What is OCD?

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There is a public misconception that obsessive compulsive disorder (OCD) is just a minor personality quirk or preference and that everyone is "a little bit OCD." In reality, OCD is a serious and often debilitating mental health disorder that affects people of all ages [1] and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions [2].

Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease distress.

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of OCD to be made, this cycle of obsessions and compulsions must be so extreme that it consumes a lot of time (more than an hour every day), causes intense distress, or gets in the way of important activities that the person values[1].

What exactly are obsessions and compulsions?

Obsessions

Obsessions are thoughts, images, or impulses that occur over and over again and feel outside of the person’s control. Individuals with OCD do not want to have these thoughts and find them disturbing. In most cases, people with OCD have some insight — they realize that these thoughts are illogical. 

Obsessions are typically accompanied by intense and uncomfortable feelings such as fear, disgust, uncertainty, and/or doubt, or a feeling that things have to be done in a way that is “just right.” In the context of OCD, obsessions are time-consuming and get in the way of important activities the person values. This last part is extremely important to keep in mind as it, in part, determines whether someone has OCD — a psychological disorder — rather than an obsessive personality trait.

A head with the acronym for obsessive compulsive disorder written on it.

How is this different from being "obsessed"?

“Obsessing” or “being obsessed” are commonly used terms in everyday language. These more casual uses of the word mean that someone is preoccupied with a topic, an idea, or even a person. To be “obsessed” in this everyday sense doesn’t mean that a person has problems in their day-to-day living — there may even be a pleasurable component to their experience of being “obsessed.” For example, you can be “obsessed” with a new song you hear on the radio, but you can still meet your friend for dinner, get ready for bed in a timely way, get to work on time in the morning, etc., despite this obsession. 

The content of an everyday “obsession” can be more serious: for example, everyone might have had a thought from time to time about getting sick, or worrying about a loved one’s safety, or wondering if a mistake they made might be catastrophic in some way. While these thoughts look similar to what you would see in OCD, someone without OCD may have these thoughts, be momentarily concerned, and then move on.

In fact, research has shown that most people have unwanted intrusive thoughts from time to time, but in the context of OCD, these intrusive thoughts come frequently and trigger extreme anxiety, fear, and/or disgust that gets in the way of day-to-day functioning.

Contamination Obsessions

  • Fear of coming into contact with perceived contaminated substances/things, such as:
    • Body fluids (e.g., urine, feces)
    • Germs/disease (e.g., herpes, HIV, COVID-19)
    • Environmental contaminants (e.g., asbestos, radiation)
    • Household chemicals (e.g., cleaners, solvents, battery acid)
    • Dirt

Violent Obsessions

  • Fear of acting on an impulse to harm oneself
  • Fear of acting on an impulse to harm others
  • Excessive concern with violent or horrific images in one's mind

Responsibility Obsessions

  • Fear of being responsible for something terrible happening (e.g., fire, burglary, car accident)
  • Fear of harming others because of not being careful enough (e.g., dropping something on the ground that might cause someone to slip and themselves)

Perfectionism-related Obsessions

  • Excessive concern about evenness or exactness
  • Excessive concern with a need to know or remember
  • Fear of losing or forgetting important information when throwing something out
  • Excessive concern with performing tasks "perfectly" or "correctly"
  • Fear of making mistakes

Sexual Obsessions

  • Unwanted thoughts or mental images related to sex, including:
    • Fears of acting on a sex-related impulse
    • Fears of sexually harming children, relatives, or others
    • Fears of performing aggressive sexual behaviors towards others

Religious/Moral Obsessions (Scrupulosity)

  • Fear of offending God, damnation, and/or concern about blasphemy
  • Excessive concern with right/wrong or morality

Identity Obsessions

  • Excessive concern with one's sexual orientation.
  • Excessive concern with one's gender identity.

Other Obsessions

  • Relationship-related obsessions (e.g., excessive concern about whether one’s partner is “the one," the partner’s flaws and qualities)
    • These types of obsessions can center around romantic partners, relatives, friends, and other relationships.
  • Obsessions about death/existence (e.g., excessive preoccupation with existential and philosophical themes, such as death, the universe, and one’s role in “the grand scheme.”
  • Real event/false memory obsessions (e.g., excessive concern about things that happened in the past and what impacts they may have had)
  • Emotional contamination obsessions (e.g., fear of "catching" personality traits or personal characteristics of other individuals)
  • About 1 in 40 adults currently have OCD. That’s over three million adults in the United States, or the populations of Phoenix, AZ and Philadelphia, PA combined.
  • About 2.2 million children in the United States have OCD.
  • OCD affects men, women, and children of all races, ethnicities, and backgrounds.
  • On average, it takes over 7 years for an individual to receive an accurate OCD diagnosis.
  • More than ⅔ of the public cannot accurately identify OCD.
  • The obsessions and compulsions of OCD are ego-dystonic, as people with OCD are distressed by the content of their intrusive thoughts and would truly prefer not to do the compulsive behaviors or have the compulsive thoughts that keep their distress at bay for a moment. Something that is “ego-dystonic” is separate or opposite of what someone truly agrees with, desires, believes in, and values. 
  • There are effective treatments for OCD
  • Exposure and Response Prevention (ERP) is the proven, most effective, first-line therapy for OCD in adults, children, and adolescents. ERP is a specific type of cognitive-behavioral therapy (CBT). Backed by decades of research, ERP that is guided by a knowledgeable therapist and carried out properly helps individuals extinguish fears and eliminate compulsive behaviors in a structured, supportive environment.
  • Selective Serotonin Reuptake Inhibitors (SSRIs) are effective medications for treating OCD. Common SSRIs include Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, and Sertraline; all have comparable effectiveness. Medication is often used in combination with ERP, especially when treating pediatric OCD.
  • If ERP and SSRIs do not relieve symptoms, second-line therapies offer alternative approaches. These therapies include Inference-Based Cognitive Behavioral Therapy (I-CBT), Acceptance and Commitment Therapy (ACT), Transcranial Brain Stimulation (TMS), and other strategies.
  • There are many disorders that are related to OCD, including, but not limited to:
  • Hoarding Disorder (HD) is a mental health disorder where people have difficulty getting rid of possessions that are no longer useful.
  • Body Dysmorphic Disorder (BDD) involves thinking too much about an imagined or slight flaw in a person’s own looks. If there is a slight flaw, the person’s concern is extreme.
  • Body-Focused Repetitive Behaviors (BFRBs) are repeated self-grooming actions—such as biting, pulling, picking, or scraping the hair, skin, lips, cheeks, or nails—that can cause physical harm and often persist despite multiple attempts to reduce or stop them.

Challenges for people with OCD:

  • Public recognition of OCD and related disorders: Not enough people have an accurate understanding of OCD. More than ⅔ of the public cannot accurately identify OCD. This misunderstanding of the disorder results in stigma, misuse of the term in casual conversation, and delays in diagnosis and treatment of people with OCD, making one’s OCD journey even more challenging.
  • Access to effective treatment: Due to stigma and public misconceptions of OCD and related disorders, it takes an average of seven years for an individual to receive an accurate OCD diagnosis.
  • Advancing research: We need to know more about the causes and treatments for OCD. Research funding is disproportionately low compared to disorders with similar or lower prevalence rates.

 

Compulsions

Compulsions are repetitive behaviors or thoughts that a person uses to neutralize or counteract the obsession — essentially to try and make their obsessions go away. People with OCD realize this is only a temporary solution, but without a better way to cope, they rely on compulsions nonetheless. Compulsions can also include avoiding situations that trigger obsessions. They are time-consuming and get in the way of important activities the person values.

A look into an OCD mind.

Compulsions vs. Rituals

Similar to obsessions, not all repetitive behaviors or “rituals” are compulsions. This depends on the function and the context of the behavior. For example, bedtime routines, religious practices, and learning a new skill all involve some level of repeating an activity over and over again, but are usually a positive and functional part of daily life. Similarly, arranging and ordering books for eight hours a day isn’t a compulsion if the person works in a library. 

The feelings associated with a behavior also indicate whether it is compulsive. If you are just a stickler for details or like to have things neatly arranged, you might consider these things to be “compulsive” behaviors, but that doesn’t necessarily mean they are symptoms of OCD. In these cases, “compulsive” refers to a personality trait or something about yourself that you actually prefer or like. In most cases, individuals with OCD feel driven to engage in compulsive behavior and would rather not have to do these time-consuming and often torturous acts. Rather than being a source of pleasure, people with OCD perform compulsions because they believe they are necessary to prevent negative consequences and/or to escape or reduce anxiety or the presence of obsessions.

Common Compulsions in OCD [3]

Washing and Cleaning

  • Washing hands excessively or in a certain way
  • Excessive showering, bathing, tooth-brushing, grooming, or toilet routines
  • Cleaning household items or other objects excessively
  • Doing other things to prevent or remove contact with contaminants

Checking that:

  • You did not/will not harm others
  • You did not/will not harm yourself
  • Nothing terrible happened
  • You did not make a mistake
  • Some parts of your physical condition or body

Repeating:

  • Routine activities (e.g., going in or out doors, getting up or down from chairs)
  • Body movements (e.g., tapping, touching, blinking)
  • Activities in "multiples" (e.g., doing a task three times because three is a "good," "right," "safe" number)

Mental Compulsions

  • Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)
  • Praying to prevent harm (to oneself others, to prevent terrible consequences)
  • Counting while performing a task to end on a "good," "right," or "safe" number
  • "Cancelling" or "Undoing" (example: replacing a "bad" word with a "good" word to cancel it out)

Other Compulsions

  • Putting things in order or arranging things until it "feels right"
  • Telling, asking, or confessing to get reassurance
  • Avoiding situations that might trigger your obsessions

One way that can help people understand the difference between OCD and everyday thoughts and behaviors is whether something is “ego-syntonic” or “ego-dystonic”. Something that is “ego-syntonic” truly aligns with one’s values, identity, core beliefs, and desires. Something that is “ego-dystonic” does not — it is separate or opposite of what someone truly agrees with, desires, believes in, and values. The obsessions and compulsions of OCD are ego-dystonic, as people with OCD are distressed by the content of their intrusive thoughts and would truly prefer not to do the compulsive behaviors or have the compulsive thoughts that keep their distress at bay for a moment.

OCD Screener

Does the cycle of obsessions and compulsions explained above sound familiar? Are you curious if you or a loved one are experiencing OCD symptoms? Our OCD Screener is a confidential, quick, and free OCD screening tool for people of all ages.

Take the OCD Screener

Learn More About OCD

Who Gets OCD?
What Causes OCD?
How is OCD Diagnosed?
Treatment for OCD
How Do I Find Help for OCD?
Related Disorders

From the Experts

From the Experts includes articles written by mental health professionals and researchers who are experts in OCD and related disorders. Articles provide information to help you or your loved one understand and manage OCD or a related disorder. Topics include subtypes of OCD, co-occurring disorders, treatment, family issues, and more.

Read the From the Experts Articles

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Sources:

  • [1] National Institute of Mental Health. (n.d.) Obsessive-Compulsive Disorder. NIMH Information Resource Center. https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd ↩
  • [2] American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Washington, DC: American Psychiatric Association. ↩
  • [3] Reprinted with permission by New Harbinger Publications, Inc. This is an adaptation of the OC Checklist which appears in S. Wilhelm & G. S. Steketee's Cognitive Therapy for Obsessive-Compulsive Disorder A Guide for Professionals (2006). www.newharbinger.com ↩