Obsessive Compulsive Disorder (OCD) is a chronic mental disorder characterized by obsessions, which are intrusive thoughts that enter the mind involuntarily and cause significant distress, accompanied by compulsions, which are repetitive behaviors performed to reduce or neutralize this distress. Among anxiety disorders, OCD is relatively common and can substantially impair daily functioning. Although obsessions are often described as irrational or excessive, the individual struggles to control them. Compulsions are time-consuming ritualized behaviors. OCD typically begins in adolescence or early adulthood and frequently follows a fluctuating yet chronic course.

DSM-5 Criteria for Obsessive Compulsive Disorder

The diagnosis of Obsessive Compulsive Disorder is based on the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria published by the American Psychiatric Association.

According to DSM-5, the following criteria must be met:

• Obsessions and/or compulsions must occupy a significant amount of time (at least one hour per day) or cause marked distress or impairment in functioning.
• Obsessions are recurrent, intrusive thoughts, urges or images that usually provoke anxiety.
• Compulsions are repetitive behaviors or mental acts performed to reduce the distress caused by obsessions or to prevent a feared event (for example, handwashing, praying, counting).
• These symptoms cannot be attributable to substance use or another medical condition.
• The symptoms cannot be better explained by another mental disorder (for example, generalized anxiety disorder, body dysmorphic disorder).

Obsessive Compulsive Disorder Symptoms

The symptoms of OCD fall into two main categories: obsessions and compulsions. These cause severe anxiety and time loss.

The most common obsessions include:

• Contamination fears (germs, dirt, toxins),
• Fear of harming oneself or others,
• Need for symmetry or order,
• Sexual or religious intrusive thoughts.

Compulsions typically develop in response to obsessions and may include:

• Excessive handwashing, bathing, cleaning rituals,
• Repetitive checking behaviors (whether the door is locked, the stove is off),
• Arranging or ordering objects in specific ways,
• Mental rituals (silent praying, counting, repeating internally).

While these behaviors may temporarily reduce anxiety, they perpetuate the disorder in the long term.

Etiology of Obsessive Compulsive Disorder

The causes of OCD are multifactorial, involving genetic, neurobiological and environmental influences.

Genetic factors play a significant role. Family studies show increased risk in individuals with a first-degree relative with OCD. Twin studies estimate heritability rates of approximately 40–50%.

Neurobiological models indicate dysfunctions in fronto-striatal circuits, particularly involving the orbitofrontal cortex, anterior cingulate gyrus and caudate nucleus. Functional neuroimaging consistently reveals hyperactivity in these regions. Additionally, dysregulation in serotonin, dopamine and glutamate systems is implicated.

Environmental factors are also important. Childhood trauma, abuse, neglect, family conflict and overly rigid parenting may contribute. Stressful life events in adolescence or adulthood can trigger symptom onset in predisposed individuals.

Risk Factors for Obsessive Compulsive Disorder

Factors increasing the likelihood of developing OCD include:

• Family history of OCD or tic disorders,
• Childhood anxiety disorders,
• Stressful life events (loss, relocation, school changes),
• Dependent or obsessive personality traits,
• Male gender (particularly in childhood-onset OCD).

Diagnosis

Diagnosis of OCD is based on a comprehensive psychiatric evaluation. Clinical interviews assess the onset, frequency, severity and impact of symptoms. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is widely used for diagnosis and monitoring treatment response.

Differential diagnosis is crucial, as OCD-like symptoms may occur in anxiety disorders, depression, schizophrenia, obsessive compulsive personality disorder, tic disorders and Tourette’s syndrome. In children, autoimmune-related conditions such as PANDAS must also be considered.

Obsessive Compulsive Disorder Treatment

Obsessive Compulsive Disorder is treatable. Both pharmacotherapy and psychotherapy play central roles. Early recognition and intervention improve outcomes.

1. Pharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) are considered the cornerstone of pharmacological treatment for obsessive-compulsive disorder. These medications help reduce the intensity and frequency of obsessions and compulsions. In some cases, higher doses and long-term administration may be required to achieve optimal therapeutic outcomes. Clinical improvement is typically observed within 8–12 weeks of consistent treatment.

For individuals who do not respond adequately to SSRIs, tricyclic antidepressants or augmentation with atypical antipsychotic agents may be considered as alternative or adjunctive strategies.

All pharmacological interventions should be closely monitored by a psychiatrist, with individualized dose adjustments and side effect evaluations throughout the treatment process.

2. Psychotherapy

Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), is highly effective. This approach exposes individuals to obsession-inducing stimuli while preventing compulsive responses, reducing emotional reactivity over time.

Other techniques include:

• Understanding thought-behavior connections,
• Developing alternative coping strategies,
• Family therapy to support treatment adherence.

3. Neuromodulation and Other Interventions

In treatment-resistant cases, advanced interventions may be considered:

• Transcranial Magnetic Stimulation (TMS),
• Deep Brain Stimulation (DBS) (for severe cases),
• Psychoeducation and group therapy to enhance adherence.

Impact on Daily Life

OCD significantly reduces quality of life. Obsessions and rituals disrupt work, school and social functioning. Time-consuming compulsions make everyday tasks difficult. Relationships with family, partners and peers may be severely strained. Many patients conceal symptoms, delaying diagnosis and increasing isolation.

Comorbid conditions such as depression, generalized anxiety disorder and tic disorders are common. Untreated OCD increases suicide risk.

Obsessive Compulsive Disorder is a severe yet manageable condition. With effective treatments such as SSRIs and CBT, substantial improvement is achievable. Early diagnosis, individualized treatment and a comprehensive biopsychosocial approach are crucial for successful outcomes.