Obsessions are persistent thoughts, ideas, impulses, or images that seem to invade a person’s consciousness. Compulsions are repetitive and rigid behaviors or mental acts that people feel they must perform in order to prevent or reduce anxiety.

According to DSM-5, OCD is diagnosed when obsession and compulsion feel excessive or unreasonable, they cause a lot of stress, they take too much time, and they interfere with daily life. OCD is not listed as an anxiety disorder in DSM-5, but anxiety is a big part of it. Here, obsession causes intense anxiety, and compulsions are done to reduce anxiety. If a person tries to resist their obsession or compulsion, anxiety rises.

Features of Obsessions

Obsessions are unwanted thoughts that keep coming back. People know these thoughts do not make sense, but they cannot stop them. Trying to ignore them often makes them worse. Common forms of obsessions are wishes, impulses, images, ideas, and doubts. Common themes in obsessions are dirt and contamination (most common), violence and aggression, order and symmetry, religion, and sexuality. These themes can vary from culture to culture.

Features of Compulsions

Compulsions are repeated actions or mental rituals that a person feels they must do, even though they know it does not make sense. People feel they have no choice, and they believe something bad will happen if they do not do it. Doing the compulsion gives short-term relief from anxiety. Common types of compulsions include cleaning compulsions, checking, order and symmetry, and counting, touching, or verbal rituals. Most people with OCD have both obsession and compulsion, but some may have only one.

Psychodynamic Perspective on OCD

Psychodynamic theorists believe OCD happens because of a conflict between id impulses (unwanted desires) and ego defenses (ways to reduce anxiety). In OCD, this conflict is visible in thoughts and actions, not hidden in the unconscious. Obsessive thoughts represent id impulses, and compulsive actions represent ego defenses.

Three common ego defense mechanisms in OCD are isolation, undoing, and reaction formation. Sigmund Freud linked OCD to developmental problems in the anal stage (around 2 years old) during toilet training. This cause intense rage, anger, and shame. Other theorists told that such early rage or angry reaction comes from insecurity. Children feel strong aggressive impulses but also feel they must control them. This conflict leads to OCD.

Psychodynamic therapists use techniques like free association and interpretation. Research shows that traditional therapy is not very effective.

Cognitive Perspective of OCD

Cognitive therapists explain OCD by pointing out that everyone has repetitive, unwanted, and intrusive thoughts, and most people can ignore them. But people with OCD cannot ignore them. Instead, they blame themselves for these thoughts and believe something bad will happen because of them. To avoid negative outcomes, they try to neutralize the thoughts by asking for reassurance, washing hands, checking things over and over, and others. When these actions reduce anxiety, the person repeats them. Over time, these become obsessions or compulsions. When people are depressed, have high moral status, they can develop OCD.

Biological Perspective of OCD

According to biological perspective, OCD is linked with biological factors. Family pedigree studies show that this disorder is developed in 53% of cases in identical twins and 23% of cases in fraternal twins. Research found two main areas caused OCD.

First, abnormally low activity of the neurotransmitter. Low activity of serotonin plays an important role in OCD. Serotonin is a neurotransmitter or brain chemical that carries messages from neuron to neuron. Other neurotransmitters, such as glutamate, GABA, and dopamine also play an important role in this disorder.

Second, abnormal brain structure and functioning. OCD is also linked with problems in specific parts of the brain, especially the orbitofrontal cortex and the caudate nuclei (thalamus). These areas are a part of brain circuit, which converts sensory informations into thoughts and actions. The circuit begins in the orbitofrontal cortex, which creates strong impulses. These impulses go to the caudate nuclei, which act like filters and passes only important ones. Then it go to the thalamus, where the person thinks and act on it.

In people with OCD, the orbitofrontal cortex and caudate nuclei are over-reactive. Cingulate cortex and amygdala may also play a role.