Do I Have OCD?

OCD stands for obsessive-compulsive disorder, a mental illness characterized by disturbing, unwanted, and persistent obsessive thoughts and compulsive, repetitive, and ritualized behaviors used to stop the thoughts or relieve the anxiety they cause. If you have OCD, these thoughts and behaviors will be extreme, excessive, and time-consuming. They interfere with your life in significant ways.

Many people experience some of the signs of OCD without meeting the criteria to be diagnosed. It is not uncommon to sometimes obsess over disturbing things or to engage in ritualized actions as a way to cope. Doing this occasionally is not OCD. To know if you do have this serious mental illness, you need to be evaluated by a mental health professional. Only with this evaluation will you get an accurate diagnosis and access to effective treatment.

OCD is a mental illness that causes obsessive thoughts and compulsive behaviors. The obsessive thoughts cause anxiety and distress; they are unwanted; and they are persistent and difficult if not impossible to stop. The compulsions are repetitive OCD behaviors that the person uses to reduce anxiety, to stop the obsessive thoughts, or to prevent something bad from happening. These compulsions could involve any type of behavior, such as hand washing, ordering items, or switching lights on or off.

While OCD was once categorized as a type of anxiety disorder, it is now part of a group of mental illnesses called obsessive-compulsive and related disorders that also includes body dysmorphic disorder, hoarding disorder, and hair-pulling and skin-picking disorders. Data from surveys indicate that about one percent of U.S. adults have been diagnosed with OCD in the last year, while more than two percent struggled with OCD at any point in their lives. More than one quarter of all adults have experienced obsessions and compulsions but did not meet all the criteria for an OCD diagnosis.

Some studies have found that up to 80 percent of people have experienced intrusive and unwanted disturbing thoughts and that nearly 50 percent have engaged in ritualized, repetitive behaviors. So, if you do have some elements of OCD, you are not out of the ordinary. To truly have OCD you must spend a lot of time and energy on these thoughts and behaviors and experience difficulties in your life because of them. Here are some signs you may be struggling with OCD:

• You have disturbing thoughts, usually that follow a common theme, which you cannot stop, no matter what you do.
• The troubling thoughts tend to intrude when you are trying to do something or think about something else.
• You try to rid yourself of the troubling thoughts by engaging in some kind of ritual, like turning the lights on and off a certain number of times, not stepping on cracks in the sidewalk, or re-checking locked doors multiple times when you leave the house.
• You feel compelled to do these rituals, and they tend to be excessive, taking up a lot of time.
• You do the behaviors to manage your anxiety or to rid yourself of the disturbing thoughts, but they aren’t really connected. For instance, counting words you see helps ease the anxiety of thoughts that your loved ones will get hurt.

These OCD behaviors and symptoms typically begin in the teenage years or in the early 20s, and for most people they vary in intensity and severity. You may have periods of time when you don’t have the signs, or they are mild, and other times when they become severe and all-consuming. For many people with OCD the symptoms intensify during periods of increased stress.

There is no OCD test, and only a mental health professional can tell you if you really have OCD after conducting a thorough psychiatric evaluation. Psychiatrists and other mental health professionals use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine if a patient can be diagnosed with a condition like OCD.

The first criterion is that you have obsessions, compulsions, or both. The obsessions are persistent and unwanted thoughts that cause you a significant amount of distress or anxiety. You try to stop the thoughts or neutralize them. The compulsions are repetitive behaviors that are used to relieve the anxiety or to stop something bad from happening. They are excessive and usually unrelated to whatever negative thoughts you are trying to stop.

The obsessions and compulsions are the characteristic signs of OCD, but there are additional criteria that have to be met to make a diagnosis:

• The obsessions and compulsions must cause significant impairment in a person’s life, take up an excessive amount of time, or cause significant distress.
• The thoughts and behaviors cannot be caused by substance abuse or a medical condition.
• They also cannot be better explained by another mental illness, like anxiety disorder, depression, hoarding disorder, or any others.

Strictly speaking, there is only one type of OCD. However, there are some common types of compulsions that can be used to classify people with this condition. It is important to remember that the obsessions and compulsions may be anything, but there are some general topics and types that are seen more often than others:

• Contamination. Many people with OCD have obsessive thoughts about germs and being contaminated. Their compulsions are usually related to this and may include excessive hand washing or cleaning.
• Harm. Obsessive thoughts may be related to a fear that harm will come to oneself or loved ones. These are kept at bay and the harm is prevented by checking compulsions, like repeatedly checking that the space heater is turned off before leaving the house because of fears about fire.
• Sin and doubt. When the obsessive thoughts are shameful and related to moral issues, religion, or sexual compulsions, the person with these thoughts may engage in non-visible compulsions, like counting words or silently reciting repetitive phrases or prayers.
• Order. Some people are obsessed with order and symmetry and having everything arranged just so. They obsessively rearrange and line objects up in the “correct” way. Or, they may count things or have superstitions about patterns or numbers.

Other patterns that may be seen with OCD include magical thinking and superstitions, obsessive thoughts about specific relationships, obsessions and compulsions related to the body, such as repetitive blinking, and thoughts of harming other people. Hoarding was once considered a type of OCD, but it is now considered a separate, but similar, disorder, characterized by obsessions over things and a fear of throwing anything away.

There are several mental and behavioral health conditions that are similar to OCD and cause symptoms that may be confused for those of OCD. This is why it is so important to have a mental health professional evaluate you to make an accurate diagnosis. Anxiety disorder is more common than OCD but can mimic the obsessive symptoms. Depression can also cause a person to obsess over things, which may seem like OCD. Tourette syndrome causes tics, which may look like the repetitive behaviors caused by OCD. Certain conditions that cause psychotic symptoms, including delusions, may also seem like OCD. The obsessive thoughts caused by OCD may seem irrational, but they are not typically delusional or psychotic.

If you do have OCD, there is a good chance you may have other co-occurring disorders or mental health issues. Several mental illnesses and behavioral conditions commonly co-occur with OCD, although why this is the case is not fully understood. It may be due to the fact that they have common risk factors and similar symptoms and personality traits. Some common co-occurring issues with OCD include:

• Anxiety disorders
• Eating disorders
• Body dysmorphic disorder
• Attention-deficit hyperactivity disorder (ADHD)
• Tic disorder
• Hair-pulling or skin-picking disorder
• Obsessive-compulsive personality disorder, which is not the same as OCD
• Poor impulse control
• Suicidal thoughts and behaviors

OCD is a serious mental illness because it can interfere with your life in significant ways. It may cause you to withdraw from friends or family or to stop engaging in other activities you enjoy because you spend so much time on your obsessions and compulsions. It can cause problems in relationships, in school, and at work. To find out if you have OCD, and to get the OCD treatment you need, be sure to get an evaluation by a mental health professional. If you aren’t sure where to turn, see your regular doctor for a recommendation of someone who can help.