Understanding OCD: Beyond Worries and Habits

Obsessive-Compulsive Disorder (OCD) is more than worries or habits; it’s a brain-based condition where the brain gets “stuck” on certain thoughts or urges. These are called obsessions. In response, many people perform repetitive behaviors or rituals, known as compulsions, in an attempt to relieve the anxiety. While OCD is often associated with handwashing or checking locks, it doesn’t always involve visible rituals. Some people experience only obsessions (“Pure-O”), such as repeated intrusive thoughts about harming others, inappropriate sexual images, or fears of losing control without any outward behaviors. These thoughts are deeply distressing, even when the person recognizes they aren’t logical.

OCD in the DSM-5

The DSM-5 no longer places OCD under “Anxiety Disorders.” Instead, it has its own category: Obsessive-Compulsive and Related Disorders. This distinction is important. While anxiety plays a role, OCD is defined by the cycle of obsessions and compulsions (or obsessions alone).

This means OCD is not just “being anxious” or “liking things clean.” It is a recognized, brain-based condition with specific symptoms and treatments.

Common Misunderstandings

• “I’m so OCD” is not the same as being neat or detail-oriented. OCD is not a personality quirk; it’s a clinical disorder that can be severely impairing.

• Rituals like bedtime routines or religious practices are normal unless they are excessive, unwanted, and interfere with functioning.

• People with OCD do not enjoy compulsions; behaviors or mental acts are done to escape overwhelming distress.

How OCD is Screened and Diagnosed

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold-standard tool for measuring severity and treatment response. Diagnosis follows DSM-5 criteria, structured interviews, and a careful assessment of comorbidities.

Treatment Options

Therapy The most effective therapy for OCD is Cognitive Behavioral Therapy (CBT) with a technique called Exposure and Response Prevention (ERP).

• ERP helps people face their fears gradually while resisting the urge to perform compulsions.

• Over time, this breaks the obsession-compulsion cycle.

Medication

Medications called SSRIs (such as fluoxetine, sertraline, and fluvoxamine) are often prescribed at higher doses than for depression. They can take up to 12 weeks to show full benefit.

Clomipramine, an older antidepressant, can also be very effective but may cause more side effects.

Supplements and Integrative Approaches

Research suggests certain supplements may support treatment:

• N-Acetylcysteine (NAC): has shown promise in reducing compulsive urges.

• Omega-3 fatty acids and inositol are being studied as well.

  While supplements aren’t replacements for therapy or medication, they may offer extra support when guided by a clinician.

Advanced Options

For people with severe, treatment-resistant OCD, options may include:

• Medication augmentation (adding a second medication under specialist care).

• Transcranial Magnetic Stimulation (TMS), now FDA-approved for OCD.

The Bottom Line

OCD is not “just anxiety” and not a personality quirk. It is a medical condition that can cause significant distress, but effective treatments exist. Whether through ERP, medication, or integrative approaches, many people see meaningful improvement and regain control of their lives.

If you’re a therapist, early recognition and referral are key. If you’re someone experiencing these symptoms, know that OCD is treatable, and support is available.