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Behavioral Psychology

Obsessive-Compulsive Disorder (OCD)

by Susan Nay, Ph.D.

What is Obsessive-Compulsive Disorder or OCD?

Estimates of 4 to 7 million children, teens, and adults suffer from OCD. Symptoms tend to change over time and intensity varies. Not all rituals or worries are considered OCD. Rituals like singing a song while cleaning, brushing your teeth for at least a minute, or performing your night time routine the same way daily, can be comforting. Normal worries can increase during stressful times, such as contamination fears escalating when someone is ill or dying. These rituals and worries do not require treatment unless they persist, are irrational, cause distress, and/or interfere with daily functioning.

OCD symptoms include obsessions and/or compulsions, which are unreasonable or excessive in nature, occur more than 1 hour a day, cause distress, and/or significantly interfere with work, social life, and/or relationships.

Obsessions: Thoughts; images; or impulses that repeatedly occurs and feel out-of-control. People do not want these thoughts, find them disturbing, and typically think they do not make sense.

Common obsessions are: contamination fears (e.g., germs, dirt), imagining having harmed oneself or others, imagining losing control or having aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts, a need to have things "just right," and a need to tell, ask, or confess.

Compulsions: Behaviors people repeatedly perform to alleviate the uncomfortable feelings brought on by obsessions. They typically realize that the compulsions are excessive or unreasonable. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Common compulsions are: Washing; repeating; checking; touching; and counting.


Evidence-based treatments include cognitive-behavioral therapy (CBT) and possibly medication, in severe cases. In therapy, individuals learn ways to relax and challenge the distorted thoughts. Then they systematically face the situations that cause or trigger their obsessions and anxiety without performing the rituals (i.e., compulsions) that previously helped to relieve their anxiety. This common approach is called exposure with response prevention. Medications that have been found to help alleviate symptoms work to increase seratonin levels in the brain. When there is a sudden onset of OCD following strep throat in childhood, this may be due to an autoimmune reaction called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). If caught early, antibiotic treatment can prove very helpful in the relief and remission of OCD-like symptoms. It should be noted that the existence of PANDAS is still somewhat controversial in nature.

What Causes OCD

It is heritable and there is a slightly increased risk that a child will develop OCD when a parent has OCD. The risk is fairly low despite this. The symptoms that are exhibited though can be very different from person to person within the same house. Some environmental factors that can trigger OCD include abuse, changes in living situations, illness, death of a loved one, work or school-related changes or problems, and relationship concerns.

What We Do

At Behavioral Psychology Associates, all of our therapists offer CBT for OCD. Our Psychiatrists can help with medication management when cases are severe enough to warrant this. Working under the same roof, it is easy for us to collaborate when seeing the same individual. Often times, the families of individuals with OCD need support in managing their own emotions about their loved one and in not becoming/remaining enmeshed with that person. Many of our therapists provide family and marital therapy that can be adjunctive to the individual's treatment.

Helpful websites relating to Obsessive-Compulsive Disorder:

Behavioral Psychology