Disturbo ossessivo-compulsivo (DOC): sintomi, cause, trattamenti

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What is obsessive-compulsive disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is a chronic condition that can significantly impact quality of life. It manifests itself with persistent, unwanted thoughts called obsessions and repetitive behaviors or rituals called compulsions . Those who suffer from OCD often find themselves trapped in a cycle: obsessions create anxiety, and compulsions serve as an attempt to relieve it, but the relief is only temporary . This cycle can lead to significant impairment in emotional well-being, relationships, and daily functioning.

Obsessive Compulsive Disorder
The Obsessive-Compulsive Disorder Cycle. Source: disturbassessivo.it

You may have heard OCD discussed superficially or seen it portrayed in stereotypes. The reality is that it is a complex condition that deserves understanding and attention , both for those who suffer from it directly and for those who live with people with the disorder.

Symptoms of obsessive-compulsive disorder: how to recognize them

If you’re wondering how to recognize OCD symptoms, it’s helpful to know that the disorder presents itself through two main manifestations: obsessions and compulsions . These symptoms aren’t just temporary annoyances, but can become so pervasive that they severely impact your daily life.

You may be interested in the article " Obsessive Thoughts: What Are They? Do They Go Away? "

Obsessions

Obsessions are thoughts, images, or impulses that repeatedly and unintentionally appear in your mind. They are often distressing and difficult to ignore. You may try to push them away or forget them, but they keep recurring, causing anxiety and distress. Common obsessions include:

  • Fear of contamination : Perhaps you worry excessively about being contaminated by germs or dirt, fearing that you will get sick or infect others.
  • Obsessive doubt : You may constantly doubt whether you’ve done something important, like locking the front door or turning off the gas. This doubt may lead you to repeatedly double-check.
  • Aggressive or violent thoughts : Some individuals with OCD have intrusive thoughts about harming themselves or others, even when they do not want to do so.
  • Religious or moral obsessions : You may have excessive worry about committing sins or not being morally perfect, accompanied by fears of being punished for these thoughts.

These thoughts are not under your control and often feel irrational, but despite this, they persist, fueling a cycle of distress.

Compulsions

Compulsions are repetitive actions you perform in an attempt to relieve the anxiety caused by obsessions. They may be visible behaviors or mental activities. While they may offer temporary relief, they actually reinforce the obsession-compulsion cycle , making it more difficult to break out of the spiral. Some common examples of compulsions include:

  • Overwashing : You may wash your hands repeatedly, sometimes to the point of causing skin breakdown, in an attempt to eliminate a feeling of contamination.
  • Repetitive Checking : You may feel the need to continually check that doors are locked or appliances are turned off, even though you rationally know you’ve already checked.
  • Counting Rituals : You may need to count to a certain number or repeat a series of actions a certain number of times to feel “safe.”
  • Excessive Tidying Up : The desire to get everything in perfect order could consume hours of your time, even when it isn’t necessary.

Compulsions may seem ridiculous or unnecessary, but they’re often seen as the only way to relieve distress . In reality, however, they don’t address the root cause and can increase frustration and discomfort in the long run.

Did you know I wrote a book about obsessive doubts? It's called "Pathological Doubt: Obsessive-Compulsive Thought Disorder" + Free Course

Causes of OCD: Genetics, Neurobiology, and Environment

Obsessive-compulsive disorder doesn’t have a single, unequivocal cause; it’s the result of a combination of genetic, neurological, and environmental factors. If you’re trying to better understand why OCD develops, here are some key points that will help you understand the complexities of this disorder.

Genetic factors of obsessive-compulsive disorder

Research has shown that OCD can be hereditary. If you have a close family member who suffers from OCD, you are more likely to develop the disorder than someone with no family history of the disorder. Twin studies have strengthened the hypothesis that there is a genetic component. There is no single gene responsible; rather, it is a combination of genes that determines increased vulnerability .

Twin studies support the hypothesis that obsessive-compulsive disorder has a genetic component.
Twin studies support the hypothesis that obsessive-compulsive disorder has a genetic component.

Neurobiological factors

Neurologically, OCD is linked to dysfunction in the cortico-striato-thalamo-cortical (CSTC) circuit, a network of brain connections that regulates behavior and emotional response. When this circuit malfunctions, obsessive thoughts and compulsive behaviors can arise. Scientific studies have shown that serotonin levels , a crucial neurotransmitter for controlling mood and anxiety, can be altered in people with OCD. For this very reason, many of the medications used to treat OCD aim to correct imbalances in this neurotransmitter.

Environmental factors

Environment also plays an important role in the development of OCD. Traumatic events, periods of intense stress , or significant life changes can trigger the disorder, especially in individuals who are already genetically predisposed. For example, childhood strep throat infections have been linked to the onset of OCD in some children, although this link still requires further research . Stressful life events can “activate” OCD in people who already have a genetic predisposition, acting as a trigger for the development of the disorder.

Diagnosis of obsessive-compulsive disorder

If you believe you suffer from OCD, diagnosis requires a professional evaluation by a psychologist or psychiatrist. During the diagnostic process, you will be asked to describe your symptoms, their frequency, and their impact on your daily life. It will also be important to assess whether these symptoms cause you significant distress or interfere with your ability to perform daily activities, such as work or interpersonal relationships.

Diagnostic criteria for OCD are often based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . To be diagnosed with OCD, the obsessions and/or compulsions must occupy a significant amount of your time (at least an hour a day) and cause significant distress or impairment in social, occupational, or academic functioning .

In addition to gathering information about your symptoms, your doctor may request a physical exam to rule out other medical conditions that could be causing OCD-like symptoms. For example, neurological or endocrine disorders can present with similar symptoms, so it’s crucial to rule out these possibilities.

OCD Treatments: What Really Works?

Fortunately, OCD is a successfully treatable condition, and many individuals are able to live happy lives with proper treatment. Treatment for OCD primarily involves two approaches: psychological and pharmacological . Sometimes, a combination of both therapies can be helpful.

Cognitive Behavioral Therapy (CBT)

One of the most effective treatments for OCD is cognitive behavioral therapy (CBT) . Within this approach, one of the most commonly used techniques is exposure and response prevention (ERP) . With ERP, you’ll be encouraged to gradually expose yourself to situations that cause anxiety, without resorting to compulsions to relieve it. For example, if you’re afraid of germs, you might gradually expose yourself to contact with “dirty” objects, learning to tolerate the anxiety without resorting to compulsive washing.

Over time, repeated exposure to these situations without performing compulsive rituals helps reduce anxiety and break the obsession-compulsion cycle. ERP has proven to be extremely effective in treating OCD, and many people notice significant improvements after just a few weeks of therapy.

Strategic therapy: an innovative approach

Another promising approach to treating OCD is strategic therapy , an innovative method that focuses on interrupting the obsession-compulsion cycle through practical and targeted techniques. This approach aims to help you become aware of your compulsions and obsessions, using strategies that interrupt the so-called “dysfunctional attempted solutions” that perpetuate the problem.

One of the most common techniques is symptom prescription , which involves asking you to consciously and intentionally perform the compulsion, thus reducing its intensity. In this way, you can gradually free yourself from the control the disorder exerts over you.

Solution-focused therapy: A future-oriented approach

Another psychological approach that deserves attention is solution-focused therapy . This method focuses on finding practical solutions to current problems, rather than delving into the underlying causes of the disorder.

In solution-focused therapy, you and your therapist, through targeted questions, will develop strategies you can apply to build a path toward a future where OCD is no longer a problem. One way this happens is by identifying situations where obsessions are less present, building solutions based on these exceptions. This approach focuses on your strengths , helping you find small changes that can have a positive impact over time.

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Drug treatment

Medications are often used in conjunction with therapy to manage OCD symptoms. Selective serotonin reuptake inhibitors (SSRIs) , such as fluoxetine, sertraline, and fluvoxamine, are the most commonly prescribed medications for OCD.

SSRIs can take several weeks to show effects, so it is important to carefully follow your prescribed treatment plan and stay in touch with your doctor to monitor any side effects or dosage adjustments.

OCD in cinema and popular culture

OCD has found ample space in popular culture and cinema, contributing to awareness, but often also to the spread of stereotypes or simplified representations. Films such as ” As Good As It Gets” (1997), starring Jack Nicholson, and the television series “Monk” have brought this disorder to public attention, albeit sometimes in a caricatured manner.

Adrian Monk is a character suffering from Obsessive Compulsive Disorder
Adrian Monk is a character suffering from Obsessive Compulsive Disorder

A more complex depiction of OCD is found in “The Aviator” (2004), starring Leonardo DiCaprio. The film explores the life of famed aviator Howard Hughes, showing how OCD profoundly affected his personal and professional life. Unlike other, more lighthearted depictions, the debilitating impact of the disorder is emphasized here.

Stigma and DOC

One of the main obstacles for those suffering from OCD is social stigma . Despite advances in understanding mental health, OCD is often perceived as a lack of willpower or a behavioral quirk. This can lead sufferers to isolate themselves and delay seeking help. Overcoming stigma is essential to improving the quality of life of those suffering from OCD.

Unfortunately, people with OCD also face the challenge of being judged. If you suffer from OCD, there’s nothing to be ashamed of: seeing a mental health professional is the first step to improvement.

Frequently Asked Questions (FAQ) about obsessive-compulsive disorder

What are the main symptoms of OCD?

OCD symptoms can be divided into obsessions and compulsions . Obsessions include intrusive thoughts, such as fears of contamination or harming someone, while compulsions are repetitive behaviors performed to reduce the anxiety caused by the obsessions, such as repeatedly washing one’s hands or constantly checking whether a door is locked.

Does strategic therapy work for OCD?

Yes, brief strategic therapy has proven to be highly effective in treating OCD. This innovative approach aims to break the obsession-compulsion cycle through targeted techniques such as symptom prescription. Many people experience significant improvements after just a few sessions.

How long does it take to see improvements with cognitive behavioral therapy?

With cognitive behavioral therapy , improvements can begin to be seen after just a few weeks, especially if exposure and response prevention (ERP) is used. However, the duration of treatment varies depending on the severity of symptoms and the person’s commitment to the treatment plan.

Which medications are most effective in treating OCD?

The most commonly used medications for OCD are selective serotonin reuptake inhibitors (SSRIs) , such as fluoxetine, sertraline, and fluvoxamine. These medications help regulate serotonin levels in the brain, reducing anxiety and obsessive-compulsive symptoms.

Can I overcome OCD without medication?

Of course! People with OCD can achieve significant improvements only through psychological therapy. Sometimes, however, using medication in conjunction with therapy can be a useful addition.

How can I help a family member or friend with OCD?

If you know someone with OCD, the most important thing is to be supportive without judgment. Avoid minimizing their symptoms or forcing them to stop compulsions without a treatment plan. Instead, encourage them to seek professional help and follow a treatment plan.

What are the differences between OCD and OCPD?

Obsessive-compulsive personality disorder (OCPD) differs from OCD primarily in its rigidity and perfectionism in daily life, while in OCD, obsessions and compulsions are perceived as intrusive and unwanted. People with OCPD view their behaviors as part of their personality, while those with OCD are aware that their obsessions and compulsions are excessive and irrational.

Articles on Obsessive-Compulsive Disorder

If you’re interested in learning more about this topic, you can read my other blog posts by clicking below:

Bibliography

Taylor, S. (2018). Genetics of obsessive-compulsive disorder. Psychological Medicine , 49 (9), 1407–1419. https://doi.org/10.1017/S0033291718001599

Abramovitch, A., & Anholt, G. (2019). Stigma in obsessive-compulsive disorder. In IntechOpen . https://www.intechopen.com/chapters/65312

American Psychiatric Association. (2013). Handbook on Obsessive-Compulsive and Related Disorders . DSM-5 Task Force.

Grohol, J. M. (2019). DSM-5 changes: Obsessive-compulsive and related disorders. Psych Central . https://psychcentral.com/ocd/dsm-5-changes-obsessive-compulsive-and-related-disorders

Jackson, C. (2020). Is obsessive-compulsive disorder genetic? Verywell Mind . https://www.verywellmind.com/ocd-and-genetics-2510481

Cherney, K. (2020). Is there a genetic component to OCD? Healthline . https://www.healthline.com/health/ocd/is-ocd-genetic

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maurizio iengo psicologo

Maurizio Iengo

Psicologo, formatore e consulente. Membro dell'American Psychological Association. Da anni studio e pratico l'ipnosi, oltre ad essere formato nella tecnica EMDR - lo strumento più scientificamente validato per il lavoro sul trauma. Collaboro con Psicohelp, uno dei maggiori portali di terapia di coppia in Italia. Ho un master in Terapia e Clinica del Legame di Coppia e sono autore di vari libri, tra cui "Tornare a Vivere", "il Salvacoppie", "La Trappola della Felicità".
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