OCD: Understanding Obsessions and Compulsions

Compassionate guide to obsessive-compulsive disorder, symptoms, and evidence-based treatments.

10 min readLast updated: 2026-02-17

Quick Facts

Prevalence
OCD affects 1-2% of population
Onset
Often begins in late teens or early 20s
ICD-10
F42

Overview: Understanding OCD

Obsessive-compulsive disorder involves unwanted, intrusive obsessions (thoughts, images, urges) and repetitive compulsions (behaviors, mental acts) intended to reduce anxiety. OCD causes significant distress and impairs functioning. Many myths surround OCD; it's far more than being organized or clean .

Effective treatment helps people resist compulsions and tolerate uncertainty, ultimately reducing symptom frequency and distress.

Key Information
Obsessions are unwanted, intrusive thoughts causing anxiety. Compulsions are repetitive behaviors performed to reduce anxiety. This obsession-compulsion cycle becomes increasingly time-consuming and distressing. Insight varies; some recognize thoughts as unreasonable while others doubt this.

Common OCD Themes

Contamination obsessions and cleaning/washing compulsions are common but represent only one variant. Harm obsessions involve fear of causing injury; checking compulsions attempt prevention. Symmetry/exactness obsessions drive repetitive arranging. Sexual, religious, or aggressive obsessions cause shame and distress. Hoarding obsessions and compulsive collecting occur. Most people have multiple obsession themes.

Impact on Life

OCD consumes significant time (often hours daily), impairs work/school and relationships, and causes tremendous suffering. Avoidance behavior restricts activities and social engagement. Depression and anxiety frequently co-occur.

Cognitive-Behavioral Treatment

Exposure and Response Prevention (ERP) gradually confronts feared situations while resisting urges to perform compulsions . Over repeated exposures, anxiety naturally decreases. Cognitive therapy addresses problematic beliefs about thoughts. Acceptance and Commitment Therapy helps tolerate uncomfortable thoughts while pursuing valued living.

Warning
Reassurance-seeking and accommodation of OCD rituals typically worsen symptoms over time. Family members should avoid engaging in compulsions or providing reassurance. Effective treatment requires tolerating temporary increased anxiety.
Clinical Note
SSRIs are first-line medications; higher doses than those used for depression are often needed. Cognitive-behavioral therapy, specifically ERP, is most effective treatment. Combining medication and therapy shows superior outcomes. Treatment requires qualified professionals trained in OCD; standard anxiety treatment approaches may worsen symptoms.

Recovery and Hope

With appropriate treatment, most people achieve significant symptom reduction. Recovery involves learning to tolerate uncertainty and resist compulsive urges. Peer support and advocacy organizations provide community and education.

Sources

  1. [1]Stein DJ et al.. "Obsessive-Compulsive Disorder." Nature Reviews Disease Primers, 2016.
  2. [2]Abramowitz JS et al.. "Cognitive-Behavioral Therapy for OCD: An Update." Current Psychiatry Reports, 2018.

Medically reviewed by

Medical Review Team, Psychiatry

Last updated: 2026-02-17Sources: 2

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