Obsessive-compulsive disorder (OCD)

OCD can lead to both obsessive thoughts and compulsive behaviors. With obsessive thoughts, the unpleasant repetitions take place in the mind. They constantly force their way into our consciousness and are hard to shake off. They are often very distressing, and it's hard to stop them with will power alone.

Typical obsessions include a constant fear of germs and infections, a fear of forgetting to do something, or of behaving inappropriately. Some people have an obsessive fear of hurting themselves or others, or of sexually molesting someone. But that doesn't mean that they would actually do those things.

Compulsive behaviors are associated with actions. These actions are certain rituals that are repeated over and over. For people with OCD, this is a way to try to get frightening thoughts out of their head and feel safe again. Some people are afraid of dirt, and constantly wash their hands or clean their home all the time. People who compulsively arrange things have developed a very specific idea of how and in what order things should be arranged. If things are arranged in a different way it makes them nervous. Some people are compelled to collect things, and can't throw anything away. This can become so extreme that they may stop taking out the garbage. Others can't stop counting things: For example, repeatedly counting to 20 helps them feel calm for a short while. If people with OCD suppress this behavior, they feel anxious, tense and scared.

People with OCD know that their obsessive thoughts and compulsive behaviors are over the top and illogical. That is worrying and distressing. Many feel like they're powerless to do anything and have no control over the situation. That makes them feel even more anxious. Some worry that they might be "going mad."

There are probably many reasons why some people develop OCD. It is thought that genetic, psychological and external circumstances all play a role. OCD sometimes develops following a stressful time in life or a serious crisis. Some people with OCD experienced traumatic events in childhood, such as abuse or the sudden death of a close relative. Certain personality traits seem to increase the likelihood of developing OCD too. For example, some people who develop OCD tend to be very responsible and conscientious by nature, and may be scared of making mistakes.

Genes might also influence the development of OCD. There are often several people in one family who have OCD symptoms. But the causes may vary from person to person.

OCD is fairly common. It is estimated that as many as 3 out of every 100 adults are affected by it at some point in their lives. Although it can develop at any age, it usually starts in childhood, puberty or young adulthood.

It usually takes some time before people notice that they or someone else have developed OCD. This condition doesn't appear from one day to the next. A lot of people think that their behavior is normal until they realize how much time their rituals are taking up. This may affect their work, family lives or relationships and make it difficult for them to fulfill their responsibilities or pursue hobbies. OCD starts to govern their lives.

The way in which OCD develops over time can vary. Without treatment, it often becomes chronic, although the intensity of symptoms may vary. Some people with OCD go through phases in which they feel less controlled by it. The type of obsessions and compulsions might change over time too.

OCD is often less severe in adults than it is in children and teenagers. If teenagers with OCD don't have treatment, only 4 out of 10 of them experience an improvement in symptoms within five years. But many people only manage to get their OCD under control with the help of professionals.

It is sometimes difficult to clearly distinguish between OCD and other conditions similar to OCD. It is important to see a doctor or psychotherapist in order to get a reliable diagnosis. The first step is finding out what kind of obsessive thoughts or compulsive behaviors you have, and how you feel about them. The doctor or therapist asks various questions, such as the following:

• Do you find that certain thoughts or images keep coming to mind even though you try to shut them out?
• What do you do to get rid of these thoughts?
• Do you think that any of your behavior is illogical or exaggerated?
• Do you feel you need to do certain things over and over again even though you don't want to?

To be diagnosed with OCD, a person must have obsessions and compulsions on most days for at least two weeks, or their symptoms must have a noticeable impact on daily life. Sometimes OCD also causes physical symptoms, like very dry skin in people who feel compelled to wash themselves all the time.

The diagnosis also involves looking for signs of other medical conditions that cause similar symptoms. For instance, people who constantly worry too much about all sorts of things might have general anxiety disorder rather than OCD.

OCD sometimes occurs together with several other psychological problems or disorders. Many people with OCD also have depression.

Although there's no “cure” for OCD, with good professional help the symptoms can be reduced to a tolerable level, enabling people with OCD to start leading normal lives again.

People with OCD are usually advised to have psychological treatment. Cognitive behavioral therapy (CBT) in particular has been proven to be an effective treatment for OCD. In Germany, it is offered by behavioral therapists (in German: Verhaltenstherapeuten).

Medication for depression (antidepressants) may be considered in addition to CBT, or if psychological treatment isn't an option (yet). Selective serotonin re-uptake inhibitors (SSRIs) are commonly used for this purpose. The tricyclic antidepressant clomipramine can also be used, but not as the treatment of first choice.

Apart from these treatments, self-help is an option, for example by talking to other people with OCD in a support group. Some people like to use books or websites to learn about their obsessive-compulsive behaviors and deal with them. Others may try to manage their OCD using mindfulness exercises, relaxation techniques like meditation, autogenic training, breathing exercises or sports.

Repetitive transcranial magnetic stimulation (rTMS) is an option for severe obsessive-compulsive disorder – but only if psychotherapy and medication aren't effective. rTMS uses magnetic fields to influence the brain. Deep brain stimulation (DBS) is also possible for very severe and persistent OCD. It uses electrodes implanted in the brain to stimulate the activity of the nerve cells.

Compulsions are exhausting and can be very time-consuming. They may become so severe that you hardly have time for anything else in life, making it difficult or impossible to get on with daily activities. People with OCD are also often ashamed of their thoughts or behavior. They might try to hide their behavior because they're worried that other people will think they're weird. It can be difficult to hide, though.

Many people are reluctant to seek help or tell others about their problem. Others might be scared of how being labeled "mentally ill" could affect their work and their families. But many people who have completed treatment say that they wish they had sought help earlier.

OCD can be a challenge for families and possibly lead to conflict. Family members may feel they also need to go along with the compulsive behavior, for instance by arranging things in a certain order, so they don't upset or frighten the person with OCD.

Parents in particular often also feel bad because they think they should have noticed their child's problem sooner.

But it often takes a long time to realize that someone has a problem, not least because they try to hide their obsessive-compulsive behavior as long as possible. Others don't think that they have OCD themselves, so they refuse to accept any help.

But family members are important when it comes to helping people with OCD because they may understand the person’s condition better than other people do. When family members are involved in therapy, they can help the person face their fears and manage their behavior. This can be especially helpful after the treatment is completed, to help make sure it is successful over the long term.

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.