Obsessive-Compulsive Disorder

Obsessive Compulsive Disorder, usually just called OCD, is a mental health disorder that involves intrusive thoughts paired with ritualistic behavior to keep those thoughts at bay.  

While everyone has intrusive thoughts, preferences, and fears, the connection and severity of these things is what sets OCD apart. It’s usually diagnosed when these obsessions and compulsions interfere with your life and relationships.

OCD falls in the category of anxiety disorders, as the intrusive thoughts that are a staple of the disorder are very distressing and anxiety inducing. 

Just over 2% of US adults are diagnosed with OCD, but half of those report serious impairment in their day to day lives. 

Obsessions vs Compulsions

As the name may suggest, OCD is identified through obsessions and compulsions. Simply put, the obsessions are the driving thoughts, and the compulsions are the actions. For someone with OCD, the thought process is, “If I do X, that will keep Y from happening.


These thoughts are uninvited and they are invasive. Usually, they are illogical, or beyond what a neurotypical person would think. A person with OCD will usually have a specific type of intrusive thought that they obsess over. 

Intrusive Thoughts

For the average person, intrusive thoughts can happen every single day. These are the thoughts that are wildly out of character. They can be shameful or frightening, or even just confusing. 

Suddenly driving into oncoming traffic, inappropriate sexual acts, harming yourself or others, or even germs on the straw in your water bottle are all examples of intrusive thoughts. They come from nowhere and are not a reflection of a person’s character. Most of the time, they might make us pause for a second, then we forget about them moments later.

A person with OCD will usually have a specific type of intrusive thought that they obsess over.

What sets those with OCD apart, is that they cannot let these thoughts pass through. They dwell on them and take them as fact. They will drive into traffic, their water bottle straw is contaminated and unusable.


This is where compulsions come in. These ritualistic behaviors are done to keep those intrusive thoughts at bay. They might seem unrelated to the obsession in some cases, but it really does curb anxiety for that person. 

The urge to do these things is really uncontrollable. If this ritualistic behavior is inhibited in any way, the resulting anxiety can send that person into a panic attack.

Types of OCD

While OCD can vary significantly from one person to the next, all forms of it include obsessions and compulsions. These different types of OCD aren’t mutually exclusive, nor does someone have to have symptoms that perfectly fit into one category. These are just some of the most common types.

The common thread among them is that each obsession revolves around possible harm that will come if the compulsions aren’t completed.

Harm OCD

Harm OCD, as the name may suggest, revolves around fear of a disaster happening to themselves or others. The obsession is the fear of danger, and the compulsion is repeated checking of door locks, oven knobs, or anything that may cause the injury that they are anxious about.

Checking compulsions can either be a specific number of checks, or until that person feels things are ‘right’ or safe. This ritualistic behavior can be time consuming, since often the person needs to make those checks dozens of times. It might make them late to work or other important functions, but the harm obsessions are even more distressing for them. 


Most people have certain standards for cleanliness, but those with contamination OCD fear that germs are truly dangerous. The obsessive thoughts of deadly diseases on surfaces and other people can cause someone to resist participating in everyday activities where they might be exposed to them. This might mean avoiding shaking hands or eating in public places.

The other compulsive counterpart to these obsessions involve cleaning. They might bring supplies in public to wipe down surfaces, or they wash their hands far more than is necessary. 

However, this cleaning and avoidance can take a toll on a person. They often aren’t able to relax when in environments that they deem ‘dirty,’ or they wash their hands until they bleed or with cleaning products not meant for human skin. 

Symmetry and Ordering

You’ve probably heard a friend say that they’re ‘so OCD’ when they keep their space tidy and organized. This thought really minimizes those with symmetry OCD. A person with this type of OCD has a need to rearrange and reorder their space until it feels right. 

Symmetry isn’t just material objects arranged in a mirror pattern. They might need to do something with their right hand and left hand to the same degree. Another example is put on chapstick the same way and number of passes on their bottom lip and top lip.

Counting usually also falls into this category. Like creating symmetry, the precision of counting items or saying a phrase a specific amount of times ease the anxiety. Like harm OCD, symmetry and ordering is often done to ward off perceived threats and dangers, though they might seem unrelated. 


While similar to Hoarding Disorder, hoarding OCD is its own, unique, subtype of OCD. A person with Hoarding Disorder will usually hold on to objects because of their perceived value, whereas someone with hoarding OCD will hold on to objects because they believe getting rid of them will cause harm to them or a loved one.

The things they are compelled to keep can be related to the person they are worried about. For example, they might keep their mother’s wedding dress because they believe getting rid of it will cause their mother to die.

Pure O OCD

A fairly rare subtype, Pure O OCD involves obsessions with no obvious compulsions. There is some debate about the legitimacy of the term ‘pure o.’ OCD UK states that though the compulsions aren’t always immediate or outward like repeatedly checking that the oven is turned off, they do exist.

For example, the compulsions may manifest as assurance from others about their obsessions. They might Google the phrase ‘how often do ovens cause house fires.’ Usually, people can let intrusive thoughts lie, but those with OCD cannot.

Tic-Related OCD

Particularly in children and young people, compulsions can sometimes manifest as a tic. Tics are physical movements or vocals that satisfy an urge. They aren’t unique to OCD and are usually associated with Autism and Tourette Syndrome.

While studies are still being done to find the prevalence in tics, tic disorders and OCD, one study found that over 70% of those with Tourette Syndrome had comorbid ADHD or OCD.

The common thread among [each type of OCD] is that each obsession revolves around possible harm that will come if the compulsions aren’t completed.

Is Trichotillomania OCD?

Trichotillomania is the diagnosis of compulsive hair-pulling. Those with it usually feel anxious and tense, then feel a sense of relief or even pleasure once they pull their hair out. It’s usually hair on your scalp, but some pull eyebrows, eyelashes, or facial hair. It’s usually most common in children and adolescents.

The anxiety followed by a release sounds like OCD, but experts don’t consider trichotillomania as a type of OCD. The act might be compulsive and automatic, but it doesn’t “solve” an obsession. Pulling hair doesn’t prevent anything from happening. Instead, pulling hair is a way to find relief from negative emotions.

However, trichotillomania is on the obsession-compulsion spectrum and is often comorbid with OCD. Many with trichotillomania will also be diagnosed with anxiety and depression. 

Trichotillomania and Skin Picking

Trichotillomania is just one behavior that falls under the body-focused repetitive behaviors category of the obsession compulsion spectrum. Skin picking, or excoriation, is another similar behavior.

Excoriation can either happen on its own or alongside hair-pulling, but it accomplishes the same goal—relief from negative emotions. Excoriation can look like picking, rubbing, itching, or biting at the skin of specific body parts like fingers.

Both trichotillomania and excoriation can cause bald, irritated skin. In some cases, medical and dermatological intervention may be necessary. However, intervention isn’t required to receive a diagnosis.


Closely related to OCD is Obsessive Compulsive Personality Disorder, or OCPD. This disorder is often comorbid OCD, or OCD can be a precursor for an OCPD diagnosis. 

OCPD shares some of the common compulsions of most types of OCD such as contamination and symmetry. However, they start to differ with the motives behind the actions. 

Instead of fearing some kind of doom, those with OCPD feel anxious or distressed when they aren’t perfect. The International OCD Foundation Outlines OCPD as an obsession with work, punctuality, order, and neatness.

Those with OCD are often very aware that their thoughts and actions aren’t normal. But those with OCPD don’t. One marker of OCPD is that they believe that their way of doing things is correct, and it’s just how everyone should function. It can cause someone to come off as frequently annoyed and righteous.

The OCDF believes that OCPD is caused by some combination of personality and childhood trauma. A child that had a very authoritarian upbringing is more prone to the pursuit of being immaculate.  

Symptoms of OCPD

Just because someone demonstrates some traits of OCPD, doesn’t necessarily mean that they have it. However, here are some symptoms to talk to a doctor about:

  • Extreme attention to detail
  • Obsessiveness about punctuality
  • Extreme devotion to work
  • Fixation with rules and lists
  • Inability to allow others to perform a task, instead doing everything themselves

Essentially, perfectionism is at the core of OCPD. It can interfere with daily life just as much as OCD. 

What Causes OCD?

OCPD can often be traced to childhood trauma, but unfortunately the cause of OCD remains uncertain. However, risk factors are becoming more obvious that may answer some questions.

Is OCD Genetic?

For OCD and most mental health disorders, genetics play a huge part. While researchers are still trying to figure out exactly how genetics ties in with OCD, it’s crystal clear that there is a very strong link. Someone with OCD is four times more likely to have a relative with OCD than someone who isn’t diagnosed.

It is possible that even with these close genetic connections, a person who is at risk of developing OCD never will. However, certain environmental factors or trauma may trigger it. 

Is Brain Biology a Factor?

Because OCD falls under the Anxiety Disorders category, brain biology and chemistry come into play. Studies have shown that serotonin, a neurotransmitter that stabilizes mood may play a part in brain functions that inhibit thoughts and reactions. 

For some, anxiety and depression medications like SSRIs and SNRIs can alleviate some symptoms of OCD, especially when diagnosed with other mental health disorders. 


Researchers have found a link between strep throat and OCD in children. The strep bacteria hide themselves through molecular mimicry to blend in with the surrounding tissue cells. Some of these tissues lie in the brain. When the immune system starts to identify the strep bacteria, they also attack the now similar looking brain cells. 

This sets off  Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS. This autoimmune response is closely linked to OCD and tic related disorders.

How to Treat OCD

Luckily, OCD can be managed and treated. Medications like SSRIs and SSNRIs keep serotonin cycling in your brain to keep anxiety down and mood elevated. 

Talk-therapy-based treatment, such as Cognitive Behavioral Therapy (CBT), can also be an effective treatment for OCD. CBT, in a sense, rewires the brain to understand that its fears and obsessions are unfounded. 

According to the American Psychiatry Association, therapists will encourage their clients to refrain from indulging their compulsions, so the person can see that nothing bad happens without it. Eventually, the anxiety surrounding the obsessions will disappear.

Discover Freedom from Ritualistic Behavior Today

Severe OCD can be debilitating. We want you to live a fulfilling life without fear. Together, we can get to the bottom of these compulsions so that you can live the life you were meant to.

Here at Sequoia, we believe that a combination of therapies and an evidence-based approach has the most promise to help you be free from OCD running your life. If your life or that of someone you love is being held back by OCD, call us today