbidden or taboo thoughts about religion, harm, or sex

Compulsions are behaviors that a person with OCD will feel a strong urge to perform as a result of obsessive or unshakeable thoughts, such as:

• Compulsive counting
• Ordering or arranging things in a particular way
• Excessive handwashing
• Repeatedly checking to see if the door is locked, clothes iron, or oven is off
• Excessive cleaning

Many people who do these things do not have OCD. A person with OCD will not be able to control their thoughts or behaviors, even when recognizing that the behaviors are excessive and cause significant problems in their day to day life. They may spend at least an hour daily on thoughts and behaviors associated with OCD. A person with OCD derives no pleasure from doing these behaviors but may feel temporary relief from the anxiety caused by the thoughts.

A person with OCD may also experience sudden, brief, and repetitive movements known as a motor tic disorder. Shoulder jerking or shrugging, head jerking, eye blinking, or movements, facial grimaces are common tic disorders. A vocal tic can sound like repeated sniffing, grunting, or throat clearing.

Most persons with OCD will respond to treatment with medication, psychotherapy, or a combination of these two. Since the disorder affects individuals in different ways, the treatment is often unique to the patient. A doctor may prescribe both psychotherapy and medication, or either one. Some patients may experience symptoms even after treatment. A person with OCD may also struggle with depression, body dysmorphic disorder, or anxiety, and these must be considered with treatment.

There are several forms of psychotherapy that might help people with OCD, such as cognitive-behavioral therapy (CBD), habit reversal training. Specific CBD types like exposure and response prevention (EX/RP) can be as effective as medication and sometimes work better in people who found no relief with SRI medications. Transcranial magnetic stimulation (TMS) for OCD treatment in adults was approved by the FDA in 2018.

SRI medications, and some SSRIs, are frequently prescribed by doctors to treat OCD symptoms. SRIs often require a higher daily dosage when treating OCD versus depression, and may take longer to start working (eight to twelve weeks) for some patients.If these medications are ineffective, antipsychotic medication may be prescribed.

Medications are not risk-free, and many have side effects, so it is important for doctors to closely follow up patients, especially in the first few weeks of a new medication, or when the dosage is changed.

Do not stop your medication without talking to your doctor or pharmacist. Make sure you report side effects or concerns about your medication to your doctor right away so that your doctor can change your dosage or prescribe a different medication.

We don’t know what causes OCD, but genetics seem to play a role. A person that has a parent, sibling, or child with OCD is more likely to develop the disorder, and the risk is even higher if this person developed the disorder as a child or teen. Childhood trauma is also associated with OCD, and it may also develop following a streptococcal infection (PANDAS).

If you believe you or a loved one may have OCD, the most important thing is to talk to your doctor about a diagnosis and treatment options. Treatment of OCD is often very successful, and people who get treatment for OCD go on to live fulfilling lives.