What Is OCD, Exactly? A Clinical Psychologist Weighs In

This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Despite popular belief, obsessive compulsive disorder (OCD) is more than just a burning desire to keep things neat and organized. It's a mental health condition characterized by unwanted, distressing, looping thoughts and a powerful urge to engage in repetitive behavior or mental acts to reduce the stress caused by those thoughts. But OCD manifests differently among people, both in symptoms and severity. "It could be a very mild experience," Christina Charlotin, PsyD, a licensed clinical psychologist in San Francisco who specializes in OCD, tells POPSUGAR. "For other people, it could be an extremely intrusive, painful, internal experience that can lead to a lot of challenges in life." And a person's experience of OCD can shift throughout their life, too, increasing and decreasing in severity based on their stress levels, life situations, and more. This guide will help you learn more about what OCD is, how it might present, and treatment options that can help people manage their symptoms.

OCD affects about two to three percent of people in the United States, according to the American Psychiatric Association. People with OCD typically experience repetitive, unwanted thoughts (obsessions) paired with a need (compulsion) to engage in behaviors to relieve the distress brought on by those thoughts. On average, symptoms tend to appear around age 19, but they can manifest (and grow more or less powerful) at any time in life, Dr. Charlotin says.

The obsessions and compulsions experienced by people with OCD tend to follow themes. Themes of obsession, for example, include fear of dirt or germs, difficulty with uncertainty, and need for orderliness and symmetry. Themes of compulsions — the behavioral aspect of OCD — include washing and cleaning, counting, checking on things, orderliness, adherence to a strict routine, and a need for reassurance.

The compulsion piece is a key component that sets OCD apart from generalized anxiety, Dr. Charlotin explains. It's essentially a "maladaptive coping mechanism," she says: a way to avoid your fear, discomfort, or anxiety by engaging in this behavior that your brain perceives as a form of control. It might ease your discomfort in the moment, Dr. Charlotin adds, but it doesn't address the root of the fear. "When you choose to engage in this action or this behavior, [your brain] will reward you by releasing feel-good chemicals," she says. "And that strengthens the association in our brain that this is threatening and this [behavior] is the thing that helps us feel better. The problem is that the [action that] helps us feel better only helps us in the moment. In the long term, it actually further reinforces the symptoms and makes OCD worse." In other words, the avoidant behavior further conditions your brain to view the thing you fear as a threat and thus deepens your reliance on that behavior in a kind of feedback loop.

The exact cause of OCD isn't fully known, and experts expect more than one factor contribute to the development of the condition. Some theories include:

OCD is typically treated with psychotherapy, medication, or a combination of both. One option is cognitive behavioral therapy, a type of therapy that focuses on changing thinking patterns through things like cognitive restructuring and reframing. A subcategory of CBT that's especially effective for OCD is exposure and response prevention therapy (ERP), in which a therapist will help the person expose themselves to whatever triggers the feelings of fear or discomfort. Instead of avoiding those feelings by engaging in compulsive behavior, ERP encourages the person to develop tolerance to the fear by gradually increasing exposure to the thing that causes it.

"With ERP treatment, we lean into the discomfort as much as possible, as much as the person is open to," Dr. Charlotin says. ERP is likely to be challenging, she adds, because the patient is being asked to confront their fear, bit by bit, without the coping mechanism of a compulsive behavior, but it's also recognized as the "first-line psychotherapeutic treatment" for OCD, according to a 2019 review. The review cited studies showing that about two-thirds of patients who tried ERP saw their symptoms improve, while about one-third "were considered to be recovered."

Other treatment options for OCD include medications like SSRIs (selective serotonin reuptake inhibitors), such as Prozac, Zoloft, or Lexapro. Medications can help "regulate the chemical activity in the brain that further fuels these types of thinking patterns," Dr. Charlotin says.

Alternative treatments are also emerging as possible options for people with OCD, including transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate brain cells and ease symptoms of OCD. There's also some evidence for ketamine therapy as an effective treatment for OCD, although a 2022 review notes that further research is needed.

Dr. Charlotin emphasizes the importance of self-compassion while undergoing treatment for OCD. Many people with OCD may feel shame, judgment, and frustration around their thoughts and behavior patterns, she notes. "It's important to always be our [own] biggest source of support," she says. She recommends seeking out a therapist specifically trained in treating OCD as well. "The experience of treatment can be tough," Dr. Charlotin notes, but "OCD is very, very treatable."