All of us, at one time or another, wondered if we were “OCD.” That time when you couldn’t remember if you locked the door or closed the window and went back a few times to convince yourself you had. Or when you looked in your grocery bag three time to be sure you didn’t forget to buy the ingredient you needed for the pizza you’re making for tonight’s dinner. Those are common behaviors we all exhibit, but for most people they don’t reach the level of being controlling or disturbing, but are merely examples of forgetfulness, absent mindedness, or an over-cluttered mind. Sometimes we are simply distracted from thinking clearly and don’t concentrate on the task at hand.
Obsessive-Compulsive Disorder, OCD, is a common neuropsychiatric disorder characterized by obsessions and compulsions. Obsessions are “repetitive, time-consuming, life-disrupting thoughts, images, or urges that lead to anxiety and distress.” They exist in four “dimensions” which are contamination and cleaning, worry about accidental harm that leads to repeated checking, abnormal concern about order and symmetry, and “unacceptable thoughts and mental rituals.” Examples are repeated hand washing, organizing items symmetrically so both sides are even, repeated counting of objects, and abnormal thoughts of harm or even death.
Compulsions are “behaviors or thoughts that an individual performs to reduce the anxiety and distress caused by obsessions.” Examples are repeated washing, counting, saying the same word or phrase, or repeatedly checking on something. Obsessions are the thoughts that generate the compulsions. Compulsions are the physical responses to the obsessions. Symptoms of OCD are “not attributable to the physiologic effects of drugs or medications or another medical condition.”
OCD is often misdiagnosed as anxiety, depression, Attention Deficit Hyperactivity disorder (ADHD), or a psychotic disorder. These patients are very susceptible to post traumatic stress disorder, substance abuse disorders, or impulse control problems which occur at the same time as OCD symptoms. Most often, OCD is a clinical diagnosis meaning the physician diagnoses it purely from the symptoms and occurrences the patient relates to him/her. There is a “scale” called the Yale-Brown Obsessive-Compulsive Scale that will screen for OCD as well as measure the success of therapy. Other similar scales are available for use, but have many more questions and are more time-consuming.
Once OCD is confirmed, treatment consists of SSRI’s, Selective serotonin reuptake inhibitors such as Prozac, Zoloft, or Celexa in combination with psychiatric consultation and psychotherapy. An initial 6-12 week course of medication followed by 1-2 years of maintenance drug is long enough to see if an SSRI was going to provide improvement. Whether a patient should continue on treatment depends on how he/she does during “drug holidays.” If the patient lapses into uncontrollable obsession and compulsion, it is certain he/she should remain on the treatment that controlled the symptoms.
Patients with OCD make others with whom they associate feel very uncomfortable. These folks do weird things that neither you nor they can make disappear. Their strange behavior isn’t always understood, and may be mis-interpreted as psychosis. Pharmacotherapy will control this if the patient is adherent to therapy.
So, just because you check your wallet five times a day to be sure your credit card is still there and you didn’t leave it where you last used it, you’re not really OCD. But if you look at your wallet for your card and also make trips to the merchant with whom you last used it, or can’t sleep because you’re consumed by worry you’ve lost your credit card, you may well have OCD. It is curable (remittable) so patience, diligence, and compliance to therapy are very important.
Addendum: Eli Lilly and Company in Indianapolis is the inventor of Prozac (fluoxetine). Prozac has so many justified indications that it seems it is prescribed for just about anything. Some patients are taking it for two, three, or four reasons at the same time. Now, Lilly has Zepbound and Mounjaro, two names for the same generic tirzepatide (GLP1-RA); one is for weight loss (Zepbound) while the other is for T2D (Mounjaro). This company has had the foresight and wisdom to develop drugs that work and are very popular because of the demand they fulfill. The drugs developed at Lilly have definitely been an asset to physicians, greatly benefitted human kind, and improved the wealth of the company and its employees.
References: AFP Clinical Answers. “What is the recommended treatment for obsessive-compulsive disorder?” Am Fam Phys. 2025 June;111(6):492.
Semenya AM, Bhatnagar P. Diagnosis and Management of Obsessive-Compulsive Disorder in the Primary Care Setting. AmFamPhys 2024 October;110(4):385-392.
