About OCD

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an illness that causes people to have distressing, intrusive, irrational thoughts, images or impulses (i.e., obsessions) and to perform repetitive behavioral or mental acts (i.e., compulsions) aimed at reducing distress or preventing some dreaded situation. Read the DSM-5 Criteria for OCD.

Although everyone with OCD has obsessions and/or compulsions, the content varies from person to person. Typical obsessions include repetitive fears of causing harm or being harmed, fears of contamination and illness, fears of making mistakes, intrusive distressing sexual or religious imagery, or fears of losing things. Typical compulsions include repetitive washing and cleaning, excessive checking, excessive ordering and arranging, or extreme hoarding and saving. Some people with OCD have only one type of obsession or compulsion; others have several types of obsessions and compulsions.

OCD occurs in 1-3 percent of the population with its onset typically occurring in adolescence or young adulthood (although it can start in childhood). The course is often chronic.

When obsessions and compulsions cause marked distress, are time consuming (for example, take more than one hour a day), or interfere with functioning, treatment is recommended. Two treatments significantly reduce the symptoms of OCD: cognitive-behavioral therapy (CBT) using exposure and ritual prevention and pharmacotherapy with serotonin reuptake inhibitors (SRIs) clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).

How is OCD Treated?

The first-line treatments for OCD are medication with serotonin reuptake inhibitors (SRIs), therapy with Cognitive Behavioral Therapy (CBT), or their combination. Our center offers both types of treatment. We encourage patients to select the treatment that they feel most comfortable with.

  • Serotonin Reuptake Inhibitors (SRIs): Serotonin reuptake inhibitors (SRIs) are the most effective pharmaceutical treatment for OCD. SRIs are antidepressants that block the re-absorption of serotonin in the brain. Although SRIs are commonly prescribed for depression, studies have found that they can be effective for patients with OCD. The doses required for treating OCD are often higher than the doses required for treating depression (see table below). Common side effects of SRIs include: nausea, diarrhea, sexual dysfunction, and headaches. Not all patients respond to SRIs, and some who do still experience bothersome symptoms. For these patients, we recommend adding Cognitive-Behavioral Therapy (CBT).
  • Cognitive-Behavioral Therapy (CBT): Cognitive-Behavioral Therapy (CBT) that includes Exposure and Ritual Prevention (or Exposure and Response Prevention; EX/RP, ERP) has been shown to be the most effective psychotherapy for OCD. The goal of CBT is to change dysfucntional thoughts, emotions, and behaviors. To do this, the therapist helps the patient repeatedly approach situations that trigger OCD-related anxiety or distress (exposure), while refraining from performing compulsions or rituals (ritual prevention). By doing this, the patient learns that their anxiety and distress will go down, and that feared consequences will not occur, even if they don’t do their rituals. CBT with EX/RP (ERP) is typically completed in 17-25 ninety-minute sessions.

OCD Symptoms

What is OCD?

Briefly, Obsessive-Compulsive Disorder (OCD) is a psychiatric disorder that is characterized by obsessions and compulsions. Obsessions are distressing and intrusive thoughts, and compulsions are behaviors or mental acts designed to reduce the anxiety/distress caused by obsessions. 

Obsessions Are

  • Persistent and recurrent thoughts, urges, impulses, or images that are inappropriate and intrusive. These thoughts can cause feelings of anxiety, distress, or disgust.
  • Obsessions are not just excessive worries about real-life problems
  • The patient tries to suppress or ignore the obsessions, or to neutralize them with a different thought or behavior.
  • The patient recognizes that the obsessions are not based on reality

Examples of Obsessions

  • Fears of contamination or germs
  • Fears of harming oneself or others
  • Concerns about order and symmetry
  • Unwanted sexual or religious thoughts

Compulsions Are

  • Repetitive behaviors or mental acts that the patient feels driven to perform according to strict rules, or to bring down anxiety, or to prevent a feared event or situation
  • The compulsions are clearly excessive or are not connected in a realistic way with what they are supposed to neutralize or prevent

Examples of Compulsions

  • Excessive hand washing or cleaning
  • Excessive checking (e.g., locks, doors, stoves, etc.)
  • Ordering and arranging
  • Counting, praying, or repeating words silently to oneself

Prevalence

In adults, the lifetime prevalence of OCD is approximately 2.5%, and the 1-year prevalence is between 0.5%-2.1%. Research shows that the prevalence of OCD is similar in many different cultures around the world.

Onset

OCD most often begins in adolescence or early adulthood, but for many it begins in childhood. OCD is typically a chronic disorder, with waxing and waning symptoms that can worsen due to stress.

What is Obsessive Compulsive Personality Disorder (OCPD)?

Obsessive compulsive personality disorder (OCPD) is a chronic maladaptive pattern of excessive perfectionism, preoccupation with orderliness and detail, and need for control over ones environment that leads to significant distress or impairment, particularly in areas of interpersonal functioning. Individuals with this disorder are often characterized as rigid and overly controlling. They may find it difficult to relax, feel obligated to plan out their activities to the minute, and find unstructured time intolerable.

According to recent studies, about a quarter to a third of individuals with OCD meet criteria for OCPD. There is also evidence of a familial association between OCPD and OCD with studies showing increased frequencies of OCPD traits in the first degree relatives of individuals with OCD. Despite the apparent relationship between the disorders and some similarities in their symptoms, there are distinct differences between the conditions. OCD is characterized by intrusive and distressing obsessions; in contrast, OCPD traits and symptomatic behaviors are viewed by affected individuals as appropriate and correct, though they can lead to significant distress due to the associated need for control.

Helpful Resources

Obsessive-Compulsive and Related Disorders

OCD Foundation, New York Chapter

Founded in 2010, the OCD New York is a non-profit affiliate of the International OCD Foundation (IOCDF). OCD New York is a locally based group made up of people with Obsessive Compulsive Disorder (OCD) and related disorders, as well as their families, friends, professionals and others.

OCD Foundation, New Jersey Chapter

OCD New Jersey (OCDNJ) is a nonprofit organization sanctioned by the International OCD Foundation (IOCDF).

International OCD Foundation

Founded by a group of people with OCD in 1986, the International OCD Foundation (IOCDF) is an international not-for-profit organization that encompasses both OCD NY & OCD NJ. This is an especially good resource for gaining global information on the most up to date research findings and advocacy news.

Cognitive Behavioral Therapies

Association for Cognitive & Behavioral Therapies (ABCT)

The Association for Behavioral and Cognitive Therapies is a multidisciplinary organization committed to the advancement of scientific approaches to the understanding and improvement of human functioning through the investigation and application of behavioral, cognitive, and other evidence-based principles to the assessment, prevention, treatment of human problems, and the enhancement of health and well-being.

Anxiety and Depression

Columbia Psychiatry/Anxiety Disorders Clinic

The Anxiety Disorders Clinic (ADC) was established in 1982 to study the diagnosis, pathophysiology, and treatment of anxiety disorders. The clinic now includes programs in obsessive-compulsive disorder (OCD), posttraumatic stress disorder and related traumatic conditions (PTSD and Trauma program), social anxiety disorder, generalized anxiety disorder, anxiety and depression in Hispanic Americans (Hispanic Treatment Program), anxiety and depression in primary care and other medical specialty patients, and pathological gambling. Studies include effectiveness trials in community settings, efficacy trials in tertiary care settings, biological studies (e.g., brain imaging studies, translational studies), and epidemiological and health services research.

Anxiety & Depression Society of American (ADAA)

ADAA is a national nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, depression, and related disorders and to improving the lives of all people who suffer from them.

Depression Evaluation Service

This website describes the research studies conducted at the Depression Evaluation Service, an outpatient research and treatment clinic at Columbia University Medical Center and the New York State Psychiatric Institute that offers eligible participants a no-cost psychiatric evaluation and treatment for depression. In addition, the website offers contact information for current research studies, information about depression in a question-answer format, and suggestions for further resources.

Youth Help

Youth Anxiety Center, New York Presbyterian Hospital

The Youth Anxiety Center is a clinical and research collaboration of NewYork-Presbyterian Hospital, Columbia College of Physicians and Surgeons and Weill Cornell Medical College with a common goal of understanding how anxiety affects youth and young adults as they transition out of the home into independent living, and when needed, to provide services to youth and their families to facilitate a successful transition to college or work and independent living.

Other Related Disorders

Social Anxiety Research Clinic

The website is devoted to education about Social Anxiety Disorder (SAD), and provides information on how to volunteer to participate in a Social Anxiety treatment study at the New York State Psychiatric Institute. Visitors can take an online Social Anxiety Self-Assessment that measures the severity of their social concerns.

Center for the Study of Trauma & Resilience

The website offers information on our research program that includes specialized treatment for 9/11-related PTSD at no cost, and an intensive resilience-building group program offered at September Space in Lower Manhattan. In addition, the website is dedicated to education about Posttraumatic Stress Disorder (PTSD) and grief-related problems, and describes other treatment and research efforts underway at the Center.

Columbia Gambling Disorders Clinic

The website is devoted to education about Problem Gambling, and provides information on how to get free treatment for problem gambling at the New York State Psychiatric Institute. Visitors can take an online Problem Gambling Self-Assessment that helps determine the severity of their gambling problem. The site also provides information for teens with problem gambling.

Research Centers

Center for the Treatment and Study of Anxiety at the University of Pennsylvania

An internationally renowned treatment research center dedicated to developing, refining, and testing state-of-the-art therapies for anxiety and traumatic stress disorders.
They provide evidence-based cognitive-behavioral therapy to children, adolescents, and adults with anxiety disorders.
A well-established resource for professionals, offering specialized training in the treatment of anxiety disorders to health professionals around the world.

Helpful Information

Finding a Therapist/Health Care Provider

Find a therapist from ABCT.