OCD: what obsessive-compulsive disorder is, and how it's treated

Signs at a glance

• Unwanted thoughts, images or urges that keep coming back and cause distress
• Intense fear of germs, contamination, or causing harm by mistake
• A strong need for things to feel exactly right, even or in order
• Repeated checking, such as locks, stoves or messages
• Excessive washing or cleaning
• Counting, repeating words, or mentally reviewing things over and over
• Asking for reassurance again and again
• Avoiding places, people or things that trigger the fears
• Rituals that take up a lot of time or get in the way of daily life

Everyone has some of these sometimes. What matters is how long they last, how strong they are, and whether they get in the way of daily life. Only a doctor or licensed counselor can diagnose. If you're worried, that's reason enough to ask.

If your mind keeps throwing thoughts at you that you hate, and you feel you have to check, wash, count, pray or ask “are you sure?” one more time just to get through the day, you may be dealing with OCD. It is exhausting, and it can feel very lonely. But OCD is well understood, it is treatable, and you are not your thoughts.

What is OCD?

Obsessive-compulsive disorder (OCD) is a mental illness with two parts, according to the National Institute of Mental Health (NIMH):

• Obsessions: uncontrollable, recurring thoughts, images or urges that cause anxiety or distress. The International OCD Foundation (IOCDF) calls them “unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.”
• Compulsions: repeated behaviors or mental acts a person feels driven to do to ease that distress or prevent something bad from happening.

Some people have mostly obsessions, some mostly compulsions, and many have both. The relief from a compulsion is short, so the cycle repeats.

What does OCD feel like?

NIMH lists common obsessions, including fear of germs or contamination, fear of losing or forgetting something, unwanted thoughts about harm, sex or religion, and a need for things to be symmetrical or in perfect order. Common compulsions include excessive washing or cleaning, arranging things in a precise way, repeated checking, counting, and praying or repeating words silently.

Many people describe a feeling that something is “not right” that won’t go away until a ritual is done, sometimes many times. Others mostly fight battles in their head, reviewing, analyzing or arguing with thoughts for hours.

One of the most painful parts of OCD is that the thoughts often go against everything the person values. A gentle parent may have unwanted thoughts about harming their child. A devoted believer may have blasphemous thoughts in church. These thoughts are not wishes or plans. The distress they cause shows how much they conflict with who you are.

How common is OCD?

NIMH reports that about 1.2% of U.S. adults had OCD in the past year, and about 2.3% will have it at some point in their lives (National Comorbidity Survey Replication, 2001–2003). In that survey, past-year OCD was more common in women (1.8%) than men (0.5%). Symptoms usually begin between late childhood and young adulthood.

The IOCDF notes it takes over seven years on average for someone to get an accurate OCD diagnosis, partly because of stigma and misunderstanding. Clear, kind conversation helps shorten that wait.

What causes OCD?

No one causes their own OCD, and parents and churches don’t create it. NIMH describes several risk factors:

• Genes. OCD is more likely if a parent or sibling has it.
• Brain differences. Imaging studies show differences in brain areas involved in controlling behavior and emotional responses.
• Temperament. Being more reserved, having more negative emotions, or having anxiety or depression in childhood are linked to higher risk.
• Childhood trauma. Some studies suggest a link, though more research is needed.

People with OCD often also have anxiety or a mood disorder such as depression.

How is OCD treated?

There is no cure for OCD, but treatment helps many people manage symptoms and live well:

• Exposure and response prevention (ERP). This specific kind of cognitive behavioral therapy (CBT) is first-line for adults, children and teens, according to the IOCDF. With a trained therapist, you gradually face the thoughts or situations that trigger fear, and practice not doing the compulsion. It’s hard work, but compulsions and fear usually decrease over time.
• Other CBT. Helps you notice and respond differently to unhelpful thoughts.
• Medication. A doctor may prescribe medicines that act on serotonin. They can take several weeks to help. Never stop or change medicine without talking to your prescriber.

Healthy habits like steady sleep, regular exercise and leaning on people you trust also help.

What is scrupulosity, or religious OCD?

Scrupulosity is a form of OCD that focuses on religious or moral fears. The IOCDF describes it as “a subtype of obsessive compulsive disorder (OCD) involving religious or moral obsessions.” It might look like:

• constant fear of having sinned, blasphemed, offended God or being unforgivable
• needing to be certain about salvation or doctrine
• praying, confessing or rereading Scripture over and over until it feels “right”
• asking pastors or family for reassurance again and again
• avoiding church or the Bible because they trigger fear

Scrupulosity is not a sign of a sensitive conscience gone too far, and it is not a sign of weak faith. The IOCDF says there is no evidence linking it to any particular religion. OCD simply goes after what a person cares about most, and for a believer, that is often God. It is treated like other OCD, mainly with ERP, and the goal is to separate OCD from your real faith and values so you can live by them freely. Many therapists are glad to work with a person’s pastor to tell healthy devotion from OCD.

For pastors and friends: the IOCDF notes that repeated reassurance, though loving, keeps the OCD cycle going. A helpful sign of OCD is motive: when religious practice is driven by fear, obligation, guilt or shame rather than love. Stay warm, encourage treatment, and ask the person and their therapist how you can help.

How can I support someone with OCD?

• Take it seriously, and avoid jokes like “I’m so OCD.”
• Don’t take part in rituals or give endless reassurance, but do it kindly. You might say, “I love you, and I think this is the OCD talking. What would your therapist suggest?”
• Encourage treatment with a therapist trained in ERP, and celebrate small steps.
• Be patient. Progress isn’t a straight line.

When should you get help right away?

OCD can sometimes come with depression or hopelessness. If you or someone you know has thoughts of suicide, call or text 988, or call 911 in an emergency. Our Get help now page lists more options.

Faith and OCD

If OCD has turned your faith into a place of fear, know this: God is not the voice demanding one more prayer, one more confession, one more certainty. Scripture speaks to the anxious, accusing heart:

“Because if our heart condemns us, God is greater than our heart, and knows all things.” — 1 John 3:20 (WEB)

Getting treatment for scrupulosity is not turning away from God. It is clearing away what OCD has piled on top of your faith so you can rest in it. Jesus’ invitation still stands for every tired, burdened mind:

“Come to me, all you who labor and are heavily burdened, and I will give you rest.” — Matthew 11:28 (WEB)