OVERVIEW

What is OCD?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder and a mental health condition characterized by intrusive obsessive thoughts and compulsive behaviors. A key feature is the coexistence of conscious obsessions and resistance to them.

Patients experience repetitive, intrusive thoughts or urges that are often meaningless or contrary to their own wishes, disrupting their daily lives.

Although they recognize these thoughts or impulses as originating from themselves and try hard to resist them, they ultimately cannot control them. The intense conflict between obsession and resistance causes significant anxiety and distress, affecting work, studies, social interactions, and even basic daily functioning.

Treatment options include psychotherapy, physical therapy, and medication, but effectiveness varies widely due to multiple factors. Currently, there is no definitive cure for OCD.

In addition to experiencing negative emotions, OCD patients often face misunderstanding from others, such as comments like "You're overthinking" or "You're too sensitive."

If you are diagnosed with OCD, seek active treatment. If a friend or family member is diagnosed, offer them patience, encouragement, and care to support their recovery.

Is OCD common? How harmful is it?

• Recent statistics indicate a rising incidence of OCD. Studies suggest that 1%–3% of the general population may develop OCD in their lifetime, with about two-thirds experiencing symptoms before age 25.

• Due to its early onset and chronic nature, OCD often severely impacts patients' work, social life, and overall quality of life. The WHO's global disease survey found OCD to be among the top 20 most disabling conditions for people aged 15–44.

• Many patients delay seeking treatment initially. For example, those with contamination fears or excessive handwashing may only seek help when symptoms severely disrupt daily life. The gap between onset and first treatment can span a decade, complicating recovery.

• Uncontrollable thoughts or repetitive rituals can severely impair concentration, hindering academic or professional performance. In severe cases, patients may lose the ability to work or study, leading to mental disability.

SYMPTOMS

What are the symptoms of obsessive-compulsive disorder?

The core symptoms of OCD are obsessions and compulsions.

Obsessions are persistent and recurring thoughts, ideas, impressions, or impulses. Specific manifestations include:

Obsessive thoughts:

• Obsessive doubts: Patients constantly doubt whether tasks have been completed properly and repeatedly check to relieve anxiety. For example, doubting whether doors/windows are locked, letters are properly addressed, or the gas is turned off, accompanied by significant anxiety.
• Obsessive reminiscence: Patients repeatedly recall past events or experiences, knowing it’s meaningless but unable to stop, leading to extreme frustration. For example, replaying conversations to analyze wording or tone.
• Obsessive associations: When encountering certain objects or ideas, patients involuntarily think of opposing concepts (e.g., "good" triggering thoughts of "evil").
• Obsessive rumination: Patients endlessly ponder unrealistic questions despite knowing it’s unnecessary. Examples: "Why does it rain? Why do people eat? Why is Earth round?"
• Obsessive impulses: Patients experience intrusive urges contrary to their intentions (e.g., imagining jumping in front of a car) but never act on them.
• Obsessive emotions: Irrational disgust or worry (e.g., fear of harming others, saying something wrong, or contamination by germs/toxins).

Compulsions (or compulsive behaviors) include:

• Compulsive washing: Excessive handwashing, cleaning, or changing clothes due to contamination fears (e.g., a hospital clerk avoiding "cancer-contaminated" objects).
• Compulsive checking: Repeatedly verifying actions (e.g., locked doors, written letters) to ease doubt-driven anxiety.
• Compulsive rituals: Superstitious actions (e.g., tapping chest to "ward off bad luck") to neutralize anxiety.
• Compulsive counting: Uncontrollably counting objects (e.g., stairs, license plates) to avoid distress.

What are the characteristics of OCD?

• The symptoms stem from the patient’s own thoughts/urges, not external forces.
• At least one thought/action is persistently resisted, though symptoms may shift over time.
• Compulsions cause distress, and patients recognize their irrationality but feel worse if unfulfilled.
• Repetitive thoughts/actions lead to significant suffering.

CAUSES

What Causes OCD?

• The etiology of OCD is complex and remains inconclusive. Current research suggests it is primarily associated with psychosocial factors, personality traits, genetic predisposition, and neuroendocrine imbalances.

• Many studies indicate that patients often experience stressful life events during their initial onset, such as interpersonal conflicts, marital challenges, academic or professional setbacks, etc.
  OCD patients typically exhibit perfectionistic tendencies, holding themselves and others to excessively high standards.
  Some patients already display obsessive-compulsive personality traits before onset, characterized by excessive caution, an overwhelming sense of responsibility, and an insistence on flawlessness. This rigidity makes it difficult for them to adapt to stressful situations.
  The internal conflicts and anxiety they experience ultimately manifest through compulsive rituals or other symptoms.

• Additionally, recent research suggests a genetic predisposition for OCD, as relatives of patients have a higher likelihood of developing the disorder.
  Neuroendocrine dysfunctions, such as imbalances in neurotransmitters like serotonin and dopamine, also disrupt normal physiological processes in patients.

Do OCD Patients Have Personality Flaws?

Generally, strong-willed individuals are more prone to self-imposed pressure, strict self-discipline, and setting excessive goals or rules.

On one hand, this can be beneficial, as it enhances motivation and contributes to personal success. However, excessive self-demand increases psychological stress, damages emotional well-being, diminishes satisfaction, and raises the risk of OCD.

Specifically, the following traits are common:

• Overvaluation of thoughts: Patients catastrophize minor intrusive thoughts, making them unbearable.

• Intolerance of uncertainty: An inability to tolerate ambiguity is a hallmark of obsessive beliefs and a strong personality-driven reaction in OCD.

• Perfectionism: The most significant personality factor in OCD. Patients believe there must be a perfect solution to every problem, and its absence becomes unacceptable.

DIAGNOSIS

Which department should you visit for OCD examination?

Psychiatric departments and psychological departments in specialized mental health hospitals, as well as psychological and psychosomatic departments in general hospitals, are professional diagnostic and treatment institutions that can provide both medication and psychotherapy.

Patients with mild symptoms can also seek help from private counseling institutions. However, these institutions typically only offer psychotherapy for diagnosed patients and are not qualified to prescribe medication.

Many OCD patients avoid seeking medical help due to "stigma." In reality, struggling with overwhelming emotional issues is not your fault, and you have the right to seek assistance.

How is OCD diagnosed?

• Strictly speaking, psychological counselors alone do not have the authority to diagnose diseases, as only licensed physicians can diagnose and treat medical conditions.

• To diagnose OCD, it is first necessary to distinguish it from normal repetitive behaviors to avoid overdiagnosis.
  Almost everyone engages in some repetitive behaviors or follows certain routines, such as checking the door multiple times before leaving home to ensure it is locked, or brushing teeth in a specific sequence. These habitual actions are usually efficiency-driven, do not cause distress, and do not interfere with daily life.

• Additionally, a professional physician must rule out other conditions, such as schizophrenia, depression, anxiety disorders, medication-induced obsessive symptoms, or mental symptoms caused by physical illnesses.

• Therefore, if you suspect you have OCD, it is essential to undergo a thorough examination at a specialized mental health center for an accurate diagnosis.

Can you self-diagnose OCD?

If you suspect you might have OCD, ask yourself if you experience any of the following:

• Frequently checking doors, windows, switches, gas, money, documents, or letters unnecessarily;

• Repeating the same words, sentences, or numbers multiple times for no reason;

• Feeling compelled to follow a specific order when dressing, undressing, washing, or walking;

• Washing hands repeatedly for excessively long periods;

• Counting things without reason;

• Persistently worrying about having a serious illness without cause;

• Unwanted, distressing thoughts that are hard to dismiss;

• Fearing that minor mistakes could lead to catastrophic consequences;

• Doubting most of your actions;

• Being troubled by the need to remember trivial details;

• Worrying about losing control and acting embarrassingly in certain situations;

• Frequently being late due to unnecessary repetitive actions;

• Feeling disturbed by knives, sharp objects, or weapons;

• Repeating tasks multiple times until they feel "just right";

• Being deeply upset by topics like suicide, crime, or illness and unable to stop thinking about them;

• Having urges to overeat even when unwell;

• Experiencing sudden impulses to destroy objects or harm others without reason.

If one or more of these symptoms persist and significantly disrupt your life, causing distress, consult a professional doctor for diagnosis and treatment.

What is the difference between OCD and mysophobia (germophobia)?

• Mysophobia refers to an excessive focus on cleanliness beyond what is typical. If it does not interfere with daily life, work, or social interactions, it is not OCD. Severe mysophobia, however, may indicate a mental disorder, such as OCD.

• OCD-related mysophobia manifests as repetitive cleaning behaviors despite having already cleaned. For example, washing hands, clothes, or disinfecting objects repeatedly—even when they are already clean. Patients may feel their hands are still dirty, the cleaning was insufficient, or they don’t recall cleaning at all. This behavior is a classic sign of OCD.

TREATMENT

Is Psychotherapy Necessary for OCD? What Are the Treatment Options for OCD?

• OCD is a mental disorder, and psychotherapy is essential and beneficial. However, depending on factors such as the severity of the condition, duration of illness, and impact on daily life, other treatment options like medication and physical therapy may also be considered.

• The choice of treatment should be made in consultation with a doctor. It is important not to dismiss medication as unnecessary for a "mental condition," nor to rely solely on drugs while neglecting personal efforts to combat the illness.

Being diagnosed with OCD may be difficult to accept, but regardless, it is crucial to follow medical advice and actively pursue treatment for improvement.

What Are Effective Psychotherapy Methods for OCD?

• As a psychological disorder, OCD has a highly complex mechanism, and patients with similar symptoms may have vastly different psychological underpinnings.
  In psychotherapy, therapists establish a strong doctor-patient relationship, listen to the patient, help identify and analyze internal conflicts, facilitate problem-solving, enhance adaptability, and rebuild a healthy personality.

• Common clinical methods include psychodynamic therapy, cognitive behavioral therapy (CBT), supportive psychotherapy, and Morita therapy.
  Among these, CBT is considered the most effective psychotherapy for OCD, primarily involving thought-stopping techniques and exposure and response prevention (ERP).

What Is Cognitive Behavioral Therapy for OCD? What Does It Include?

• CBT is a psychotherapy method that aims to eliminate obsessive-compulsive symptoms and interrupt habitual processes by correcting the patient's distorted views and attitudes toward themselves, others, and situations.
  It includes techniques such as thought stopping, exposure therapy and response prevention, and systematic desensitization.

• Effective CBT requires collaboration between the therapist and the patient. The patient must take responsibility, participate in planning, and diligently complete homework assignments given by the therapist.

What Is Morita Therapy for OCD?

• Developed by Japanese psychiatrist Dr. Shoma Morita, Morita therapy is a humanistic psychotherapy primarily used for OCD, social phobia, agoraphobia, and panic attacks.
  It emphasizes accepting symptoms objectively and acting naturally. Treatment concludes when the patient realizes the principle of "acceptance and natural action."

• Inpatient Morita Therapy:

  • Stage 1 - Absolute Bed Rest: The patient is isolated, prohibited from socializing, reading, smoking, or other activities. Only eating and bathroom breaks are allowed. Lasts about 1 week.
  • Stage 2 - Light Work: Socializing and talking remain restricted. Bedtime is limited to 7–8 hours. Patients must go outside for fresh air and sunlight, keep a diary, and read prescribed texts. Lasts 3–7 days.
  • Stage 3 - General Work: Patients engage in tasks like farming, cleaning, or crafts but avoid social activities or aimless walks. Lasts 1–2 weeks.
  • Stage 4 - Life Preparation: Patients prepare for daily life, maintaining a behavior-focused diary reviewed by the doctor.

• Outpatient Morita Therapy: Based on the principle that "healthy behavior leads to a healthy mind," it involves reading Morita's books or guided diary writing.

Can OCD Be Cured Through Psychotherapy?

No.

• Each psychotherapy method for OCD has limitations, addressing only certain aspects of the disorder. While they can alleviate symptoms, they do not provide a fundamental cure. Treatment can be lengthy with modest results.

• Recent research highlights the interplay of emotions, cognition, and behavior in OCD. New treatments are being explored, but a definitive cure remains elusive.

How to Choose Between Medication and Psychotherapy for OCD?

Common treatments for OCD include medication and psychotherapy.

As a complex psychological disorder, OCD varies widely among patients. Psychotherapy's effectiveness depends on the condition's characteristics and the therapist's expertise, often requiring prolonged treatment. Mild cases may benefit from psychotherapy alone.

For severe cases or when psychotherapy is inaccessible, early medication is crucial. Modern drugs offer improved efficacy, fewer side effects, and faster results than psychotherapy.

What Medications Are Used to Treat OCD?

• OCD is linked to imbalances in brain neurotransmitters, particularly serotonin. First-line medications are antidepressants that regulate serotonin function.

• Commonly used drugs include SSRIs (e.g., fluvoxamine, paroxetine, sertraline, fluoxetine, citalopram) and the tricyclic drug clomipramine. Beta-blockers or benzodiazepines may help with anxiety and insomnia.

• For treatment-resistant OCD, antipsychotics like aripiprazole or quetiapine may be added. Medication effects take 2–4 weeks to appear, with full benefits seen after 10–12 weeks. Maintenance therapy lasts 1–2 years.

What Is Physical Therapy for OCD?

Physical therapy is an alternative for refractory OCD cases unresponsive to medication or psychotherapy. Options include modified electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS).

Neurosurgery is a last resort due to irreversible risks like seizures or sensory loss. It requires strict criteria and consultation with multiple specialists.

Does OCD Require Hospitalization?

Generally, OCD can be managed with outpatient care, regular psychotherapy, and medication. However, severe cases disrupting daily life or causing suicidal depression may need hospitalization for intensive treatment.

Can OCD Improve Without Medical Treatment?

Studies show spontaneous remission is rare, with 54%–61% of cases worsening. Early, adequate treatment—whether psychotherapy or medication—is crucial for recovery.

What to Do If an OCD Patient Has Suicidal Thoughts?

• Unlike other mental disorders, OCD patients rarely act on intrusive thoughts, including suicidal ones. However, severe OCD can lead to depression and genuine suicidal risk.

• About 30% of OCD patients also have depression. Treating depression first is essential before addressing OCD.

How Effective Is OCD Treatment?

Medication achieves significant improvement (full remission or minimal life impact) in about 60% of cases. Stubborn cases may require combined therapy. A small percentage remain treatment-resistant, risking chronic disability.

How Long Does OCD Treatment Take?

• Medication effects appear in 4–8 weeks, followed by 6+ months of consolidation therapy. Maintenance therapy typically lasts 2+ years, adjusted based on severity, relapse history, and patient factors.

What Are the Principles of OCD Medication Use?

• Duration: A full course lasts at least 3 months before evaluating efficacy, as OCD responds slowly.

• Dosage: Higher doses (2–3 times antidepressant levels) are often needed for effectiveness.

• Maintenance: After achieving optimal results, maintain the dose for 6 months before tapering over 2–3 years.

• Acceptance: Complete symptom elimination is rare. Learning to live with residual symptoms is key to long-term recovery.

What Are Common OCD Medications?

• Antidepressants are used, but dosing differs from depression treatment.

• Clomipramine (150–300 mg/day) is a classic option, though side effects make it a second-line choice. SSRIs (e.g., fluoxetine, paroxetine) are preferred for fewer side effects.

• Adjuvant therapies like mood stabilizers or antipsychotics may help resistant cases.

What Are Common Side Effects of OCD Medications?

• Unlike sedating antipsychotics, OCD drugs have mild calming effects. Common issues include nausea, vomiting, or digestive discomfort, manageable by taking with food or adjusting doses.

• Patients should not fear listed side effects, as they rarely all occur. Doctors can manage any adverse reactions.

Can I Stop OCD Medication After Improvement?

No.

• Psychiatric medications require specialist guidance. Premature stopping risks relapse or withdrawal effects. Even after symptom relief, consolidation and maintenance phases are critical.

• Frequent unplanned medication changes can lead to chronic, treatment-resistant OCD.

Are OCD Medications Addictive?

• Most OCD drugs (e.g., SSRIs, clomipramine) are non-addictive. Symptom recurrence upon tapering reflects incomplete stabilization, not dependence.

• Adjuvant drugs like benzodiazepines (e.g., diazepam, alprazolam) can be addictive and require careful monitoring.

DIET & LIFESTYLE

What Self-Adjustments Can OCD Patients Make?

• Accept symptoms: Obsessive-compulsive symptoms are part of oneself. Rejecting them means rejecting oneself, which only worsens symptoms, anxiety, and suffering. No matter how anxious or painful, one must accept the symptoms.
  Once mentally accepted (essentially accepting the "fear"), the sense of anxiety will lessen. Accepting symptoms doesn't yield immediate results—it requires a process. It demands wisdom and courage, as well as continuous practice and realization.

• Engage fully in life, seeking joy and value in daily living. Gradually become more relaxed, optimistic, decisive, and courageous day by day. When life becomes fulfilling and happy, symptoms lose their foothold.

• Accepting symptoms doesn't mean surrendering to them. For example, compulsive washing behaviors—even when one subjectively realizes excessive cleaning is unnecessary—reflect an obsessive addiction. While accepting the "fear," it's crucial to interrupt such compulsive actions promptly.
  It may be difficult and painful at first, but it will pass with time. Persistence makes each attempt easier and lighter until symptoms fade.

Can OCD Patients Get Married and Have Children?

Most OCD patients retain intact cognitive functions. With proper treatment and recovery, their social functioning can remain unimpaired.

Marriage is feasible when symptoms are stable, alleviated, or cured.

For pregnancy, medication risks must be considered. Consult a doctor to reduce dosage, temporarily discontinue medication, or replace drug therapy with psychotherapy to minimize pregnancy-related risks.

What Dietary Considerations Should OCD Patients Have?

• No specific dietary restrictions—just maintain a healthy, balanced diet.

• Use less salt, oil, and high-sodium seasonings when cooking. Avoid pickled vegetables and meats.

• Don't rely solely on refined grains. Substitute with whole grains, legumes, potatoes, or pumpkin for some staple foods.

• Balance meat and vegetables. Prioritize white meats like chicken, duck, and fish over fatty meats. Eggs and milk are key sources of protein and nutrients.

• Vegetarians can increase intake of beans and bean products for protein.

• Eat more fruits and vegetables.

• Avoid alcohol if possible.

PREVENTION

Can OCD Be Prevented?

The onset of OCD is related to factors such as social psychology, personality, genetics, and neuroendocrine influences. Among these, the first two can be intervened to prevent the condition.

Everyone should strive to build a stable, safe, and harmonious living environment, minimizing negative external stimuli. Avoid being overly demanding of yourself, learn to be flexible in interactions, and refrain from rigid thinking.

Emphasizing mutual communication and understanding between people, as well as continuously improving and strengthening one's personality, can all help prevent OCD.