The often off-hand or casual way in which OCD is sometimes referred to in the media or in everyday conversation may make it seem that the obsessions or compulsions are just something annoying or amusing that a person could “get over.” But for people with OCD, it’s not a simple annoyance. OCD obsessions are recurring, unwanted and unpleasant thoughts, ideas, urges, or images that are usually hard to control. The obsessions usually trigger time-consuming repetitive behaviors (also called compulsions, or rituals) that feel as though they have to be done.
Many people will at times have concerning thoughts or prefer a clear routine and structure. But for people with OCD, the thoughts usually create a great deal of anxiety, and OCD compulsions often disrupt normal daily activities. A diagnosis of OCD requires that the obsession or compulsions are time consuming (for example, take more than one hour a day in total) or cause significant distress or significant interference in functioning (for example, cause problems at home or work or in other important areas of life).
Talking about your OCD and deciding who to tell are personal decisions. Family and friends can be an important source of support and understanding. They may have noticed your OCD symptoms or changes in your behavior, and talking about it could provide them with a better understanding and the ability to be more supportive and helpful.
In addition to the basic information on this help page, suggestions for other sources of information include the National Institute on Mental Health – NIMH-OCD page, the International OCD Foundation and NAMI OCD page.
Personal stories of people living with OCD can also be very useful in helping someone understand what it is like. Some examples include:
Some people with mild OCD improve without treatment. More moderate or severe OCD usually requires treatment. There may be periods of time when the symptoms get better and also times when symptoms get worse, such as when a person is stressed or depressed. But without the right treatment, OCD is often chronic.
Try to learn as much as you can about OCD, what it’s like, and what options are available to treat and manage the disorder. Remember to view obsessive thoughts and compulsive behaviors as part of a medical condition and not as personality traits or a matter of simple choice. Recognize small accomplishments – what may seem like a small change may actually take significant effort. Be patient – remember progress may be slow, and symptoms may increase or decrease at times. Be mindful of life changes and stressors — any change, including positive change, can be stressful and increase OCD symptoms. Work together with your family member to develop a family plan with agreed upon actions for managing symptoms. For example, set limits on discussions relating to obsessions/compulsions.
Support effective treatment, which are medications called serotonin-reuptake inhibitors (SSRIs/SRIs) and cognitive-behavioral therapy that includes exposure and response (ritual) prevention. It may also be helpful to participate in your family member’s exposure and ritual prevention practice at home, with the guidance of a therapist. It is important that family members not accommodate the patient’s OCD (for example, it is best to not help the patient do rituals or avoid healthy activities). A therapist can help family members to support their loved one without accommodating their OCD symptoms.
Yes, OCD is more common among people who have a family member who has the disorder. People with a first-degree relative (parent, sibling, or child) with OCD are two times more likely to experience OCD than someone without a first-degree relative with OCD. Among first-degree relatives of people with onset of OCD in childhood or adolescence, the rate is increased 10-fold. But most family members of a person with OCD do not get OCD themselves.
A good trial of a serotonin-reuptake inhibitor (SSRI/SRI) usually improves OCD and body dysmorphic disorder (BDD) symptoms. But the medication may not help if you didn’t take a high enough dose, try it for long enough, or take it every day. Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication treatment for both OCD and BDD. SSRIs available in the U.S. are fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), fluvoxamine (Luvox), and paroxetine (Paxil). Citalopram (Celexa), another SSRI, is not recommended because OCD and BDD often require relatively high SSRI doses, and the maximum dose of citalopram that can be used (the dosing limit is firmer than for other SSRIs) is often too low to effectively treat these disorders. Clomipramine (Anafranil) is an SRI (not an SSRI) that is also effective for OCD and BDD.
Effective SSRI doses for OCD and BDD are often higher than those used to treat depression and certain other mental health disorders. An SSRI/SRI should be tried for at least 12 weeks, reaching a high enough dose during that time and being sure to take the medication every day. If OCD and BDD don’t improve enough, it may help to take a dose that is higher than the manufacturer’s maximum dose (but this should not be done with clomipramine or citalopram).
If a good trial of an SSRI/SRI isn’t adequately helpful, OCD and BDD symptoms may improve by adding certain other medications to the SSRI/SRI. Alternatively, patients who do not improve sufficiently with one SSRI/SRI medication may improve with another one.
Patients with mild to moderate OCD or BDD should be treated with either medication (an SSRI/SRI) or therapy (CBT), or both medication and CBT, depending on patient preference, the presence or absence of associated psychiatric conditions, treatment availability, and other considerations. Severe OCD and severe BDD should be treated with both CBT and an SSRI/SRI concurrently.
Medication treatment is very similar for BDD and OCD. But CBT for these disorders has some important differences, so CBT needs to be tailored to each disorder.