Family Member Showers for Long Periods, Fears Germs, Has Obsessions with Cleanliness, Repeatedly Checks Things? Understanding OCD (Obsessive-Compulsive Disorder): Symptoms, Causes, Treatment Methods, Self-Assessment
What Is OCD?
Obsessive-Compulsive Disorder (abbreviated as OCD) primarily manifests as obsessive thoughts, strong anxiety feelings induced by them, and compulsive behaviors that appear to relieve anxiety—such as repeated checking, silently reciting certain words, or arranging things in fixed order. These compulsive behaviors, while temporarily alleviating anxiety, often recur, bringing physical, mental, and interpersonal exhaustion.
OCD is not a rare diagnosis, with a lifetime prevalence of about 2-3%. This means each of us may know one or more people with OCD.
Common Symptoms of OCD
Obsessive Thoughts
Obsessive thoughts refer to a series of intrusive, recurring thoughts, impulses, or images that trigger strong anxiety. Most of these intrusions are involuntary. The intense anxiety, fear, and unease they trigger sometimes exceed normal emotional responses and may involve illogical connections.
Common obsessive thoughts include: Some OCD patients constantly worry they or their family will be harmed, fear contact with dirt or bacterial infection, or continuously doubt whether the door is locked or the stove turned off.
Compulsive Behaviors
Compulsive behaviors are repetitive actions or mental activities developed to reduce the unease brought by the above obsessive thoughts. These repetitions are supported by a strong feeling of “must do.” Patients feel a strong drive to execute these behaviors according to strict rules because they feel unable to withstand the anxiety brought by obsessive thoughts.
Common compulsive behaviors include: constantly washing hands or cleaning the environment, repeatedly checking doors and windows, organizing items in fixed order, or counting over and over, silently reciting specific words, etc. If these symptoms occupy significant time, they can severely affect the patient’s or cohabitants’ daily routines and quality of life.
Does Having a Cleanliness Obsession Count as OCD?
If someone simply likes cleanliness or is particular about hygiene, it doesn’t mean they have OCD. If cleaning or organizing behavior comes from their own heart and doesn’t cause excessive anxiety, doesn’t occupy several hours of their day, and doesn’t severely affect their daily routines, work, study, or interpersonal relationships, it’s usually just a personal lifestyle habit and doesn’t need special concern.
Conversely, if demands and persistence about cleanliness or hygiene are involuntary, bring excessive anxiety, occupy excessive time, and severely affect daily routines, work, study, or interpersonal relationships, it may be a manifestation of OCD. For example, washing hands dozens of times a day, unable to stop doubting whether things touched are clean, not daring to touch anything for fear of dirt, etc.—even when feeling distressed, unable to stop these behaviors.
People with cleanliness obsessions can also have OCD—they’re not mutually exclusive. If severe interfering behaviors matching the above OCD description appear, seeking professional mental health assistance is recommended, using appropriate treatment to help escape these troubles.
Causes of OCD
OCD’s occurrence results from multiple factors. It’s not like a cold caused only by viral invasion; rather, it’s more like a complex network—the result of many different factors intertwining. Its causes can mainly be divided into three categories:
Physiological Brain Factors
OCD’s core lies in patients’ “Cortico-Striato-Thalamo-Cortical (CSTC) circuit” dysfunction. This neural circuit involves the brain’s “information filtering and behavioral decision-making.” When the filtering system is abnormal, excessive obsessive thoughts cannot be intercepted.
In neurotransmitter research, serotonin is the most thoroughly researched neurotransmitter. OCD isn’t simply “serotonin deficiency” but rather a serotonin system “dysfunction or regulatory imbalance.”
Evidence-based medicine and clinical evidence also show that using selective serotonin reuptake inhibitors (SSRIs) is the most effective first-line medication for treating OCD.
Genetic Factors
If someone in a family has OCD, other family members’ OCD onset risk also relatively increases, showing genetics plays a certain role in OCD disease development.
Psychological and Environmental Factors
Early childhood growth experiences, perfectionism, and excessive sense of responsibility are risk factors for OCD formation. Additionally, long-term high-pressure or anxious living environments also make OCD symptoms easier to appear and persist.
These physiological, genetic, and psychological-environmental factors intertwine, jointly affecting brain operation, causing obsessive thoughts and compulsive behaviors.
OCD Treatment Methods
OCD treatment typically adopts comprehensive approaches, combining medication and non-medication therapies:
1. Medication Treatment
Clinically commonly uses selective serotonin reuptake inhibitors (SSRIs) to help regulate serotonin concentration in the brain, reducing anxiety and OCD symptoms. For some patients, antipsychotic medications are also considered for assistance.
Regarding medication treatment, we need to note that medication must be prescribed by a psychiatrist; during treatment, regular follow-ups are needed to track efficacy and side effects; and never stop medication or adjust dosage on your own.
2. Mindfulness-Based Cognitive Therapy (MBCT)
Mindfulness-Based Cognitive Therapy is the most effective psychotherapy for treating OCD, combining mindfulness practice with cognitive behavioral therapy, particularly the former’s presence and the latter’s Exposure and Response Prevention (ERP). Treatment helps patients gradually face anxiety-triggering situations while practicing not executing compulsive behaviors, thereby reducing sensitivity to obsessive thoughts.
Research shows that for mild to moderate OCD patients, MBCT can provide stable treatment effects comparable to medication, not only sustaining therapeutic effects but also being safe and easily accepted by patients during treatment [1].
3. rTMS (Repetitive Transcranial Magnetic Stimulation)
For patients who respond poorly to medication and psychotherapy, TMS (Transcranial Magnetic Stimulation) treatment can be considered. This is a non-invasive method that stimulates brain regions related to OCD through magnetic fields, potentially regulating brain activity and reducing symptoms.
Compared to invasive deep brain stimulation (DBS), rTMS as a non-invasive brain stimulation therapy has higher safety, helping improve patient acceptance.
Quick reminder: Different treatment methods can be used alone or in combination, requiring professional physician evaluation of the most appropriate treatment plan based on individual circumstances.
How to Know If You Have OCD? Simple Self-Assessment Method
Below is a clinically common OCD assessment tool: Y-BOCS Self-Assessment Scale (Yale-Brown Obsessive Compulsive Scale). This scale can help you preliminarily understand symptom severity. While it cannot replace professional diagnosis, it can provide a clear starting point:
Y-BOCS Self-Assessment Scale (Simplified Version)
Please assess the following questions, ranging from 0 (not at all) to 4 (very severe):
- How much time do obsessive thoughts occupy daily?
- How much distress do obsessive thoughts cause you?
- Your ability to control these thoughts?
- The degree these obsessive thoughts affect life?
- Ability to resist these thoughts?
- How long do you spend on compulsive behaviors daily?
- How much do these behaviors distress you?
- How difficult is controlling these behaviors?
- The degree these behaviors interfere with life?
- Ability to resist these behaviors?
Total Score:
0–7: Minimal / 8–15: Mild / 16–23: Moderate / 24–31: Severe / 32–40: Extreme
Quick reminder: If you experience obsessive thoughts or behaviors for over two weeks and they’ve caused life difficulties, seeking professional help is recommended for early diagnosis and treatment.
Conclusion
OCD is a mental illness requiring understanding and treatment.
When obsessive thoughts and behaviors gradually affect your daily life, interpersonal relationships, or psychological state, please don’t ignore its existence.
Through correct knowledge, appropriate treatment and professional support, plus continuous self-treatment practice in daily life, most people can effectively manage symptoms.
If you or someone around you has related troubles, we encourage you to proactively seek professional help.
Extended reading: When Family Members Have Mental Illness, What Should You Do? When to Take Them to Mental Health Services? | Family Self-Help Guide + Mental Health Resource Map
Author: Dr. Wan-Hsi Chien
Treatment Areas:
Sleep disorders, anxiety disorders, depression, addiction disorders, LGBTQ+ populations
👉 I want to learn about online mental health consultation with Dr. Wan-Hsi Chien
References
Zhang, T., Lu, L., Didonna, F., Wang, Z., Zhang, H., & Fan, Q. (2021). Mindfulness-based cognitive therapy for unmedicated obsessive-compulsive disorder: A randomized controlled trial with 6-month follow-up. Frontiers in Psychiatry, 12, 661807. https://doi.org/10.3389/fpsyt.2021.661807
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