Websites with information about Obsessive Compulsive Disorder

Written by Tamara Pringsheim MD FRCPC Neurology

Obsessive-compulsive disorder is a condition characterized by the presence of obsessions and/or compulsions. 

Obsessions are recurrent, intrusive thoughts, urges or images that are experienced as intrusive and unwanted and cause marked anxiety or distress. They are not simply excessive worries about real-life problems. People with obsessions attempt to ignore or suppress them, or to neutralize them with some other thought or action, and recognize that the obsessions are a product of their own mind.

Compulsions are defined by repetitive behaviours (for example, hand washing, ordering, checking) or mental acts (such as, praying, counting, repeating words) that a person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. Compulsions are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, they are not connected realistically with what they are designed to neutralize or are clearly excessive. 

To be diagnosed with OCD, symptoms must cause marked distress, be time-consuming (more than 1 hour per day), or significantly interfere with person’s normal routine, work or school functioning, or usual activities or relationships. The symptoms must not be due to the direct effects of substance or a general medical condition. 

Obsessions and compulsions are subgrouped into thematic categories:

• Contamination and cleaning
• Taboo thoughts or fears: sexual, religious, or aggressive
• Fear of harm
• Symmetry, superstition and perfectionism
• Fear of illness or disease
• Hoarding

People may have symptoms in several of these categories, and symptoms may change over time. 

Many people with OCD are affected by other conditions, with Tourette syndrome, ADHD, anxiety disorders and mood disorders being most common. Conditions which are considered obsessive-compulsive related disorders include hoarding disorder, hair pulling disorder, body dysmorphic disorder and skin picking/excoriation disorder. 

OCD is a disorder of neural circuitry, with complex and multifactorial etiology. Genetic factors are strongly implicated, especially in people with childhood onset of symptoms. Environmental factors also appear to have a role, including prenatal and perinatal adversity. 

OCD is a common condition, affecting approximately 2% of people in their lifetime. There are two peaks in the age of onset, one at age 11 and one at age 21. People with younger onset of OCD symptoms are more likely to be male and have a history of tics. Individuals with tic-related OCD are more likely to have remission of OCD symptoms by adulthood.  Some children with OCD experience improvement in the severity of their OCD symptoms as they mature into adults. However, for many people, OCD is a chronic condition, but fortunately there are a number of effective treatments that can improve symptoms and quality of life. 

Effective treatments for OCD include behavioural therapies and medications. The main behavioural therapy used in OCD is Exposure and Response Prevention (ERP). Other behavioural therapies include mindfulness and cognitive therapy.  The main medications used for OCD are selective serotonin reuptake inhibitors (SSRIs), which are typically used first line in people with moderate to severe OCD symptoms. Other types of antidepressant medications and dopamine receptor blocking medications can also be tried in people who do not respond adequately to SSRIs.  Other treatments are also being researched for the treatment of OCD, including the use of transcranial magnetic stimulation, and deep brain stimulation.