Understanding OCD and How to Cope with it

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woman with ocd arranging pencils

You’ve probably heard of obsessive-compulsive disorder (OCD). Recently, psychologists conducted a population-based study targeting OCD patients and to their surprise, there is an increased OCD prevalence with older age. This finding may have suggested that as people age, they become more susceptible to OCD. Here is an inclusive guide to OCD that will help you to gain a deeper understanding of the causes, symptoms and treatments of OCD.


What is OCD?

According to the American Psychological Association, obsessive-compulsive disorder (OCD) is defined as a mental illness where patients experience recurring, unwanted thoughts, ideas or sensations which make them feel driven to act repetitively. The mental disorder is characterized by the occurrence of obsessive thinking and compulsive repetitive behaviors. Patients with OCD have to cope with undesired thoughts in their brain, which are difficult for them to resist.


As its name suggests, OCD comprises “obsession” and “compulsion.” Obsession refers to a persistent thought and impulse which can lead to anxiety. Compulsion refers to an irresistible need to perform specific actions to reduce the anxiety. The majority of OCD patients perform compulsive behaviors because they hope to reduce anxiety that arises from obsession.

What are the causes of OCD?

The OCD cycle can be used to explain the causes of OCD. In brief, the OCD cycle suggested that OCD patients feel the need to carry out the compulsions because their actions lead to relief of their anxiety. Obsession and compulsion are an entwined process which makes the cycle difficult to escape if patients do not receive appropriate treatment. 


The 4-Step Process of OCD

  1. Firstly, when an obsessional thought intrudes the person’s thinking, an obsession is formed. Repetition of this obsession leads to the patient experiencing anxious feelings.
  2. As the patient hopes to reduce anxiety, they develop compulsive behaviors to manage the anxiety. 
  3. By performing these compulsive behaviors, the anxiety is temporarily ameliorated. 
  4. After a while, the obsession returns and creates anxiety again. The patient will have to repeat compulsive behaviors to gain relief and to reduce anxiety.


the 4-step process of OCD

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What are the symptoms of OCD?

OCD patients experience obsessions that are associated with specific themes. Common obsession themes include dirt, contamination, aggression, bodily functions, the need for order and symmetry in lives, the need to do things in a particular sequence and a specific number of times.


Common examples of obsessions include:

According to the American Psychiatric Association, there are some common obsessions that OCD patients experience:

  • Fear of getting contaminated by people or the environment 
  • Disturbing sexual thoughts or images 
  • Fear of blurting out obscenities or insults 
  • Extreme concern with order, symmetry, or precision 
  • Recurrent intrusive thoughts of sounds, images, words, or numbers
  • Fear of losing or discarding something important

Furthermore, patients with OCD show compulsive behaviors which as mentioned, are conducted to reduce anxiety. Therefore, compulsive checking is a common form of compulsion in many OCD patients. Compulsive behaviors are also known as coping mechanisms to reduce the anxiety caused by obsessive thoughts. Examples of compulsions include:

  • Grooming
  • Excessive hand washing
  • Unstoppable action (e.g. going in and out of a door)
  • Frequent checking behavior (e.g. check if the door is locked)
  • Counting
  • Ordering

How do mental health professionals diagnose OCD?

When obsessions and compulsive behaviors occupy the majority of your time, you may consider seeking help from OCD therapists. In general, OCD therapists rely on diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and conduct diagnoses through the use of psychiatric assessments. One example of the assessments would be the Obsessive-Compulsive Inventory (OCI), which measures the frequency of 1) washing; 2) checking; 3) doubting; 4) ordering; 5) having obsessional thoughts; 6) hoarding; and 7) mental neutralizing.


Examples of questions include asking the patient to rate their agreement on the following statements:

  • Unpleasant thoughts come into my mind against my will and I cannot get rid of them.
  • I wash and clean obsessively.
  • Even when I do something very carefully I feel that it is not quite right.

What are the treatment options for OCD?

There are various intervention approaches for treating OCD. Some common approaches for OCD are discussed as follows:


Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) can help patients identify their thought patterns and the associated emotions and behavior. One specific type of CBT is known as exposure and response prevention (ERP). Exposure treats obsessions by directly exposing the patient to thoughts, images, objects and situations that lead to anxious feelings and obsessions. By repeated exposure, the treatment allows patients to experience the fear until it subsides. Response prevention treats compulsions. To take washing hands as an example, ERP eliminates the rewarding effect of handwashing. Ultimately compulsive hand washing will become extinct.



Medications are often used to treat OCD. Examples of antidepressants commonly used to treat OCD include selective serotonin reuptake inhibitors (SSRIs) and clomipramine. These medications are used to treat OCD by increasing the concentration of serotonin in the brain. 


Biological treatment

In more severe cases, biological treatments are often combined with other approaches to treat OCD. One example of biological treatments would be surgery. Surgery is exceedingly rare. A typical surgery for treating OCD is deep brain stimulation. However, this treatment approach is only applicable for patients with severe OCD as it involves a high risk of side effects. Therefore, patients need to evaluate different treatment approaches before seeking help from an OCD therapist. 


Is OCD a type of anxiety?

OCD is a type of anxiety disorder characterized by unwanted thoughts and repetitive behaviors. Other common types of anxiety disorders include generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder.

What happens if OCD is left untreated?
How do you check if you have OCD?

This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Frances Cheng
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