How to Control Obsessive-Compulsive Disorder (OCD)

Select a therapist. Find a therapist who specializes in treating OCD or related disorders. You can search by asking your doctor for a recommendation, getting referrals from friends or family, or using the American Psychological Association's therapist locator tool.

• Make sure the therapist is someone with whom you feel comfortable and who is appropriately qualified to meet your needs.

Diagnosing OCD. It's crucial to see a specialist for an accurate diagnosis, as several other conditions may share similar symptoms with OCD. Your doctor will likely refer you to a trusted facility, and only a licensed mental health professional is qualified to make the diagnosis. OCD symptoms are divided into two main types: obsessions and compulsions. Obsessions are recurring, unwanted thoughts, pressures, or images that cause distress or fear. Despite your efforts to avoid or dismiss them, these thoughts or images persist. Compulsions are behaviors you perform to relieve the anxiety caused by obsessions, aimed at preventing feared outcomes, often taking the form of rituals or routines. The combination of obsessions and compulsions leads to distinctive behaviors such as:

• People who fear contamination may frequently wash their hands or clean to cope with their fear.
• Others may constantly check things (like locked doors or turned-off appliances) out of anxiety about potential dangers.
• Some individuals fear that failing to do things correctly may cause harm to themselves or loved ones.
• Many are obsessed with order and symmetry, becoming strict adherents of certain organization and arrangement methods.
• Some are terrified that discarding items will lead to bad outcomes, resulting in compulsive hoarding of unnecessary items, such as broken things or old newspapers. This is called Hoarding Obsession.
• To be diagnosed with OCD, you must experience obsessions and compulsions on most days for at least two weeks. Alternatively, if your obsessions and compulsions severely disrupt your daily life (for example, washing your hands to the point of injury or avoiding touching anything outside your home), you may be diagnosed with OCD.

Working with a therapist to manage compulsive behaviors. This treatment focuses on Exposure and Response Prevention (ERP), which involves gradually exposing you to the things you fear or are obsessed with, and then teaching you healthier ways to cope.

• Therapy sessions can be done individually, with family, or in group settings.

Discussing appropriate medications with your doctor. It may take several attempts to find the right medication, and in some cases, combining multiple medications might be more effective than using just one to alleviate symptoms.

• Common medications prescribed include selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and escitalopram (Lexapro). These medications increase serotonin, a neurotransmitter that helps regulate mood and reduces anxiety.
• Another commonly prescribed drug is the tricyclic antidepressant (TCA) clomipramine, which is FDA-approved for treating OCD. SSRIs are generally prescribed more frequently due to fewer side effects compared to clomipramine.
• Never stop taking medication without consulting your doctor, as doing so may cause a relapse in symptoms or withdrawal effects, similar to addiction.

Understanding the OCD cycle. OCD begins with an intrusive thought (such as fearing you might infect loved ones), followed by extreme interpretations (like believing you're a bad person for accidentally harming others). This thought-interpretation cycle leads to anxiety.

• To manage this anxiety, you engage in actions to prevent the feared thought from becoming reality. For instance, you may wash your hands after touching something and pray for your loved ones while doing so.
• Although this action may temporarily reduce anxiety, the negative thoughts return more frequently as you continue to try to avoid them. This is the vicious cycle of OCD.
• The main concept of ERP is to expose you to situations that trigger your obsessions, and then prevent you from performing compulsive behaviors (unnecessary actions).
• If your OCD is severe, consider undergoing ERP with the guidance of a professional.

Identifying Triggers. Whatever the source of your obsession or compulsive behavior—whether it be a situation, object, person, or specific thought—these are all considered "triggers" because they activate the OCD cycle. Recognizing these triggers is essential, as they represent the challenges you’ll face when learning to resist the compulsive responses.

• Use this form to track your triggers for a week.

Create a "Fear Hierarchy". After tracking your obsessions and compulsive behaviors for a week, rank the situations you fear from least to most frightening.

• For example, if you're afraid of germs, being at your parents' house might rank low on your fear scale, perhaps at 1/10. In contrast, using a public restroom might rank high, potentially at an 8 or 9 on the scale.
• If you have multiple sets of triggers, consider creating separate fear hierarchies for each. For instance, all health-related fears could belong to one hierarchy, while fears related to disease prevention could belong to another.

Confronting Your Fears. For exposure to be effective, it’s crucial to resist performing compulsive behaviors while, or after, facing your triggers (to the best of your ability). This is because ERP teaches you to confront your fears "without" engaging in compulsive responses.

• Next, ask a trusted person to guide you in ways to manage activities that OCD has impacted. Observing their behaviors can be helpful, as you may have been performing compulsions for so long that you’ve forgotten how to cope with the anxiety without them. For example, someone obsessed with handwashing may ask a loved one about their handwashing habits to gain a better understanding of the appropriate frequency and context for washing hands.
• If resisting compulsive behaviors proves too difficult (especially in the beginning), delay them instead of doing nothing at all. For example, after leaving your home (exposing yourself to the trigger), wait 5 minutes before re-entering to check the appliances, and check only 2 devices instead of 5. Gradually increasing the delay time will help you phase out the compulsive act.
• If you still end up engaging in compulsive behavior, immediately return to the situation that triggered your fear, and repeat the process until your anxiety is reduced by half. For instance, leave your home immediately after following the steps above and repeat everything until your fear drops from an 8 to a 4/10.

Move on to Exposure with Other Triggers. Once you feel only slight anxiety after completing an exposure task, you can proceed to the next one. For example, after several practice sessions, if waiting 5 minutes before checking the devices no longer causes significant fear, you can challenge yourself to wait 8 minutes instead.

• Remember, even if you feel extremely anxious, your fear will rise and then gradually subside. If you don't react to the anxiety, it will naturally end.
• Exposure can be a tough experience, and you shouldn’t hesitate to ask for support from others when needed.

Document Your Obsessive Thoughts. In order to challenge the assumptions stemming from your obsessions, you first need to identify them. The best approach is to begin tracking two things: (1) your obsession and (2) the meanings or inferences you attach to that obsession.

• Use this form to log three obsessions (and how you interpret them) each day throughout the week.
• Record the situations that trigger your obsession and the intrusive thoughts you experience in each situation. When did you first have this thought? What happened when you had it? Write down all the emotions you feel when the obsession occurs. Rate the level of distress on a scale from 0 (no emotion) to 10 (highest intensity).

Track Your Inferences About the Obsession. Alongside noting your thoughts, it's crucial to track how you understand or the meaning you assign to them. To identify these inferences (since this can be challenging), ask yourself the following questions:

• What is so disturbing about this obsession?
• What does this obsession say about me or my personality?
• What do I think would happen to me if I didn’t act on this obsession?
• What might occur if I don’t respond to this thought?

Challenge Your Inferences. Confronting your inferences helps you realize that your unchecked thoughts are often unrealistic for a variety of reasons. Additionally, these inferences aren’t useful in resolving the problems that the obsession raises. Ask yourself these questions to recognize where you've gone wrong:

• What evidence do I have to support or contradict this inference?
• What are the advantages and disadvantages of this way of thinking?
• Am I confusing my thoughts with actual facts?
• Are my inferences about this situation accurate or realistic?
• Am I 100% sure that this thought will come true?
• Is there any possibility that I’m completely wrong?
• Are my predictions based purely on emotions?
• Would a friend agree that the scenario I’m imagining will happen?
• Is there a more rational way to view this situation?

Learn Practical Thinking Techniques. The unnecessary inferences often stem from the twisted thinking patterns common in OCD. Some examples of common thinking traps are:

• "Catastrophizing" is when you are certain (without evidence) that the worst possible outcome will occur. Challenge this by reminding yourself that such an outcome is highly unlikely.
• "Filtering" is the trap where you focus only on the negative aspects, ignoring or dismissing the positive. To counter this, ask yourself what other aspects of the situation you may have overlooked, especially the positive ones.
• "Overgeneralizing" is when you exaggerate a specific situation to encompass all situations. For example, thinking that because you made a spelling mistake, you often make foolish mistakes. Avoid overgeneralization by considering counterexamples (such as times when you were sharp or noticed errors and corrected them).
• "Black-and-white thinking" is when you view situations in extreme terms, either all good or all bad. For instance, if you skip washing your hands once, you may think you’re irresponsible and dangerous. Combat this thinking by realistically assessing whether any harm has been caused, and remind yourself that this is not the time (or any time) to make absolute judgments about yourself.
• You can learn more about these thinking traps here.

Resist the Urge to Self-Blame. OCD is a chronic condition, and the continuous appearance of unwanted, distressing thoughts is something beyond your control. Recognize that these thoughts are simply disturbances, and they have no influence over anything outside of your mind. Thoughts are just thoughts—they do not define who you are.

Pay Attention to the Connection Between OCD and Your Lifestyle Habits. Since OCD is an anxiety disorder, stress can trigger symptoms, making it more difficult to manage them. Any lifestyle changes you can make to reduce stress and anxiety will also help alleviate OCD symptoms.

Incorporate Omega-3 Rich Foods into Your Diet. Omega-3s can directly increase serotonin levels in the brain, a neurotransmitter influenced by OCD medications. This means that these foods can also help you manage anxiety. Prioritize consuming omega-3-rich foods over supplements. These include:

• Flaxseeds and walnuts
• Sardines, salmon, and shrimp
• Soybeans and tofu
• Broccoli and winter squash

Limit Caffeine Consumption. Caffeine inhibits serotonin production in the brain. Foods and drinks containing caffeine include:

• Coffee and coffee-flavored ice cream
• Black tea, green tea, and energy drinks
• Sodas
• Chocolate and cocoa products

Try to Exercise Regularly. Exercise not only strengthens muscles and promotes cardiovascular health, but it also helps combat anxiety and OCD. When you exercise, you stimulate the release of endorphins, hormones that improve mood, reduce anxiety, and counteract depression.

• Try to exercise for at least 30 minutes, five times a week. Some examples of healthy exercises are running, cycling, weight lifting, swimming, and hiking.

Spend More Time Outdoors. Among the many benefits, sunlight increases serotonin production in the brain by preventing nerve cells from reabsorbing it. Exercising in the sun is like hitting two birds with one stone!

Manage Stress. When you’re stressed, you may notice that your symptoms (or their intensity) worsen. Learning mental and physical techniques to reduce stress is helpful. Examples include:

• Making long-term healthy lifestyle changes, such as diet and exercise
• Using a to-do list
• Limiting negative self-talk
• Practicing progressive muscle relaxation therapy
• Learning mindfulness meditation and contemplation meditation
• Recognizing the sources of your stress
• Learning to say no when asked to do something beyond your capacity

Join a Support Group. There are support groups for people facing challenges similar to yours. In these groups, you can discuss your experiences and struggles with others who understand. Support groups are incredibly helpful in reassuring and reducing the isolation often associated with OCD.

• Speak with a therapist or doctor about support groups in your area. You can also search online for nearby groups.