Obsessive-Compulsive Disorder

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.


Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others participating; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function.

In The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, which was published by the American Psychiatric Association (APA) in 2013, obsessive-compulsive disorder sits under its own category of obsessive-compulsive and related disorders where the following subcategories were placed:

  1. Obsessive-compulsive disorder (OCD)

  2. Body dysmorphic disorder (BDD)

  3. Hoarding disorder

  4. Trichotillomania

  5. Excoriation (skin-picking) disorder

  6. Substance/medication-induced obsessive-compulsive and related disorder

  7. Obsessive-compulsive and related disorder as a result of another medical condition

  8. Other specified obsessive-compulsive and related disorder

  9. Unspecified obsessive-compulsive and related disorder

A. Presence of obsessions, compulsions, or both:

Obsessions are defined by the following two points:

  1. Recurrent thoughts, urges, or images that are experienced, at some time during the disturbance, as unwanted, and that in most individuals cause marked distress.

  2. The individual attempts to suppress such thoughts, urges, or images, with some other thought or action (i.e., by replacing them with a compulsion).

Compulsions are defined by the following two points:

  1. Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession.

  2. The behaviors or mental acts aim at reducing anxiety or distress or preventing some dreaded situation; however, these behaviors or mental actions do not connect in a realistic way with what they are designed to prevent or are clearly excessive.

B. The obsessions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms do not arise from the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The symptoms of another mental disorder do not better explain the disturbance (e.g., excessive worries, as might be found in a generalized anxiety disorder; preoccupation with appearance, as seen in a body dysmorphic disorder; difficulty discarding or parting with possessions, as found in a hoarding disorder; hair pulling, as in trichotillomania a hair-pulling disorder; skin picking, as appears in excoriation [skin-picking] disorder; stereotypies, as found in a in stereotypic movement disorder; ritualized eating behavior, as found in eating disorders; preoccupation with substances or gambling, as seen in a in substance-related and addictive disorders; preoccupation with having an illness, as found in illness anxiety disorder; sexual urges or fantasies, as found in a paraphilic disorders; impulses, as seen in a disruptive, impulse-control, and conduct disorders; guilty ruminations, as occurs in a major depressive disorder; thought insertion or delusional preoccupations, as found in schizophrenia spectrum and other psychotic disorders; or repetitive behavior patterns, as found in an autism spectrum disorder).

Obsessions are defined as intrusive thoughts or urges that cause significant distress; the patient attempts to neutralize this distress by diverting thoughts or performing rituals. Compulsions are actions the patient feels pressured to do in response to the anxiety/distress producing obsessions or to prevent an uncomfortable situation from occurring. These compulsions may be illogical or excessive.

The most common obsessions include fears of contamination, fears of aggression/harm, sexual fears, religious fears, and the need to make things “just right.” The compensatory compulsions for these obsessions include washing and cleaning, checking, reassurance-seeking, repeating, ordering, and arranging.

As OCD has the possibility of hindering one’s social growth and development, the WHO lists OCD as one of the ten most disabling conditions by financial loss and a decrease in quality of life.

Termed “obsessional neurosis” by Freud in 1895, OCD has had acknowledgment for centuries. However, only recently has the DSM listed OCD as less of an “anxiety” disorder, and more of a disorder similar to hoarding, body dysmorphia, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. The use of modern technology has allowed us to map areas of the brain that get affected by this disorder. These areas of the brain do not typically correspond with anxiety and fear as previously thought and further separate OCD as an “anxiety” disorder.

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