Home Diseases Obsessive-compulsive disorders: forms, signs, diagnosis, therapy

Obsessive-compulsive disorders: forms, signs, diagnosis, therapy

by Josephine Andrews
Published: Last Updated on 179 views

Obsessive -compulsive disorder is a serious mental illness. Sufferers compulsively perform the same rituals over and over again or are plagued by disturbing thoughts from which they cannot escape. Although they realize that their actions and fears are irrational, they cannot control their thoughts and actions. Read here how to recognize obsessive-compulsive disorder, how it develops and how it is treated. 

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


Obsessive Compulsive Disorder: Description

Obsessive compulsive disorder (OCD) is a serious mental disorder that is devastating to sufferers.

Obsessive-compulsive disorder encompasses a wide range of behavioral and other psychological characteristics. Some sufferers are haunted by obsessive thoughts. For example, you may have a compulsive idea of ​​committing a violent or sexually undesirable act. Other sufferers are under pressure to perform certain actions over and over again in a ritualized form (eg, washing hands, counting passing cars).

The thoughts and actions are called compulsions because those affected often try to fight them without success. The inner resistance to refraining from actions or thoughts takes a lot of strength and creates increasing tension and fear . Only when they give in to the constraints does the pressure subside. Similar to addicts, a kind of habituation effect sets in over time: the ritual usually becomes more and more complex and lengthy until it brings the hoped-for relaxation. The compulsions therefore take up more and more time and energy.

An outdated term for obsessive-compulsive disorder is obsessive-compulsive disorder. The definition of obsessive-compulsive neurosis means that people with obsessive-compulsive disorder – in contrast to people with a psychosis – do not lose touch with reality. They know their obsessions and obsessions are irrational, but they still can’t stop them.

A little bit of compulsion is normal

There is a bit of compulsiveness in everyone – superstitious ideas are just as much a part of it as harmless rituals. For example, some otherwise rational people feel a little uncomfortable when they are asked to sign an important contract on Friday the 13th.

The transition from normal behavior to obsessive-compulsive disorder is fluid. For example, some may only feel compelled to double check that the stove is off before going to bed – even if they haven’t cooked at all. Others, on the other hand, have to complete a washing ritual lasting several hours before they can leave the house.

Basically, obsessive-compulsive disorder only exists if the person affected suffers from it themselves or is severely restricted in their everyday life.

How many are affected?

People who suffer from OCD are often ashamed of their irrational behavior and try to keep quiet about it. The number of unreported cases is therefore high. Experts estimate that around one to three percent of the population will be affected by obsessive-compulsive disorder at some point in their lives. Men have more frequent control of compulsions, while women suffer more often from washing or cleaning compulsions.

In addition to the obsessive-compulsive disorder, those affected usually also have other mental disorders such as depression or anxiety disorders.

washing compulsion

For more information on the signs and treatment of compulsive washing, see Compulsive washing .


You can find out how an obligation to control manifests itself and how it is treated in the article Obligation to control .

Compulsions in children

Obsessive-compulsive disorder often begins in childhood or adolescence. In about half of those affected, the first symptoms of obsessive-compulsive disorder appear before the age of 15. Children and young people often try to keep these compulsions secret. Boys are affected more often than girls. The compulsions then manifest themselves massively in life crises or conflict situations.

Obsessive-compulsive disorder in children is treated in the same way as in adults as part of cognitive behavioral therapy. If the compulsions are severe, medication, especially selective serotonin reuptake inhibitors (eg fluoxetine ), can also be used in children.

Obsessive Compulsive Disorder: Symptoms

The main feature of OCD is recurring obsessions or compulsions. These symptoms often occur together. The obsessions and compulsions create a lot of inner tension and are mostly associated with fear.


Compulsions are irrational acts performed by the subject. It is often about averting a possible misfortune. The content of the actions does not have to be in a rational connection with the fears. For example, a mother might fear that something bad will happen to her children if she forgets to turn off the lights. Out of fear for her children, she constantly checks the light switches.

Frequent forms of compulsive behavior are, for example, the compulsion to clean and the compulsion to keep things in order. When cleaning is compulsory , those affected have to clean the apartment or objects again and again. The need for order goes hand in hand with a compulsive desire for uniformity and symmetry. For example, the pens on the desk may need to be lined up exactly parallel, or all the shirts need to be folded to exactly the same size. Deviating from this requirement is unbearable for those affected.

Many also suffer from counting and repetition compulsions , in which they feel a compulsion to perform certain actions a certain number of times. If people make a mistake in their rituals or feel that they weren’t thorough enough, they have to start all over again. Due to the increasing complexity of the rituals, a compulsion may at some point take several hours to complete.

Whether obsession or compulsive action – those affected are well aware of the senselessness of their thinking and behavior and they are ashamed of it. They keep trying to resist the coercion, but this is only successful for a short time and with great effort.


Obsessions take the form of intrusive ideas, images, or impulses. Often they have violent, sexual or blasphemous content. For more information on signs and treatment of compulsive thinking, see Obsessive-compulsive thinking .

Obsessive Compulsive Disorder: Causes and Risk Factors

How obsessive-compulsive disorder develops is not yet clear. Family research and twin studies show that, as with most mental illnesses, there is a hereditary predisposition to OCD. For it to break out, however, other factors must also be present.

This includes, for example, childhood experiences that have led to a person being more insecure and having a stronger need for control. Obsessive-compulsive disorder is often preceded by a particularly stressful experience or life crisis. With the help of the compulsory ritual, the affected person regains the lost feeling of security – the external insecurity is balanced by an internal structure. But this certainty is deceptive: if the compulsory ritual is not carried out, the fear will come back with a vengeance. In the long term, it gets worse and worse, making the OCD worse – a vicious circle.

changes in the brain

It is now known that in people with OCD the frontal lobe of the brain is overactive. Among other things, it controls the so-called basal ganglia . These are brain structures that are responsible for motor processes. This hypothesis is corroborated by the fact that people whose basal ganglia are affected by tumors or head injuries often develop obsessive-compulsive disorders.

In addition, the serotonin balance in the brain seems to be disturbed in people with OCD. Serotonin is an important neurotransmitter. Many patients are helped by drugs that increase serotonin levels.

environmental influences

In interaction with one’s own personality and biological conditions, bringing up can also contribute to the development of obsessive-compulsive disorder. Children, who tend to be anxious, are made even more insecure by their parents’ overprotective behavior. They learn from their parents to avoid threatening situations instead of facing them. Parents who are very critical of their children or who have perfectionist demands can also promote obsessive-compulsive disorder in their offspring.

As mentioned above, obsessive-compulsive disorder is often triggered by stressful events. Any overload creates a desire for control. However, if the situation is not manageable for the person, obsessions and compulsions serve as a distraction. Second, obsessive-compulsive thoughts and actions provide people who are anxious and have an increased need for security with the illusion of being able to control events that are fundamentally uncontrollable. They hope, for example, to be able to avert misfortunes through certain rituals.

Obsessive Compulsive Disorder: Investigations and Diagnosis

Those affected are often ashamed of their compulsions because they recognize them as nonsensical. They find it difficult to confide in a psychologist or doctor. However, sufferers should realize that the odd thoughts and actions are part of OCD and many people wrestle with the same or similar compulsions. Above all, compulsions usually do not go away on their own. It is therefore important to be open and honest with the doctor or psychologist so that they can identify and treat the OCD.

diagnostic criteria

For the diagnosis of obsessive-compulsive disorder, the therapist uses the ICD-10 classification of mental disorders as a guide. The following criteria must apply:

1. People have obsessions and/or compulsions most days for at least two weeks.

2. The obsessions and actions show the following characteristics:

  • Those affected know that the thoughts/actions are their own and are not generated by outside influences.
  • The thoughts/actions are repeated over and over again, are perceived as unpleasant and recognized as exaggerated or nonsensical.
  • People try to resist the obsessive thoughts or actions.
  • Those affected find the execution of the compulsive thoughts or actions unpleasant.
  • Those affected suffer from the obsessive-compulsive disorder and the associated enormous expenditure of time limits them in their professional and social life.


In a first interview ( anamnesis ), the doctor or therapist will ask questions to determine whether the criteria mentioned apply to the person. The obsessive-compulsive disorder expert might ask the following questions:

  • Do you often have unpleasant thoughts that come to you?
  • Do you feel an inner pressure to do certain actions over and over again?
  • Do you find these thoughts or actions absurd?
  • Do you worry that something bad might happen if you don’t do the actions?
  • Do you need a long time for everyday activities?

Obsessive Compulsive Disorder: Treatment

Cognitive behavioral therapy shows the best treatment successes. In addition, medication can be helpful.

Cognitive Behavioral Therapy

At the beginning, the therapist discusses the concrete procedure with the patient. One method in cognitive behavioral therapy is exposure exercises , which are considered to be particularly effective. In these exercises, the patient is confronted with the stimulus that normally triggers his compulsive behavior without being allowed to give in to the internal pressure. Someone who has a compulsion to keep things tidy, for example, has to mess up their closet and is then not allowed to sort the clothes again. The exposure can be such that the challenges are increased from time to time, or the person concerned is confronted with his greatest fear right at the beginning of the therapy.

While the urge to follow the usual ritual initially seems overpowering, the patient experiences how the pressure slowly eases – even without giving in to the compulsion. Through this conscious experience, he regains some control over his behavior. However, at the beginning of the obsessive-compulsive disorder therapy, it may take several hours for this effect to set in.

To cope with obsessive thoughts , patients are asked to allow the unpleasant thoughts. Because suppressing them means that they occur even more frequently. If those affected get involved and deal directly with the thoughts, they can overcome their compulsions.

In addition, the behavioral therapist explains to the patient how compulsions arise and helps him to change unfavorable thought patterns.

Stress reduction methods such as autogenic training , progressive muscle relaxation or mindfulness training also have a supportive effect.

OCD: Medication

So-called selective serotonin reuptake inhibitors (SSRIs) – a special group of antidepressants – help a large proportion of obsessive-compulsive disorders. They usually have to be dosed significantly higher than in the treatment of depression. Taking SSRIs reduces the inner tension in most of those affected. The obsessional symptoms below. However, they usually do not disappear completely and come back even after the medication has been stopped. Accompanying cognitive behavioral therapy is therefore always recommended.

Tips for relatives

Obsessive-compulsive disorder is a burden not only for the patient, but also for everyone who lives with them. The time-consuming compulsions are also at the expense of the partner and family. Sometimes they are even asked to submit to the compulsion, for example by having to comply with exaggerated hygiene rules themselves.

The following tips can help relative to cope with the difficult situation:

  • The patient can only control the forced ritual to a limited extent and with great effort. The call to pull yourself together and discussions about the pointlessness of doing so do not help. The only thing that really helps is therapy.
  • Therefore, encourage the affected person to seek therapeutic help.
  • Do not support the victim in his ritual. For example, don’t help him check all electrical appliances before leaving the house or count things for him to calm him down. In the long run, this only stabilizes the compulsive behavior.
  • Praise him for progress, but don’t criticize him if symptoms worsen again – for example, when the sufferer is under pressure. Such fluctuations in symptom severity are normal.
  • Do not allow yourself to be taken over by the compulsion of the person concerned. Continue to pursue your hobbies, meet friends, and try to do something with the OCD as much as you can.
  • Set clear boundaries for what you are willing and not willing to put up with.
  • If you feel frustrated and angry at times (and it’s inevitable!), make it clear that this relates to the symptoms and not to the sufferer.

Obsessive-compulsive disorder: disease course and prognosis

Obsessive-compulsive disorder is usually chronic. Symptoms worsen with stress.

In the past, obsessive-compulsive disorder was considered almost untreatable. With today’s methods of psychotherapy and certain medications, however, the symptoms can usually be reduced to a tolerable level. The following applies: The earlier the therapy starts, the better the prognosis. However, those affected who also suffer from depression have worse prospects.

Long-term studies have shown that the condition of about two-thirds of the treated patients has improved or greatly improved two to six years after the end of therapy compared to before. However, a complete cure for OCD is very rare.

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