UNC Health Talk

Living with OCD

Many of us like things a certain way. Sometimes a person’s need to be clean, orderly or organized can feel excessive. But that doesn’t mean the person has obsessive-compulsive disorder (OCD).

“Some people like to say they have OCD, but it’s not about perfectionism,” says UNC Health psychiatrist Jim Bedford, MD. “It’s also not an overreaction to everyday stress.”

OCD is much more severe and debilitating than a personality quirk. Dr. Bedford explains how to recognize it and how treatments can help.

What Is OCD?

OCD is an undesired, all-consuming mental health disorder. It involves intrusive thoughts, images or urges called obsessions. These obsessions can lead to behavioral actions—compulsions—performed in response to the thoughts or urges. The actions can become a rule or routine that a person follows rigorously to make the obsession go away momentarily, but unfortunately it occurs over and over, causing anxiety and distress.

A classic example is hand-washing: A person with OCD may obsess about germs and contamination, then wash his or her hands compulsively to calm the obsessive thoughts. This strategy doesn’t last long, though, and the thoughts return, so the compulsion must be repeated over and over, leading to red, cracked and even bleeding hands.

But it’s a mistake to think OCD is always—or even usually—about germs, Dr. Bedford says. “People think it’s always about germs, washing your hands, being tidy and cleanliness. That’s a subset of people with OCD,” Dr. Bedford says.

People can be particular without having OCD. For a person to be diagnosed with OCD, the cycle of obsessions and compulsions has to become so extreme that it interrupts his or her daily life and impairs quality of life.

Signs and Symptoms of OCD

Common obsessions include:

  • Fear that something bad is going to happen to you or others
  • Extreme concern with order, symmetry or precision
  • Disturbing or unwanted thoughts (sometimes sexual or violent)
  • Fear of losing control and harming yourself or others
  • Extreme fear of germs or contamination
  • Religious fears or fixations

Common compulsions include:

  • Compulsive counting (following “rules,” such as counting to end on a specific number)
  • Repeatedly checking things, not just once but many times (making sure the stove is off or the door is locked)
  • Checking that you did not make a mistake, not just once but many times
  • Needing to touch things a certain number of times
  • Asking others for reassurance or approval

Although some of the symptoms of OCD can be visible, often it is a secretive disorder.

“People can be ashamed of it, or they may try to hide it. Some people who wash their hands for hours a day may develop skin problems, but that’s not the majority of people with OCD. There’s not always an outward sign,” Dr. Bedford says.

When Does OCD Begin?

Worldwide, an estimated 2 percent of people have OCD, Dr. Bedford says. It usually first becomes apparent in adolescence, and it is unusual for it to begin in old age. Some women develop postpartum OCD.

Dr. Bedford says children can also get OCD. “Twenty-five percent of OCD cases begin prior to age 14, and the mean onset has been reported to be 19 years old. Males seem to have a slightly earlier age of onset than females, but the prevalence of OCD in females is slightly higher overall,” Dr. Bedford says.

Children with OCD may have the same signs and symptoms as adults, but sometimes their anxiety or trouble focusing can result from or be mistaken for other conditions, so careful evaluation is needed.

Causes and Risk Factors for OCD

There are believed to be environmental and biological risk factors associated with OCD, but the precise causes are unknown.

“The exact genes involved in OCD compared to other mental health disorders are still unclear,” Dr. Bedford says.

Risk factors include having a family history of OCD, experiencing a traumatic event or acute stress, or having another mental health disorder, such as generalized anxiety or depression. Hormonal changes that take place after childbirth or during the premenstrual period can play a role too.

OCD and COVID-19

The COVID-19 pandemic has been challenging for many people with OCD, whose fears and behaviors may feel somewhat validated, in that people around the world are more on guard and taking precautions. Because the COVID-19 is very real and frightening, it might challenge some skills that people with OCD have learned in the past to control anxiety.

“Everyone is supposed to be following the guidelines—washing your hands, practicing social distancing and wearing a mask—but some people are finding that they can’t get their mind off of practicing these tips. They end up spending hours a day engaging in repetitive behaviors to try to fight off this worry through compulsions,” Dr. Bedford says.

The extra stress felt by virtually everyone also could be a trigger to developing OCD.

“We’ve seen that in addition to the COVID-19 pandemic, there’s also a mental health pandemic that’s occurring in tandem with it. We are seeing a clear increase in mental health problems related to COVID-19,” Dr. Bedford says.

Treatments and Therapies for OCD

OCD can be severely impairing. It can lead to people struggling to leave home or live independently. However, most people with OCD can have meaningful recoveries with the help of treatments.

“The prognosis can vary. A person can deal with OCD for a few months to a few years before it resolves. Or a person could receive treatment for years to keep it under control. It can become a chronic condition that people have to manage, similar to illnesses like diabetes, asthma or COPD,” Dr. Bedford says.

OCD is often diagnosed during a psychiatric assessment. Treatment for the disorder can include:

  • Cognitive behavioral therapy, a type of talk therapy that helps people understand and change thinking and behavior patterns
  • Exposure and response prevention, a subtype of cognitive behavioral therapy in which the patient is exposed to stressors slowly and under supervision and taught how to respond differently
  • Psychiatric medicines, including selective serotonin reuptake inhibitors, clomipramine and others, to help reduce OCD symptoms

Dr. Bedford says the first step in treating OCD is to talk with your healthcare provider to arrange an evaluation. Working to minimize behavior rituals can be very difficult at first, but through the help of treatment, obsessions and compulsions can be reduced, and life can become more enjoyable.


If you think you have obsessive-compulsive disorder, talk to your doctor. Need a doctor? Find one near you.