Obsessive-compulsive disorder

People with an obsessive-compulsive disorder may do things like wash their hands very frequently due to a fear of germs. This type of compulsion can become so intense that it controls every part of their daily lives. Obsessive-compulsive disorders can be treated effectively and managed with certain therapies. 

At a glance

  • The life of a person with an obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive behaviors.
  • If the disorder is very severe, it can be very difficult to deal with and make normal everyday life impossible.
  • In most cases, obsessive thoughts and compulsive behaviors cannot be intentionally suppressed and they often trigger anxiety.
  • Behavioral therapy helps people learn to live well with OCD.
  • Medication may also be used.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

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What is an obsessive-compulsive disorder?

You’ve barely left the house and are sitting in the car when you begin to wonder if you’ve turned off the stove top or locked the front door. Everyone knows this unpleasant feeling. But for some people, the fear of having forgotten something or made an easily avoidable mistake is so great that it develops into compulsive checking. This type of compulsion can intensify in such a way that it determines the entire daily routine over time.

Important: With appropriate treatment, the effects of an obsessive-compulsive disorder can be reduced to the extent that a largely normal life is possible again.

What are the signs of an obsessive-compulsive disorder?

An obsessive-compulsive disorder expresses itself in the form of obsessive thoughts and compulsive behaviors.

Obsessive thoughts are unwanted and constantly recurring, debilitating thoughts that push their way into the forefront of a person’s mind. Among the most common obsessive thoughts are agonizing worries about having forgotten something or becoming infected with germs. 

Compulsive behaviors or acts are described as rituals that people with an obsessive-compulsive disorder frequently repeat. The aim of these rituals is to make the debilitating obsessive thoughts go away and become calm again. 

For example, people who develop a washing or cleaning compulsion are afraid of dirt and the transmission of diseases. This leads them to constantly wash their hands or clean their home.

People with compulsive orderliness are convinced that objects on a desk, on shelves or in the home as a whole must be located in a certain place facing a certain way. Once this is not the case, they become uneasy. This nervousness grows into anxiety if the usual ritual – for instance, the supposedly correct arrangement of objects – is not performed.

Possible symptoms of an obsessive-compulsive disorder: compulsive washing, compulsive cleaning, compulsive ordering and arranging.

Many people who have obsessive thoughts and compulsive behaviors realize themselves that they are excessive or meaningless. However, they find that willing themselves to go against their compulsions doesn’t help eliminate these thoughts or behaviors. This often leads to feelings of powerlessness, which intensifies their anxiety. Some people even fear that they will “go mad”.

What are the causes of an obsessive-compulsive disorder?

It is likely that people develop an obsessive-compulsive disorder due to a combination of several factors, which presumably include a history of OCD in the family (i.e., genetic predisposition), physical factors and external circumstances.

For example, an obsessive-compulsive disorder may develop as a result of a trauma or severe life crisis. Some people with OCD have experienced severe childhood trauma, for example due to repeated abuse or the death of parents. 

Certain personality traits may also favor the development of an obsessive-compulsive disorder. Some people with obsessive-compulsive disorders have a strong sense of responsibility and are especially conscientious. They are sometimes very afraid of making mistakes.

How many people have an obsessive-compulsive disorder?

It is estimated that up to 3 percent of people in Germany will develop an obsessive-compulsive disorder at some point in their lives. Obsessive-compulsive disorders often develop in childhood or adolescence. However, they can, in principle, develop at any stage of life.

How does an obsessive-compulsive disorder develop?

An obsessive-compulsive disorder develops over time rather than suddenly. Many people with compulsions only gradually realize that their rituals are taking more and more time and energy. An advanced obsessive-compulsive disorder may lead to problems in a person’s job, private life or relationship. For many people with OCD, their entire lives eventually become controlled by compulsions and rituals.

Everyone who develops an obsessive-compulsive disorder does so in a distinctly different way. The symptoms can temporarily abate only to intensify again. Some people can also go weeks or months without symptoms. In addition, the type of compulsions they experience can change over time.

If left untreated, an obsessive-compulsive disorder often becomes chronic. Some people require professional help in order to deal effectively with their compulsions and to cope with everyday life. 

How is an obsessive-compulsive disorder diagnosed?

An obsessive-compulsive disorder is sometimes not so easy to distinguish from another disorder with similar symptoms. For example, a person who constantly worries about the future may also have a generalized anxiety disorder

An obsessive-compulsive disorder may also occur alongside other mental illnesses and problems. Many people with an obsessive-compulsive disorder have depression at the same time. Both illnesses can then make each other more intense.

The first step to getting a reliable diagnosis is to consult a family doctor. It is also possible to make an appointment to see a psychotherapist. The consultation will include, in particular, questions about what type of obsessive thoughts and compulsive behaviors are occurring – for example:

  • Do you repeatedly get certain thoughts or images in your mind that you try in vain to get rid of?
  • What do you do to make these thoughts and images go away?
  • Do you feel as though your actions are pointless or excessive?
  • Do you have the impression that you have to do certain things repeatedly against your will?

Important: OCD cannot be diagnosed unless the compulsions have been present for at least two weeks. The compulsions must also occur on most days or impact daily life. An obsessive-compulsive disorder can sometimes also have physical effects, such as cracked skin on the hands due to compulsive hand washing.

How is an obsessive-compulsive disorder treated?

Psychotherapy helps to alleviate obsessive thinking and compulsive behavior to the extent that people can begin to live a normal life again. However, obsessive-compulsive disorders cannot be cured.

Obsessive-compulsive disorders cannot be cured but can be managed effectively with professional help.

The most common type of psychotherapy used for OCD is cognitive behavioral therapy. As part of behavioral therapy or in addition to it, relaxation techniques like autogenous training or breathing exercises can help people to get their symptoms under control.

It is also possible to take medication for OCD alongside psychotherapy. Antidepressants are usually prescribed – these are drugs that are normally used to treat depression. Doctors may also prescribe these drugs to bridge a waiting period until the person can begin psychotherapy.

You will find more detailed information about treating an obsessive-compulsive disorder at gesundheitsinformation.de.

What is everyday life like for people with an obsessive-compulsive disorder?

An obsessive-compulsive disorder is often debilitating and can be very time-consuming. The compulsions can even become so intense that a normal life is no longer possible. Many people with an obsessive-compulsive disorder feel ashamed of their obsessive thoughts or compulsive acts. As a result, many try to hide their compulsions from others. This can be extremely draining for them.

People with an obsessive-compulsive disorder often wait for a long time before getting help and telling their partner or other loved ones. Some worry that people knowing about their illness could have a negative impact or their career or home life. Following successful treatment, many regret not seeking help sooner.

An obsessive-compulsive disorder also affects the behavior of loved ones. For example, they may feel compelled to follow certain patterns to avoid making the sufferer nervous about what they perceive as a lack of order.

Parents in particular often feel guilty for not noticing their children’s compulsions earlier. However, it is normal for OCD not to be detected by loved ones immediately. There are various reasons for this. For example, some people with an obsessive-compulsive disorder do their utmost to conceal it. Others fail to recognize their own compulsions themselves for a long time or don’t want to accept any help.

However, family and close friends can provide an important source of support, as close relatives, life partners or close friends usually tend to be more understanding than others. If loved ones are included in therapy, it can be easier to face up to fears and compulsions. In the long term, this can also be an important factor for maintaining the success that has been achieved by the end of therapy.

Where can I find more support for OCD?

Self-help groups offer people with obsessive-compulsive disorder and their relatives a way of obtaining information and advice, and of sharing personal experiences. This type of communication often helps people to cope better with their compulsive impulses. Some also find it helpful to consult books and websites that provide good, serious information on the topic of obsessive-compulsive disorders.

A database of self-help services can be found on the website of the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen – NAKOS).

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen – IQWiG).

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