Listing of Frequently Asked Questions
- What is OCD?
- What are some of the symptoms of OCD?
- Are all people with OCD 'washers' or 'checkers'?
- If I have any of these symptoms or behaviors, does it mean that I have OCD?
- Is OCD considered an anxiety disorder?
- How common is OCD?
- Is OCD just a fad?
- Why doesn't an individual with OCD "just stop" their behavior?
- Is a person with OCD crazy?
- Is OCD psychological, biological or both?
- Is OCD acquired or are people born with it?
- Are there any other disorders related to OCD?
- Are OCD and depression related?
- What are some signs of depression?
- What are the chemical causes of OCD?
- Is OCD curable?
- What are some of the biggest problems in treating OCD?
- Why do so many people with OCD hide their symptoms?
- What is the prognosis for OCD without treatment?
- What is the prognosis for OCD with treatment?
- What are some of the treatment methods for OCD?
- What medications are used for drug therapy?
- How much can medications help?
- What are the primary types of behavior therapy used?
- Is behavioral therapy treatment easy?
- Is marijuana a good treatment for OCD?
- Can stress affect OCD?
- Do people with OCD need to be hospitalized?
- Do obsessions ever change over time?
- Is OCD contagious?
- If a parent has OCD, what are the chances that the children will have it too?
- Does everyone with OCD have obsessions and compulsions?
- Can trying to reason out an obsession help?
- Are there any techniques to help stop an obsession before it strengthens?
- What is scrupulosity as it relates to OCD?
- What is a YBOCS?
- How do I find treatment?
- How can I reach the OCD Foundation?
- What are some titles of books about OCD?
- Are there other resources for OCD that I can contact?
- What Internet resources are available?
- What can family and friends do to help?
Most Frequently Questions About
This document attempts to impart an understanding of OCD by addressing some
of the most frequently asked questions, in terms of what OCD is, its symptoms,
medications, and treatments. In addition, this FAQ covers information on where to
get help, books to read, and Internet resources.
OCD stands for Obsessive Compulsive Disorder. It is a disorder which causes an
individual to have intrusive thoughts of a frightening or disturbing nature, which in turn may cause the person to do things repeatedly. They might perform certain rituals to guard against danger, or clean one's self or personal areas of home or work again and again. Fact sheet about OCD.
Symptoms and behaviors associated with OCD are wide and varied. The primary
thing they have in common is they are generally unwanted behaviors and/or
thoughts that occur very frequently -- ie, several times a day. Symptoms, if
untreated, may progress to the point of taking up all of a sufferer's waking
Some of symptoms and behaviors may include, but are not limited to:
A more comprehensive check-list
of possible symptoms.
No. OCD manifests itself in a large variety of ways, and individuals usually suffer from a combination of symptoms. Most people with OCD also share common difficulty with daily activities, such as tardiness, perfectionism, procrastination, indecision, discouragement and family difficulties.
That depends much upon the degree in which the symptoms or behaviors interfere
with your thinking, reasoning, and/or life functioning. If you feel you have any
of these symptoms or symptoms of a similar nature, see a competent psychiatrist
experienced with OCD and discuss your symptoms.
Yes. The obsessions cause anxiety, which results in a need to perfom compulsions which
provides temporary relief. See the OCD cycle.
Although once thought to be rare, OCD afflicts as many as five million Americans, or one in fifty. The disorder is found uniformly among men, women, children, and people of all races and socio-economic backgrounds.
No. Throughout history, new disorders have been discovered, and more information has been gathered about those illnesses. Cases of OCD have been documented throughout the centuries. The secretive nature of OCD kept many away from doctors and other health care workers. After effective treatments were developed, more people stepped forward with their symptoms or were diagnosed by clinicians who now knew to look for the disease. Unfortunately, mental illness still carries a stigma. With time, experts and patients alike hope this will change.
Most truly wish they could. Probably the biggest reason why they do not "just
stop" is anxiety. The person with OCD suffers intense anxiety over whatever their
symptoms focus upon. They want to "make sure" that whatever they are focusing
upon is taken care of. OCD is a disease of doubt, therefore the person with OCD
feels they can never be sure that whatever it is is really taken care of. Often
this will show in the form of a compulsion such as hand washing. The person
cannot, no matter how hard they try, feel that their hands are really clean.
There is always a "what if" such as "what if I missed a teeny tiny little spot?"
and so they continue to wash -- just in case. With a compulsion, the anxiety
rises to unbearable and terrifying levels if the compulsion is not allowed to
No. A person who does not recognize that their behaviors and thoughts are abnormal is
"psychotic." Most people with OCD are aware that their behavior does not make sense. People with OCD are not crazy.
OCD is usually considered to have both psychological and biological components.
OCD-like behavior has been observed in animals, including dogs, horses, and birds.
Specific brain abnormalities have been identified that mediate the expression of OCD symptoms. These brain abnormalitites improve with successful treatment by either medication or behavioral therapy.
Persons are generally considered to have been born with a predisposition for OCD.
This predisposition however does not always manifest itself. Sometimes the OCD is triggered by a traumatic or stressful event, even an illness (strep throat), but one must first have the predisposition toward OCD to develop the disorder.
Tourette's syndrome is strongly related to OCD, and many people have both.
Several other disorders appear similar to OCD, including Body Dysmorphic Disorder (BDD), Trichotillomania (hair pulling), and impulse control disorders, but it is not clear whether or not these disorders are truly related to OCD. Other disorders, such as major depression, social phobia, and panic disorder are more common in people with OCD.
Approximately 60-90% of OCD sufferers have also suffered at least one major episode of
depression at some point in their life. Some schools of thought feel the OCD
causes the depression while others believe the OCD and depression simply tend to
- Checking things repeatedly, such as doors, locks, stoves, etc.
- Constant counting, "in one's head" or outwardly, while performing
- "Having" to do things a certain number of times. An example of this would
be: when taking a shower, "having" to wash the left foot three times.
- Obsessively arranging things in an extremely orderly fashion -- which often
makes no sense to anyone save the OCD sufferer.
- Pictures, words or images that "pop" into head and won't go away --
usually of a disturbing nature.
- Nonsensical words or phrases repeating themselves in the person's mind.
- The "what if's".....
- Hoarding of objects with usually no apparent value -- as in one man
collected small pieces of lint from the dryer. The person usually saves such
objects under the rationalization of "what if I need it/them someday?" or is just unable to decide what to discard.
- Excessive fear of contamination -- as in fears to touch normal everyday
things because they might have germs.
- Loss of appetite
- Weight loss
- Early morning awakenings
Lack of energy
- Too much sleeping
- Crying, especially
without knowing why
- Suicidal thoughts
- Feelings of hopelessness
Feelings of helplessness
- Lack of interest in most activities
- Lack of enjoyment in life
The presence of one or more of these symptoms does not necessarily indicate the presence of depression, however if severe or interfering with your life, treatment should be
At the present time there is no definitive agreement among members of the medical
community. OCD appears to be mediated by increased activity in the orbital frontal cortex and caudate nucleus of the brain. The orbital frontal cortex, located behind the eyebrows, is involved in the perception of fear and danger. The caudate nucleus is involved in one's ability to start and stop different thoughts and activities. OCD may also involve abnormal functioning of the neurotransmitter seratonin in the brain.
No, but it is usually controllable.
The generally secretive nature of the disease, lack of knowledge about OCD,
fear of medication, and the fear of facing one's fears in behavioral therapy.
Usually because of feeling shame for doing/thinking such bizarre things, coupled
with a fear of being considered "weird", "strange" or crazy.
The disorder waxes and wanes, but left untreated the OCD will continue indefinitely. Without treatment, generally only about 10-20% of OCD sufferers have a
spontaneous remission of symptoms.
Very good, especially if the patient is determined to work hard. Up tp 80% of OCD sufferers improve significantly with proper treatment of behavioral therapy and medication. Slips and relapses of thinking or behavior may occur but if the person is determined, these slips can usually be caught and treated before blossoming into a full blown OCD episode.
The two most effective treatments for OCD are drug therapy and behavior
therapy. It is generally most effective if the two can be used together.
The most effective medications for OCD are the SSRI's (selective serotonin reuptake inhibitors) Prozac, Paxil, Luvox,and Zoloft as well as the tricyclic Anafranil. These are the only medications proven effective for OCD thus far. Other medications are frequently added to improve the effect.
This varies by individual but generally a 40-95% decrease in symptoms can be
expected. The medications may take from six to twelve weeks to start showing an effect.
The initial mechanism of these medicaitons is to increase the availability of the neurotransmitter seratonin at the synapses (connections betwen brain cells) in the brain. This leads to other brain changes over several weeks which may be more related to improvment in OCD symptoms. Please see
Drug Treatment of OCD in Adults by Michael A. Jenike, M.D. or
Healthy Guide for more information about these type of medications.
Exposure and response prevention is the most effective type of behavior therapy for OCD.
More about behavioral therapy.
No, but it is the best method of permanently reducing obsessions and compulsions.
Although marijuana is now legal in California for medicinal purposes, it is not a good treatment for OCD. It may provide some short term relief, but it causes symptoms to later worsen. Marijuana can also interfere with OCD medications and make depression more severe.
Yes. It is typical to notice a worsening of OCD symptoms during stressful
periods. Stress does not cause OCD, but a stressful event (like the death of a loved one, birth of a child, or divorce) can actually trigger the onset of the disorder or exacerbate it.
The vast majority of people with OCD can be treated without ever having to be admitted to a hospital. Medication and behavioral therapy allow most people to improve while being treated as outpatients. Hospitalization, however, is an important and valuable option for people with severe OCD who are unable to function as outpatients.
Obsessions may change themes over time. Sometimes a person simply adds new ones
to old ones and sometimes the old ones are completely replaced by newer ones.
No, it is not.
In general, about 10% of relatives of people with OCD have the disorder, and
another 5-10% have mild "subclinical" OCD symptoms. But the risk of
having a child with OCD varies, depending on whether someone has childhood-
vs. adult-onset OCD (higher risk of genetic transmission with childhood-onset
OCD), and on whether someone also has Tourette syndrome or tic-related OCD
(conveying a higher risk of familial transmission). If both parents have
OCD, the risk is doubled, around 20% on average.
Approximately 80 percent of people with OCD have both identifiable obsessions and compulsions; about 20 percent have only obsessions or compulsions.
Usually not. Trying to reason out or make sense from an obsessive thought
usually only strengthens the thought.
Yes there are, but they are usually not considered very helpful. The most effective way to stop obsessions is to actually stop the compulsions. When one stops the compulsions, the obsessions will initially get stronger, but over time they will decrease and become less anxiety-provoking.
Some people with OCD worry excessively that they may have done or said something
blasphemous. Fears and worries may vary according to the person's religion. For
example, an Orthodox Jewish person may worry incessantly that he did not perform
a religious ritual correctly; while one who was raised Catholic may worry and
fear that they did not say enough rosaries or confess enough sins. They may fear
they have a hidden sin they have not repented, so they keep examining all
their daily thoughts and actions in an attempt to make sure they didn't miss any
sins. Others may simply fear doing anything because they fear whatever they do
might be wrong, upsetting the God or gods they believe in.
The YBOCS, or Yale-Brown Obsessive Compulsive Scale, is a scale clinicians use to grade the severity of OCD in a patient. It is based on the amount of interference, distress, and control the person has related to their OC behaviors.
Contact your local OC Foundation, the National OC Foundation in Connecticut,
the Association of Advancement of Behavior Therapy, the American Psychiatric
Association, or the American Psychological Association with offices throughout the United States and Canada. If you live in California, please see our list of professionals who treat OCD. If you have a doctor you see, ask for a referal to a psychiatrist or psychologist who is experienced in treating OCD.
Contact information for the OC Foundation and local
affiliates can be found on this web site. If you join, the OC Foundation will send you a packet of information and a bi-monthly newsletter for the membership fee of $35.00.
Below are most of the books available from the OC Foundation's Publication List. You can order many of these directly from the book store at this website. Go to Book Store now.
- Getting Control: Overcoming Your Obsessions and Compulsions by Lee Baer, PhD.
- Stop Obsessing!: How to Overcome Your Obsessions and Compulsions by Edna
Foa, PhD and Reid Wilson, PhD.
- Over and Over Again: Understanding Obsessive Compulsive Disorder by Fugen
Neziroglu, PhD and Jose A. Yayura-Tobias, MD.
- When Once Is Not Enough: Help for Obsessive Compulsives by Gail Steketee,
PhD and Kerrin White, MD.
- The Boy Who Couldn't Stop Washing, by Judith Rapaport, MD.
- Funny You Don't Look Crazy: Life With Obsessive Compulsive Disorder by
- The Doubting Disease: Help for Scrupulosity and Religious Compulsions by
Joseph W. Ciarrocchi.
- How I Ran OCD Off My Land by John March, MD is a cognitive behavioral
protocol for children and adolescents. It also contains tips for parenting. Dr.
March is associated with Duke University Medical Center.
- Brain Lock by Jeffery Schwartz, MD. Regan Books, 1996.
Yes! See our listing of OCD Related
Please see OCSDA's Listing of Useful Links.
Education about OCD is important for the family. Families can learn specific
ways to encourage the person with OCD by supporting the medication regime and the behavior therapy. Self-help books, such as those listed above, are often a good source of information. Some families seek the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country. A booklet called "Living with OCD" is available through the OC Foundation.
- Steven Levenkron, 1991,
Obsessive-Compulsive Disorders: Treating and Understanding Crippling Habits:
Warner Books ISBN: 0-445-39348-7
- John H. Greist (Dean Foundation), 1992, Obsessive Compulsive Disorder: A
Guide: Dean Foundation, Madison, WI (Comment: This booklet is available through the OC Foundation.)
- Polly's Magic Games: A Child's View of Obsessive Compulsive Disorder by
Constance H Foster. Dilligaf Pub, 1994.
- Alone in the Crowd: One Man's Struggle With Obsessive Compulsive Disorder
by Joe Vaughan. Joe Vaughan Assoc. Pub., 1993.
- OCD Anonymous - Obsessive Compulsive Disorder: A Survival Guide for Family
and Friends. OCD Anonymous, Inc., 1993.
- There is also a fiction novel dealing with OCD in a character. The book's
name is "Xenocide" by Orson Scott Card.
- Obsessive Compulsive Disorder by Frederick Toates, D. Phil., D.Sc., 1992.
Published by Thorsons (An Imprint of Harper Collins Pub). Section on famous
people who have OCD.
- New Developments in the Biology of Mental Disorders (The authoritative
guide). Research and Education Assoc. 1995. Section on government
- Living with Prozac and other selective serotonin reuptake Inhibitors by
Debra Elfenbein. Harper Pub. San Franciso 1995. 303 pages $9. Personal accounts
of life on anti- depressants.
- The Sky is Falling: Understanding and Coping with Phobias, Panic, and
Obsessive-Compulsive Disorders by Raeann Dumont. W.W. Norton and Co., 1996.
- Feeling Good by David Burns, MD.
- Ten Days to Self-Esteem by David Burns, MD.
- Mind over Mood by Greenberger and Padesky.
- It's Nobody's Fault - New Hope and Help for Difficult Children and Their
Parents by Harold S. Koplewicz. Published by Times Books. Features the latest
treatments including medication fors ADHD, anxiety, school phobia, eating
disorders, OCD and depression.