By: Andrew Hopkins, PA-C


What is Obsessive-compulsive Disorder?

Obsessive-compulsive disorder, or OCD, is a mental illness characterized by the presence of obsessions, compulsions, or both.

What are obsessions?

Obsessions are defined as recurrent and intrusive thoughts, images, or urges that causes anxiety or distress. Obsessions are not perceived as enjoyable, nor are they voluntary. Those with OCD attempt to ignore, avoid, or suppress these unwanted and disturbing thoughts. They aim to neutralize or mitigate the distress that obsessions cause through compulsions.

What are compulsions?

Compulsions are repetitive mental or behavioral acts that the individual feels driven to perform, either in relation to an obsession or according to rules he or she believes must be applied rigidly or to achieve a sense of “completeness”. These are often referred to as “rituals”, and include acts such as repetitive washing or checking.

Do I need to experience both obsessions AND compulsions to have OCD?

No, people with OCD can experience obsessions, compulsions, or both. However, the majority of people with OCD often have both.1,2 It is currently unclear whether obsessions lead to compulsions, or compulsions lead to obsessions.3,4

Who can develop OCD?

It is estimated that there is a 2.3% lifetime prevalence.5,6 In adults, women may be slightly more likely to develop OCD compared to men.6,7 Those with Schizophrenia or Schizoaffective disorder, Bipolar disorder, Eating disorders, or Tourette’s disorder appear to experience OCD at a higher frequency than the general population.8-10 The typical age on onset is around 19.5,6  It is unusual to develop OCD after the age of 35.11 Symptoms typically begin gradually over time, but sudden-onset can sometimes occur.

What is the cause of OCD?

There is no known specific cause for OCD. Current evidence suggests it is a combination of genetic, environmental, and neurobiological factors.

How might OCD manifest?

The frequency and severity of symptoms can vary from person to person, varying from mild, minimally interfering symptoms, to severe, incapacitating symptoms. The symptoms often adhere to a “theme’. Some themes include:

  • Cleaning.  Fears of contamination and repetitive cleaning.
  • Symmetry.  Symmetry obsessions and repeating, ordering, and counting compulsions.
  • Taboo thoughts.  Aggressive, sexual, or religious obsessions and related compulsions.

Avoidance behavior is common in OCD. People with OCD may often avoid people, places, or things which may trigger obsessions and/or compulsions. An example of this may be av oidance of public bathrooms for people who have contamination obsessions.

Those with OCD may impose rules on family members because of their symptoms. For example, family members may not be allowed to have visitors to the home for fear of contamination. High levels of family accomodations is often associated with poorer treatment outcomes, high family burden, and poorer quality of life among family members.

May people with OCD experience dysfunctional beliefs, such as:

  • Inflated responsibility and tendency to overestimate threat
  • Perfectionism and intolerance of uncertainty
  • Overvaluing the importance of thoughts and the need to control thoughts

Those with OCD may have varying levels of insight into their symptoms. If an individual recognizes that their OCD beliefs are definitely or probably untrue, then this represents good insight. Contrary, if a person thinks their OCD beliefs are true, this signifies low or poor insight.

Why should I be concerned about my OCD?

OCD is associated with a reduced quality of life as well as high levels of social and occupational impairment.12-14 Those with OCD can spend a significant amount of daily time obsessing and acting on compulsions. Frequent avoidance of triggers can result in reduced functioning and ability to satisfy daily needs including eating, bathing, and working. There is a strong link between suicidal thoughts and behaviors and OCD.15

Should I seek treatment?

Without treatment, the likelihood of symptom remission is poor. Remission rates were as low as 20% in patients who went untreated.16  

What treatment options are available for OCD?

Treatment options for OCD include medication and psychotherapy. It is often effective to combine medication and psychotherapy for best outcome.

There is considerable evidence supporting the use of Cognitive Behavioral Therapy, or CBT, for the treatment of OCD.17,18  CBT is typically delivered in a structured program, consisting of: Psychoeducation, cognitive training, mapping OCD, graded exposure and response prevention (ERP), and relapse prevention and generalization training. A patient’s adherence to practicing exposure therapy is one of the strongest predictors for both immediate and long-term outcomes.19-21 CBT is typically considered the first-line treatment when available.

In addition to CBT, or where CBT is unavailable, there are a number of evidence-based medications for OCD. Two classes of antidepressants (SSRI’s and TCA’s) are strongly supported by randomized clinical trials. These medications are generally considered safe, but should be prescribed and monitored under the supervision of a Psychiatrist or Psychiatric Physician Assistant.

Does Potomac Behavioral Solutions offer treatment for OCD?

Yes! If you are suffering from OCD, or are unsure about whether or not you have OCD, consider Potomac Behavioral Solutions as your first step in treatment. Our clinicians can help assess and detail your symptoms history and clarify your concerns. We offer comprehensive treatment for OCD, including medication, CBT and Exposure and Response Prevention (ERP). To gain further information on what OCD treatment would consist of, call (571) 257-3378 today.


Work Cited:

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  2. Shavitt RG, de Mathis MA, Oki F, et al. Phenomenology of OCD: lessons from a large multicenter study and implications for ICD-11. J Psychiatr Res 2014; 57:141.

  3. Gillan CM, Robbins TW. Goal-directed learning and obsessive-compulsive disorder. Philos Trans R Soc Lond B Biol Sci 2014; 369.

  4. Kalanthroff E, Abramovitch A, Steinman SA, et al. The chicken or the egg: What drives OCD. J Obsessive Compuls Relat Disord 2016; 11:9.

  5. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617.

  6. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 2010; 15:53.

  7. Weissman MM, Bland RC, Canino GJ, et al. The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry 1994; 55 Suppl:5.

  8. Achim AM, Maziade M, Raymond E, et al. How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 2011; 37:811.

  9. Pallanti S, Grassi G, Sarrecchia ED, et al. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Front Psychiatry 2011; 2:70.

  10. Kaye WH, Bulik CM, Thornton L, et al. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004; 161:2215.

  11. Grant JE, Mancebo MC, Pinto A, et al. Late-onset obsessive compulsive disorder: clinical characteristics and psychiatric comorbidity. Psychiatry Res 2007; 152:21.

  12. Huppert JD, Simpson HB, Nissenson KJ, et al. Quality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety 2009; 26:39.

  13. Koran LM, Thienemann ML, Davenport R. Quality of life for patients with obsessive-compulsive disorder. Am J Psychiatry 1996; 153:783.

  14. Bobes J, González MP, Bascarán MT, et al. Quality of life and disability in patients with obsessive-compulsive disorder. Eur Psychiatry 2001; 16:239.

  15. Angelakis I, Gooding P, Tarrier N, Panagioti M. Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clin Psychol Rev 2015; 39:1.

  16. Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder [see comments]. Arch Gen Psychiatry 1999; 56:121.

  17. Tenneij NH, van Megen HJ, Denys DA, Westenberg HG. Behavior therapy augments response of patients with obsessive-compulsive disorder responding to drug treatment. J Clin Psychiatry 2005; 66:1169.

  18. Simpson HB, Foa EB, Liebowitz MR, et al. A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatry 2008; 165:621.

  19. Simpson HB, Maher MJ, Wang Y, et al. Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder. J Consult Clin Psychol 2011; 79:247.

  20. Simpson HB, Marcus SM, Zuckoff A, et al. Patient adherence to cognitive-behavioral therapy predicts long-term outcome in obsessive-compulsive disorder. J Clin Psychiatry 2012; 73:1265.

  21. Wheaton MG, Galfalvy H, Steinman SA, et al. Patient adherence and treatment outcome with exposure and response prevention for OCD: Which components of adherence matter and who becomes well? Behav Res Ther 2016; 85:6.