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Obsessive-compulsive disorder (OCD)
What OCD is, how obsessions and compulsions feed each other, how common it is, which treatments work best, and when to get help.
Obsessive-compulsive disorder (OCD) is a health condition, not a personality quirk. A person with OCD has upsetting thoughts that keep coming back. They then feel driven to do things, or think things, to make the fear go away.1 It can eat up hours of the day and wear down work, family life and sleep.
The good news is that OCD responds well to treatment. A special kind of talk therapy and certain medicines help many people feel much better.3,7 This page gives you the big picture and points you to every page in our OCD section.
Key points
- OCD has two parts: obsessions (unwanted thoughts, images or urges) and compulsions (actions or mental rituals done to ease the distress).3
- About 1 in 40 U.S. adults has OCD at some point in life. About 1 in 80 has it in a given year.2
- The first-choice therapy is exposure and response prevention (ERP), a type of cognitive behavioral therapy.3,7 Strong evidence
- SSRI medicines also help, and the two are often used together for more serious OCD.6,7 Strong evidence
- OCD usually starts before middle age. New OCD-like symptoms after about age 50 are rare and deserve a careful medical check.5,9
What are obsessions and compulsions?
Obsessions are thoughts, pictures or urges that pop into the mind again and again. The person does not want them. They bring strong fear, disgust or a feeling that something is "not right."3
Compulsions are things a person feels they must do to calm that feeling. Some are actions you can see, like washing or checking. Others happen silently in the mind, like counting, praying in a set way, or going over events again and again.3
The compulsion brings quick relief, but it does not last. The brain learns that the ritual "worked," so the next obsession feels even stronger. This loop is the heart of OCD.
Common obsessions
- Fear of germs, dirt or illness
- Fear of causing harm to others, by accident or on purpose
- Fear of being to blame if something bad happens
- Needing things exact, even or "just right"
- Unwanted sexual or violent thoughts
- Worry about sin or doing wrong (scrupulosity)
Common compulsions
- Washing or cleaning too much
- Checking locks, stoves or appliances
- Repeating actions until they feel right
- Arranging or lining things up
- Asking others for reassurance
- Counting, praying or reviewing in your head
- Avoiding places or things that set off fears
These examples come from the International OCD Foundation.3 Read more on Signs of OCD.
How is OCD different from everyday worry or neatness?
Almost everyone has odd or unwanted thoughts now and then. In one large U.S. survey, more than 1 in 4 adults said they had had obsessions or compulsions at some point. Only a small share had full OCD.4
What makes it OCD is how much it takes over. Doctors look for obsessions or compulsions that take more than about an hour a day, cause a lot of distress, or get in the way of daily life.3,5 Liking a tidy home is not OCD. Spending three hours a night checking the doors is.
Most people with OCD know their fears do not make sense. Their thoughts also go against what they value.3 Some people have less insight and feel sure their fears are true. Doctors no longer require insight for the diagnosis.10
OCD is also different from the everyday worry of generalized anxiety, which centers on real-life matters and lacks rituals. Fear of illness with lots of body checking may be health anxiety.
How common is OCD?
A national U.S. survey found:2,4
| Group | Had OCD in the past year |
|---|---|
| All adults | 1.2% (about 1 in 80) |
| Women | 1.8% |
| Men | 0.5% |
| Adults 60 and older | 0.5% (about 1 in 200) |
Over a whole lifetime, about 2.3% of adults have OCD. That is roughly 1 in 40 people.2 About half of adults with OCD in the past year had serious problems in daily life because of it.2
Depression and anxiety disorders often come along with OCD.1,4 Getting the right diagnosis takes more than seven years on average.3
What causes OCD?
No one knows the exact cause. It likely comes from a mix of genes, brain chemistry and life events.5 OCD runs in families. A parent, brother, sister or child of someone with OCD has a higher risk, though most never develop it.5
Researchers think OCD involves problems with how certain brain areas talk to each other. The brain messengers serotonin and dopamine may play a role. Scientists are also studying stressful life events and problems around birth, which may add to a person's genetic risk.5 Learn more, including about the debated idea that infections can set off sudden OCD in some children (called PANS or PANDAS), on What causes OCD.
What treatments work?
The main options are a specific therapy, medicine, or both.
Exposure and response prevention (ERP)
Strong evidenceERP is the first choice for adults and children.3 With a therapist, you face your fears in small steps and practice not doing the ritual. Over time, the anxiety fades and the fear loses its grip. In a large review of 54 trials, behavior therapy lowered scores on a standard 0 to 40 OCD scale by about 14 points more than placebo (a dummy treatment). Many people in those therapy trials were also taking medicine, so the exact size of the benefit is uncertain.7 See Exposure and response prevention.
SSRI medicines
Strong evidenceSSRIs (selective serotonin reuptake inhibitors) are antidepressants that also treat OCD. Examples are sertraline, fluoxetine, fluvoxamine and paroxetine.6 They help, but by a smaller average amount than ERP in research.7 If there is little change after several weeks, your doctor may slowly adjust the dose.6 See Medicines for OCD.
Clomipramine
Strong evidenceClomipramine is an older antidepressant that works for OCD about as well as SSRIs.7 Guidelines suggest it after at least one SSRI has not helped or caused problems. Your doctor may check your heart and blood pressure first if you have heart risks.6
Therapy and medicine together
Moderate evidenceFor moderate OCD, a U.K. guideline offers a choice of ERP-based therapy or an SSRI. For severe OCD, it advises both together.6 Combined treatment may work better than therapy alone in severe cases.7
Deep transcranial magnetic stimulation (deep TMS)
PromisingTMS sends magnetic pulses through the scalp to reach brain areas. It does not need surgery or anesthesia. In 2018, the FDA cleared a deep TMS device for adults whose OCD did not improve with standard treatment. In its main study of 100 people, 38% of those treated had a meaningful drop in symptoms, compared with 11% of those given a sham (fake) treatment. The most common side effect was headache.8
Guided self-help
Moderate evidenceFor milder OCD, short courses of CBT with ERP, using a workbook, phone sessions or a group, can be a good first step.6 See Self-help for OCD.
When treatment works, guidelines suggest staying on it for at least a year after you feel well, then reviewing with your doctor.6 Never stop or change a medicine on your own. Talk with your doctor or pharmacist first, because stopping suddenly can cause withdrawal symptoms.6
To find care, see How to find a therapist. The International OCD Foundation lists therapists who specialize in OCD.3
OCD in later life
OCD most often begins in late childhood, the teen years or early adulthood.1 Starting after age 40 is unusual.5 Many older adults have lived with OCD for decades without a name for it. It is never too late to get help.
New OCD-like symptoms after about age 50 are rare. Doctors who study these cases say late-starting symptoms, especially ones that do not respond to treatment, should lead to a check for brain conditions. These include some types of dementia, such as Lewy body or frontotemporal dementia.9 If an older parent suddenly starts checking, hoarding or repeating things, ask their doctor for a full exam. Learn more in our dementia section.
Heavy saving and clutter can be a separate condition called hoarding disorder, which raises the risk of falls and fires. See Hoarding disorder.
OCD and related conditions
Doctors group OCD with a few related conditions. These include hoarding disorder, hair pulling (trichotillomania) and skin picking (excoriation disorder).10 Body dysmorphic disorder, an intense worry about a flaw in your looks, is treated in similar ways.6 Read more on Conditions related to OCD.
Living with someone who has OCD
Families often get pulled into rituals, such as answering the same question again and again. This is called family accommodation. It brings short-term peace but can keep OCD going. Treatment plans can help families step back gently and with kindness.6 See Helping a family member with OCD.
All pages in this section
- Signs of OCD: common themes and insight
- What causes OCD: brain circuits, genes, PANS/PANDAS and stress
- Exposure and response prevention (ERP): how ERP works and how to find an ERP therapist
- Medicines for OCD: SSRIs, clomipramine, add-on medicines and deep TMS
- Self-help for OCD: resisting reassurance, books and support groups
- Hoarding disorder: signs, safety, treatment and when it may be dementia
- Conditions related to OCD: body dysmorphic disorder, hair pulling and skin picking
- Helping a family member with OCD: how to stop reassuring, kindly
In this section
Signs of OCD
Common signs of OCD, from germ fears and checking to religious worries, what insight means, and how OCD differs from everyday worry.
Read →Causes of OCD
What we know about why OCD happens: brain circuits, genes, stress, the PANS and PANDAS debate, and why new OCD later in life needs a checkup.
Read →ERP therapy
How ERP therapy for OCD works, a sample fear ladder, what sessions are like, how well it works, and how to find a trained ERP therapist.
Read →OCD medicines
How SSRIs and clomipramine treat OCD, why higher doses and patience matter, add-on medicines, deep TMS, side effects and safety in later life.
Read →OCD self-help
Practical self-help for OCD: cutting back on reassurance, delaying and shrinking rituals, self-guided ERP books and online programs, and support groups.
Read →Related conditions
Body dysmorphic disorder, hair pulling and skin picking: how they relate to OCD, signs to notice, which treatments work, and when to get help.
Read →Hoarding
Signs of hoarding disorder, fire and fall dangers, why big clean-outs backfire, therapy that helps, hoarding in later life, and when it may be dementia.
Read →Helping someone
How families get pulled into OCD, why constant reassurance backfires, and how to step back kindly with a plan, the right words and support.
Read →When to get help
Talk with a doctor or mental health professional if:
- Thoughts or rituals take up more than an hour a day.3
- You avoid people, places or tasks because of your fears.
- OCD is hurting your work, sleep, money or relationships.
- You feel hopeless or depressed along with OCD symptoms.
- An older family member shows new rituals, checking or hoarding.
If you or someone you care about has thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, any time. If someone is in immediate danger, call 911.1
A family doctor is a good place to start. See also our Get help page.
Sources
- National Institute of Mental Health. Obsessive-compulsive disorder. NIMH, 2024. NIMH
- National Institute of Mental Health. Obsessive-compulsive disorder (OCD) statistics. NIMH. NIMH
- International OCD Foundation. About OCD. IOCDF. iocdf.org
- Ruscio AM, et al. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry, 2010. DOI
- MedlinePlus Genetics. Obsessive-compulsive disorder. National Library of Medicine, 2018. MedlinePlus
- National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31), recommendations. NICE, 2005, reviewed 2024. NICE
- Skapinakis P, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry, 2016. UCL Discovery
- U.S. Food and Drug Administration. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. FDA, 2018. FDA
- Frileux S, Millet B, Fossati P. Late-onset OCD as a potential harbinger of dementia with Lewy bodies: a report of two cases. Front Psychiatry, 2020. DOI
- Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health, chapter 3: mental illness. SAMHSA, 2016. NCBI Bookshelf
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.