Since the fourth century BC, obsessional behavior was
explained as “melancholia”, a distinct disease with
particular mental and physical symptoms. For centuries in
Europe, from the early Middle Ages, satanic possession was
believed to be the primary cause of blasphemous, sexual,
or other obsessive thoughts. Treatment involved the
In 17th century England, the concept of "religious
melancholy" became established as the cause of a many
mental disorders including those with OCD-like symptoms,
but rather religious melancholy supposedly sprang from
overzealous devotion to God. Mental distress caused by
religious melancholy could be cured by “the comfort of
cheerful friends and productive work" and the avoidance of
"solitariness and idleness".
Austrian psychiatrist Sigmund Freud believed
obsessive-compulsive behavior is linked to
unconscious conflicts manifested as symptoms of
the illness. Conflict develops between the desires
and subsequent actions of the conscious and
unconscious minds. OCD sufferers, frequently
"compelled" to carry out actions giving only
temporary relief from anxiety, still "know" it’s
ridiculous or embarrassing to do so. Freud
developed psychoanalysis for curing OCD and
other mental disorders through extensive
dialogue between patient and psychoanalyst.
Obsessions are involuntary, seemingly
uncontrollable thoughts, images, or
impulses that occur over and over again in
your mind. You don’t want to have these
ideas – in fact, you know that they don’t
make any sense. But you can’t stop them.
Unfortunately, these obsessive thoughts
are usually disturbing and distracting.
Compulsions are behaviors or rituals that
you feel driven to act out again and again.
Usually, compulsions are performed in an
attempt to make obsessions go away.
Most people with obsessive-compulsive disorder
fall into one of the following categories:
Washers are afraid of contamination. They
usually have cleaning or hand-washing
Checkers repeatedly check things (oven turned
off, door locked, etc.) that they associate with
harm or danger.
Doubters and sinners are afraid that if
everything isn’t perfect or done just right
something terrible will happen or they will be
Counters and arrangers are obsessed with
order and symmetry. They may have superstitions
about certain numbers, colors, or arrangements.
Hoarders fear that something bad will happen if
they throw anything away. They compulsively
hoard things that they don’t need or use.
behaviors in OCD include:
Common obsessive thoughts Excessive double-checking of
in OCD include: things, such as locks,
Fear of being contaminated by appliances, and switches.
germs or dirt or contaminating Repeatedly checking in on
others loved ones to make sure
Fear of causing harm to yourself they’re safe.
Intrusive sexually explicit or
Counting, tapping, repeating
certain words, or doing other
violent thoughts and images
Excessive focus on religious or
senseless things to reduce
moral ideas anxiety.
Fear of losing or not having Spending a lot of time
things you might need washing or cleaning.
Order and symmetry: the idea Ordering, evening out, or
that everything must line up “just arranging things “just so.”
Praying excessively or
Superstitions; excessive attention engaging in rituals triggered
to something considered lucky or
unlucky by religious fear.
Accumulating “junk” such as
old newspapers, magazines,
and empty food containers, or
other things you don’t have a
The etiology of obsessive-compulsive disorder is
uncertain, but it appears to include a combination
of neurological and psychological factors. The
dominant neurochemical theory of obsessive-
compulsive disorder suggests that the
neurotransmitter serotonin plays a central role in
the development of the condition. Drugs that
increase the availability of serotonin in the body
are effective in ameliorating the symptoms of
obsessive-compulsive disorder, while
nonserotonergic medications have been found to
have little or no effect.
There are many effective treatments for
obsessive-compulsive disorder (OCD),
ranging from therapy to self-help and
medication. However, the treatment for
OCD with the most research supporting its
effectiveness is cognitive-behavioral
therapy. Cognitive-behavioral therapy for
obsessive-compulsive disorder involves
two components- exposure and response
prevention and cognitive therapy.
Exposure and response prevention involves repeated
exposure to the source of your obsession. Then you are
asked to refrain from the compulsive behavior you’d usually
perform to reduce your anxiety.
For example, if you are a compulsive hand washer, you
might be asked to touch the door handle in a public
restroom and then be prevented from washing up. As you
sit with the anxiety, the urge to wash your hands will
gradually begin to go away on its own. In this way, you
learn that you don’t need the ritual to get rid of your
anxiety – that you have some control over your obsessive
thoughts and compulsive behaviors.
Four Steps for Conquering
Obsessive Thoughts and
The cognitive Compulsive Urges
therapy component for RELABEL – Recognize that the
intrusive obsessive thoughts
obsessive-compulsive and urges are the result of
disorder (OCD) focuses on OCD.
the catastrophic thoughts REATTRIBUTE – Realize that
and exaggerated sense of the intensity and intrusiveness
responsibility you feel. A of the thought or urge is caused
big part of cognitive by OCD; it is probably related
therapy for OCD is to a biochemical imbalance in
teaching you healthy and
REFOCUS – Work around the
effective ways of
OCD thoughts by focusing your
responding to obsessive attention on something else, at
thoughts, without resorting least for a few minutes. Do
to compulsive behavior. another behavior.
REVALUE – Do not take the
OCD thought at face value. It is
not significant in itself.
Source: Westwood Institute for
Medication – Antidepressants are sometimes used in
conjunction with therapy for the treatment of obsessive-
compulsive disorder. However, medication alone is rarely
effective in relieving the symptoms of OCD.
Family Therapy – Because OCD often causes problems in
family life and social adjustment, family therapy is often
advised. Family therapy promotes understanding of the
disorder and can help reduce family conflicts. It can also
motivate family members and teach them how to help their
Group Therapy – Group therapy is another helpful
obsessive-compulsive disorder treatment. Through
interaction with fellow OCD sufferers, group therapy
provides support and encouragement and decreases
feelings of isolation.
is focused on a new hypothesis of OCD: that its symptoms
may, at least in some cases, result from an imbalance in
the brain of the neurotransmitter glutamate. This suggests
that medications that modulate glutamate levels may help
those patients who get little or no benefit from established
therapies. Indeed, recent studies from the clinic, and
elsewhere, suggest that glutamate-modulating drugs hold
promise for some patients with difficult-to-treat OCD.
These include riluzole, memantine, gabapentin, N-
Acetylcysteine, and lamotrigine. MDMA, which is a powerful
and illicit serotonergic drug, has also been anecdotally
reported to temporarily alleviate the symptoms of OCD
The atypical antipsychotics olanzapine, quetiapine,
and risperidone have also been found to be useful as
adjuncts to an SSRI in treatment-resistant OCD. However,
these drugs are often poorly tolerated, and have significant
metabolic side effects that limit their use.