by Robin L Goldstein, EdD Licensed Psychologist

In the past this was thought to be a fairly rare disorder but as it has been increasingly recognized, it is being diagnosed more frequently.  The National Institute of Mental Health estimates that about 3 million people suffer from OCD or about 1 in 100.  About 1 in 200 children suffer with OCD, about the number of children who have diabetes according to the International OCD Foundation.  I suspect the numbers are higher as this is a deeply hidden disorder.

OCD is an anxiety disorder because the sufferer performs repetitive behaviors (compulsions) or has obsessive, recurring thoughts because it causes intense anxiety to avoid these obsessions or compulsions.  Scientists are exploring the link between addictions and OCD.  Behavioral “addictions” such as gambling, compulsive hoarding and shopping, eating disorders and sexual compulsions appear to be a form of OCD, ones that are harder to treat.  Even substance abuse has an OCD aspect to it.  While it is true that drug addicts and alcoholics have a chemical dependency, their obsessive thoughts about substance use and their compulsive, continuing use when they try to recover appear to be related to OCD, the OCD intensifying the addiction.

OCD seems to have a clear biological basis as brain imaging does show differences in how the brain of someone with OCD registers on a scan.  Both behavioral, psychological treatments and medications can be helpful with OCD.  The severity of the condition can determine the likelihood of successful treatment.  Many of us of have some OCD.  Friends may tease us about our quirks which may in fact be low level OCD; things we have to do that seem a little foolish, minor everyday rituals from good luck charms to how we organize our day or our desk or our house.  Many of us have morning rituals about how we start or day or the order of things we do when we come home.  If being blocked from performing these behaviors makes us anxious or distressed it begins to look like true OCD.

As with any mental illness severe levels can be crippling.  The movie The Aviator starring Leonardo DeCaprio as Howard Hughes was an excellent depiction of OCD at it’s most severe and most crippling.  Because Mr. Hughes was so wealthy and did not need to function rationally in the day to day world to survive, his OCD took over his life and he lived out his life as a prisoner of his ever increasing rituals and obsessions.

Many people associate OCD with cleanliness and neatness and it is true that this is a very common form of OCD but in no way is it the only type of obsession or compulsion.  In fact, many people, do not think of themselves as having OCD because they are messy but this is only one of many situations about which a person can obsess or be compulsive.  Other common obsessions include: perfectionism, wondering or worrying if we did something absolutely correctly, health obsessions; fearing we will become ill or that we have some terrible undiscovered disease, obsessions about germs or contamination, sexual obsessions, violent obsessions; constant thoughts about harming ourselves or others and envisioning horrific images.

Common compulsions include cleaning or ordering but also checking compulsions, counting compulsions,repeating or re-writing compulsions, rituals (behaviors that HAVE to be done in a particular manner and sequence), compulsive collecting so that clutter interferes with the home (hoarding).

Because the person often realizes that their behavior is irrational they are deeply embarrassed and distressed by their OCD.  Depression is a frequent complication of OCD although, alternatively, OCD can develop for people who become very depressed.  Others do not have insight in to their behavior and can be irritable, demanding or even tyrannical towards those with whom they live, insisting that things be done in a certain way. It is not uncommon to find OCD tendencies in the offending partner when there is domestic violence.


Treatment of OCD can be complex.  Both medications and psychotherapy are useful.  Medication alone is rarely adequate as the person needs a fair amount of education about the condition to understand and sometimes even recognize it’s impact.  Depending on how wide spread the symptoms are treatment can be rapid or more time consuming.  Close collaboration between the therapist and the patient are essential.  Since many OCD symptoms are embarrassing many patients are reluctant to disclose their problems and treatment is extended.  Relief of this suffering is available and CAN be brought under control.

I urge you to get help so you can get better, please  contact me.