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Symptoms
By Mayo Clinic Staff

Obsessive-compulsive disorder symptoms usually include both obsessions and compulsions. But it’s also possible to have only obsession symptoms or only compulsion symptoms. About one-third of people with OCD also have a disorder that includes sudden, brief, intermittent movements or sounds (tics).

Obsession symptoms

OCD obsessions are repeated, persistent and unwanted urges or images that cause distress or anxiety. You might try to get rid of them by performing a compulsion or ritual. These obsessions typically intrude when you’re trying to think of or do other things.

Obsessions often have themes to them, such as:
•Fear of contamination or dirt
•Having things orderly and symmetrical
•Aggressive or horrific thoughts about harming yourself or others
•Unwanted thoughts, including aggression, or sexual or religious subjects

Examples of obsession signs and symptoms include:
•Fear of being contaminated by shaking hands or by touching objects others have touched
•Doubts that you’ve locked the door or turned off the stove
•Intense stress when objects aren’t orderly or facing a certain way
•Images of hurting yourself or someone else
•Thoughts about shouting obscenities or acting inappropriately
•Avoidance of situations that can trigger obsessions, such as shaking hands
•Distress about unpleasant sexual images repeating in your mind

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors are meant to prevent or reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

You may also make up rules or rituals to follow that help control your anxiety when you’re having obsessive thoughts. These compulsions are often not rationally connected to preventing the feared event.

As with obsessions, compulsions typically have themes, such as:
•Washing and cleaning
•Counting
•Checking
•Demanding reassurances
•Following a strict routine
•Orderliness

Examples of compulsion signs and symptoms include:
•Hand-washing until your skin becomes raw
•Checking doors repeatedly to make sure they’re locked
•Checking the stove repeatedly to make sure it’s off
•Counting in certain patterns
•Silently repeating a prayer, word or phrase
•Arranging your canned goods to face the same way

Symptoms usually begin gradually and tend to vary in severity throughout your life. Symptoms generally worsen when you’re experiencing more stress. OCD, considered a lifelong disorder, can be so severe and time-consuming that it becomes disabling.

Most adults recognize that their obsessions and compulsions don’t make sense, but that’s not always the case. Children may not understand what’s wrong.

When to see a doctor

There’s a difference between being a perfectionist and having OCD. OCD thoughts aren’t simply excessive worries about real problems in your life. Perhaps you keep the floors in your house so clean that you could eat off them. Or you like your knickknacks arranged just so. That doesn’t necessarily mean that you have OCD.

If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health provider. People with OCD may be ashamed and embarrassed about the condition, but treatment can help.

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DEFINITION

Obsessive-compulsive disorder (OCD) is characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). It’s also possible to have only obsessions or only compulsions and still have OCD.

With OCD, you may or may not realize that your obsessions aren’t reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings.

OCD often centers around themes, such as a fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they’re sore and chapped. Despite efforts to ignore or get rid of bothersome thoughts, the thoughts or urges keep coming back. This leads to more ritualistic behavior — and a vicious cycle that’s characteristic of OCD.

CAUSES

The cause of obsessive-compulsive disorder isn’t fully understood. Main theories include:
•Biology. OCD may be a result of changes in your body’s own natural chemistry or brain functions. OCD may also have a genetic component, but specific genes have yet to be identified.
•Environment. Some environmental factors such as infections are suggested as a trigger for OCD, but more research is needed to be sure.

Many people begin to notice an improvement in their symptoms after two or three treatments with electroconvulsive therapy. Full improvement may take longer. Response to antidepressant medications, in comparison, can take several weeks or more.

No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That’s why ECT is most effective in people who receive a full course of multiple treatments.

Even after your symptoms improve, you’ll still need ongoing treatment to prevent a recurrence. Known as maintenance therapy, that ongoing treatment doesn’t have to be ECT, but it can be. More often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).

The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re hospitalized or as an outpatient procedure.

Before the procedure

To get ready for the ECT procedure:
•You’ll have general anesthesia, which means you may have dietary restrictions before the procedure. Your health care team will tell you how long to avoid food and drinks before ECT treatment. Typically, this might mean no food or water after midnight and only a sip of water to take any morning medications.
•You may have a brief physical exam to check your heart and lungs.
•You’ll have an intravenous (IV) line inserted. Your nurse or another health care team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
•Your nurse places electrode pads on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electrical currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electrical currents.

Anesthesia and medications

At the start of the procedure, you’ll receive these medications through your IV:
•An anesthetic to make you unconscious and unaware of the procedure
•A muscle relaxant to help minimize the seizure and prevent injury

You also may receive other medications, depending on any health conditions you have or your previous reactions to ECT.

A blood pressure cuff placed around your ankle stops the muscle relaxant medication from entering the foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.

During the procedure, monitors constantly check your heart, blood pressure and oxygen use. You may be given oxygen through an oxygen mask. You may also be given a mouth guard to help protect your teeth and tongue from injury

Inducing a seizure

When you’re asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electrical current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.

Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you’re having a seizure may be a rhythmic movement of your foot if there’s a blood pressure cuff around your ankle. But internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.

A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You’re taken to a recovery area, where you’re monitored for problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.

Series of treatments

In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. The number of treatments you’ll need depends on the severity of your symptoms and how rapidly they improve.

Some people may be advised not to return to work until one to two weeks after the last ECT in a series or for at least 24 hours after the last treatment.

Before having your first ECT treatment, you’ll need a full evaluation, which usually includes:
•A medical history
•A complete physical exam
•A psychiatric assessment
•Basic blood tests
•An electrocardiogram (ECG) to check your heart health

These exams help make sure that ECT is safe for you. You may also see an anesthesiologist to go over the risks of anesthesia.