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Nemours

Nemours
Providing pediatric care through
the Nemours/Alfred I. duPont Hospital for Children,
Nemours Children's Hospital, and
primary and specialty care practices
in Delaware, Pennsylvania, New Jersey, and Florida


Obsessive-Compulsive Disorder (OCD)

What Is OCD?

OCD is a mental health condition. It causes thoughts called obsessions, anxiety, and actions called compulsions (also called rituals). People with OCD feel stuck in a stressful cycle of these thoughts and actions.

Cognitive behavioral therapy helps people get past the cycle of OCD. They learn to deal with bothersome thoughts, calm anxiety, and face fears safely without doing rituals. Some people also take medicine for OCD.

If you think you have OCD, talk to a parent or adult in your life. Ask them to help you see a doctor or mental health provider to find out more. If you do have OCD, work with your doctor or therapist to learn and practice the skills that are proven to help OCD get better.

What Are Obsessions?

Obsessions are thoughts that cause anxiety. They can be fear thoughts about bad things that could happen. Or thoughts about how things have to be. They can be nagging doubts about whether things are OK. Or images or ideas about things that seem scary, bad, or wrong.

OCD causes these stressful thoughts to come to mind over and over. They can be about anything, but for many people with OCD, they are thoughts about:

  • germs, injury, harm, or illness
  • things that seem bad, rude, or wrong
  • whether things are even, straight, or placed just as they 'should' be
  • colors or numbers that seem bad, unlucky, or have special meaning
  • whether something might come true

What Are Compulsions?

Compulsions are behaviors people with OCD feel a strong urge to do. They are also called rituals. To someone with OCD, rituals seem like the way to stop the thoughts, fix things, be safe, or make sure bad things won't happen. Rituals can be actions, or they can be things people say in their head.

Here are some examples of rituals. Someone with OCD might feel like they have to:

  • wash and clean over and over
  • erase, rewrite, or start over a lot
  • repeat words, phrases, or questions
  • check and re-check if something is closed, locked, clean, right, or finished
  • touch, tap, or step in an unusual way or a set number of times
  • put things in just the right order, do things a set way
  • avoid things, such as numbers or colors that seem unlucky

What's It Like for Someone With OCD?

Most people with OCD can tell that the thoughts and rituals don't make sense. But OCD leads them to feel unsure. They feel a strong urge to do the ritual. They feel if they don't, something bad could happen. At first, rituals give some relief from the bad thoughts and feelings.

But rituals multiply. They take more time and energy. And the worry thoughts keep coming back. This is how OCD becomes a stressful cycle. Instead of stopping OCD, the rituals keep it going.

Someone with OCD will spend more than an hour a day bothered by worry thoughts and rituals. They may check, arrange, fix, erase, count, or start over many times, just to feel that things are OK. They don't want to think about these things. But OCD makes the thoughts hard to ignore. They don't want to do rituals. But OCD makes them feel they have to.

OCD can show up in many parts of their life. Things like getting dressed, having breakfast, or doing schoolwork seem full of stressful choices. OCD can make it seem like one choice might prevent a bad thing. Or that another choice might make a bad thing happen.

Someone with OCD may not know why they think, feel, and do these things. They may try to hide their fears and rituals. They may worry what others will think. They may even think they are going 'crazy' — but they're not. OCD can cause this to happen.

Why Do Some People Get OCD but Others Don't?

Like in many health conditions, a person's play a role in whether they get OCD. That's why OCD often runs in families. Genes can affect the chemistry, structure, and activity in different parts of the brain. With OCD, these differences lead unwanted thoughts to get 'stuck' instead of move on. OCD gets started because someone has genes that make it more likely.

But OCD keeps going because of rituals. The more people do rituals, the stronger OCD gets. This happens because our brains learn to do more of what we practice. Our brains also learn to do more of what gets rewarded. In OCD, rituals 'reward' the brain with a feeling of relief.

What Is the Treatment for OCD?

The treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, people meet with a therapist to talk, learn, and practice skills. Along with therapy, some people may take medicine for OCD.

In therapy, people might learn:

  • how thoughts, feelings, and behaviors affect each other
  • how OCD is like a brain 'trick' making it seem like bad things will happen unless people do rituals
  • that doing rituals keeps OCD going strong
  • that not doing rituals weakens OCD

But even when someone with OCD knows this, it's not easy to just stop doing rituals. That's why therapy teaches skills like:

  • coping and calming skills for anxiety
  • how to deal with worry thoughts
  • how to face fears safely
  • how to resist doing rituals

In therapy, people practice using these skills. One by one, they face fears without doing rituals. This can feel uncomfortable at first, but it quickly gets easier with practice. The more people with OCD resist rituals, the more worry thoughts can fade. As the person practices their skills, the brain's activity can change for the better.

Therapy takes time — how long depends on the person. Most people work with their therapist each week for a few months or more. Some people have therapy more often.

The therapist will teach, support, and encourage along the way. Often, the therapist will work with a parent, too. Parents want to know how to best help when OCD fears or rituals happen at home.

What Should I Do if I Think I Have OCD?

If you think you might have OCD:

  • Tell a parent or adult in your life what you're going through. They can take you to your doctor or mental health provider to find out if you have OCD. It can be a relief to know what's causing the symptoms. And to find out there's therapy that works for OCD.

If you find out you have OCD:

  • Go to therapy. Learn about OCD. The more you learn, the better you'll understand it.
  • Practice the skills you learn in therapy. The more you practice, the better and sooner you'll be able to overcome OCD.
  • Get support from people who care. Let a parent help you practice what you learn in therapy. Share your success and progress along the way.
  • Be patient with yourself. Dealing with OCD is tiring and stressful. And therapy takes time and practice. But many people like you have overcome OCD. You can, too.
  • Make time for good things. Find a little time to relax and do things you enjoy. Be with people who make you laugh and feel good. This helps you through the tough moments and gives you energy to overcome OCD.
Reviewed by: D'Arcy Lyness, PhD
Date reviewed: July 2021