Is paranoia part of ocd

Paranoia And How It Is Linked To OCD

  • Overview
  • What Is OCD?
  • What Is paranoia?
  • The link between OCD and paranoia
  • Treatment options for OCD
  • When to see a doctor
  • The lowdown

Most people have heard the terms "paranoia" and "OCD." Both terms come with numerous misconceptions, which can be harmful to a person suffering from them. Paranoia and OCD can make everyday life more difficult, especially when it comes to maintaining friendships and relationships.

OCD and paranoia may be related, and it is possible to experience both at the same time. Learn more about what OCD and paranoia are and how they may be linked. 

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OCD, or obsessive-compulsive disorder, is a mental disorder characterized by obsessive or repeating thoughts and rituals or compulsive behaviors. People with OCD may have fears about various things, including germs or getting sick, acting impulsively and hurting themselves or others, or doing something wrong that leads to harm. 

OCD can be diagnosed in people from all backgrounds, though there does appear to be a genetic link. Families with OCD are approximately four times¹ more likely to develop OCD than families without a history of the condition. However, having a family member with OCD doesn't guarantee that you will also develop it.

Paranoia can be described as feelings or thoughts that someone or something is threatening you, even if you don't have evidence that you are in danger. People experiencing paranoia may not even worry about physical threats, like someone wanting to harm them. Instead, they may have fears that people purposely upset them or that others are striving to make them look bad.  

It can be difficult to determine whether you are experiencing paranoia or actually in danger. Thoughts are typically paranoid when nobody else shares suspicion, there is no evidence for the thought, but there is evidence against it, and your suspicions are based more on feelings than facts. Paranoia may be mild, or it can become incredibly severe, making it difficult to operate daily. Paranoia may also stem from other mental illnesses such as paranoid schizophrenia, paranoid personality disorder, and delusional disorder. 

OCD and anxiety are commonly diagnosed together, as OCD is an anxiety-based disorder. People with OCD develop real fears of a range of things, which can cause anxiety when they are exposed to their fears. As a result, they rely on compulsive behaviors to try to keep their fears at bay, but they often worsen their condition.

Paranoia is also related to anxiety, as having untreated anxiety can cause paranoid thoughts and feelings. Paranoid thoughts can also make you anxious. Anxiety tends to make people feel more on edge and wonder if they are in danger at any given moment, which is consistent with paranoia. OCD and anxiety produce extreme worries that can be difficult to contain, leading to paranoia.

If, however, you can address your OCD and/or anxiety, your paranoia should begin to decrease in severity. The treatment options for all three conditions are similar. In some cases, OCD can trigger paranoia.  

Because paranoia can be attributed to OCD, getting the right treatment for your OCD should help to resolve your issues with paranoia too. 

Some of the most common treatment options for OCD include:

Cognitive-behavioral therapy

Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that involves discussions with a trained therapist about your thought patterns and compulsive behaviors. Your therapist may ask questions about why you think you feel or think certain things, and they may help you develop new coping strategies when you feel your thoughts getting out of hand.

CBT for OCD² often also includes exposure and response prevention (ERP), which involves facing your fears in a safe and controlled environment, so you can eventually overcome them. 


Medications can also prove helpful for OCD, especially if CBT is too difficult at first. Antidepressants can help slow your mind and lessen some of the obsessive thoughts you experience, which can make you more open and available to CBT and ERP.

Your doctor may start you off on a small dose and gradually increase it until you see results, or you may have to try a few different medications until you find the one that works best for you. It can take several weeks to feel the effects of medications, but they can make a big difference in OCD symptoms over time. 

Support groups

Support groups can provide a space for people with OCD to come together and share their experiences. They also offer a space where people with the condition can share different strategies that have helped them cope and seek advice from their peers about how to deal with certain situations.

Talk to your doctor or therapist about joining a support group near you, or check the International OCD Foundation's support group database.³ 

If you believe you have OCD, scheduling an appointment to talk with your doctor may be helpful. If your symptoms have begun to interfere with your work, school, or home life, including difficulties maintaining relationships, you should see a doctor immediately. 

If you are noticing more paranoid thoughts, regardless of OCD, it may be helpful to speak with your doctor about your symptoms. They may be able to refer you to a specialist that can run more evaluations and offer treatment options. 

OCD is a challenging condition that can make life incredibly complicated for the person suffering from it, as well as the loved ones trying to support them. With proper treatment, people with OCD can overcome their fears, obsessions, and compulsions, and they can still live happy and fulfilling lives. If you think you or a loved one may be experiencing OCD or paranoia, you should speak to a doctor to discuss your concerns.

Is it Anxiety, OCD, or Psychosis?

Recently someone asked me a question regarding the relationship between anxiety and paranoia. They reported feeling paranoid and were wondering if treatment for anxiety would help them feel better. Being paranoid means very different things to people with anxiety, Obsessive-Compulsive Disorder (OCD), or psychosis and it's helpful to know the difference.

What does paranoia mean?

Sometimes people use the word paranoia to mean someone is worried, preoccupied, or fearful of something happening. Other times paranoia is used to describe a mental illness where someone has lost touch with reality.

Let's get a few definitions out of the way thanks to the Merriam-Webster dictionary.


1. Mental illness characterized by systematized delusions of persecution or grandeur usually without hallucinations

2. A tendency on the part of an individual or group toward excessive or irrational suspiciousness and distrustfulness of others


1.  Something that is falsely or delusively believed or propagated 

2. A persistent false psychotic belief regarding the self or persons or objects outside the self that is maintained despite indisputable evidence to the contrary


An irresistible persistent impulse to perform an act (such as excessive hand washing)

If you know someone who is paranoid or are curious about the best ways to provide support, download this free PDF guide:  21 Guidelines on how to help someone with psychosis

Anxiety and paranoia

People with anxiety can be worried and fearful. They may feel paranoid that something bad is going to happen but they are not psychotic. Their anxious response may be out of proportion to the risk of the feared event but that doesn't mean they are delusional.

A person with anxiety has worries that are grounded in reality. This means that what they are worried about COULD happen even though it may be unlikely (or even highly unlikely) to happen.

Examples of paranoia: Anxiety and paranoia

  • "I don't want to leave the house because I'm paranoid that I may need a bathroom. I won't be able to find one and will have an accident."
  • "I'm paranoid I have germs and I'm going to spread them. I have to wash my hands before and after I touch anything."
  • "I'm so paranoid about losing the keys I've hidden copies all around."
  • "I installed an alarm system, video camera, and deadbolt on my front door because I'm paranoid about being robbed."
  • "I'm paranoid that if I go to that party everyone will stare at me and no one will talk to me. I will stand there alone looking dumb and humiliate myself."
  • "I'm paranoid that if I get on a train I will have a panic attack and not be able to get off."

For people with anxiety, paranoia and fear can lead to avoidance and isolation. Anxiety can take over and control peoples lives if it isn't treated. For more information about how to manage and control anxiety read these posts:

 5 Ways to Stop a Panic Attack,

Do What You are Afraid Of: Stop Letting Anxiety Control You,

Anxiety: The Best Websites, Books, and Apps to Treat It.

OCD and paranoia

This can get a bit more complicated when someone has anxiety associated with Obsessive Compulsive Disorder (OCD). With OCD, people can have fears about a bad thing happening if they don't do a particular action (ie. their compulsion). The link between the two events may be illogical and not reality-based but the person is not psychotic. A person with OCD has not lost touch with reality even if the things they worry about aren't always rational.

Someone with OCD knows that following a regimented routine to wash dishes will not really prevent a loved one from getting in a car accident. They know it makes no sense but the anxiety is too intense for them to easily stop their ritual.

OCD is a "disease of doubt" where people feel they can't quite trust their brains. They often think "What if I didn't actually check it correctly? What if I thought I did but I looked at the wrong knob?"

It doesn't matter if they already rechecked it 10 or 20 times, some people with OCD will continue to feel anxious they left a stove on, the door unlocked, or the car running.

Despite the strength of these worries, people with OCD know that the obsessions and compulsions are irrational. However, just knowing they aren't real doesn't mean a person can stop them without getting treatment.

Examples of paranoia: OCD and paranoia

  • They may convince themselves they ran over someone on the way to work and retrace their drive for hours. Unable to eliminate the worry, they may later scour the news for any reports of a hit and run or even call the police to ask if anyone was hit.
  • "If I don't tap this object 4 times and start walking with my left foot first something bad may happen. A train may crash."
  • "If I don't look at that sculpture first when I walk in the room and cross myself 3 times, someone in my family may get cancer and it will be my fault."


Psychosis and paranoia

Psychotic paranoia is a worry that is not grounded in reality. The thoughts are delusional and cannot possibly happen. The reasoning may be bizarre and illogical.

A person with psychotic paranoia isn't aware their thoughts are not real. It is not helpful to tell them they don't make sense or argue with them that it cannot happen.

Psychosis can be terrifying. Some people with paranoia feel constantly under attack and scrutiny. Everything feels unsafe. They may feel close family members have been replaced with imposters, or even their own bodies are being controlled by outside entities.

It can be difficult to know the best way to support someone who is in the midst of psychosis. I put together a list of 21 recommendations to keep communication lines open and increase the chance to be helpful.

Get your free PDF: 21 Guidelines on how to help someone with psychosis


Examples of paranoia: Psychosis and paranoia

  • "There are people breaking into my house every night and sprinkling dust all over my house to poison me."
  • "My skin is being peeled off in my sleep by aliens and replaced by other peoples skin. "
  • "The government is trying to capture and kill me. They have implanted me with tracking devices so I cannot escape. Everywhere I go there is someone following me. They are listening to us right now."
  • "The wiring in my house is set to a particular frequency that causes my food to spoil."
  • "My body was replaced by someone else's body that I don't recognize."

Paranoia, Fear, and Worry

Paranoia can be upsetting and scary regardless if the source is anxiety, OCD, or psychosis. If you are struggling to overcome paranoia, fear, and worry; seek help from your psychiatric physician. Together you can come up with a treatment plan, find a way to help feel more at peace, and free yourself from the limitations set on your life because of the fear.

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A version of this article was first published here, on the blog of Dr. Melissa Welby

Obsessive-compulsive disorder

A prominent role among mental illnesses is played by syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which received its name from the Latin terms obsessio and compulsio.

Obsession (lat. obsessio - taxation, siege, blockade).

Compulsions (lat. compello - I force). 1. Obsessive drives, a kind of obsessive phenomena (obsessions). Characterized by irresistible attraction that arises contrary to the mind, will, feelings. Often they are unacceptable to the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as wrong and painfully experienced by them, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsions is also used in a broader sense to refer to any obsessions in the motor sphere, including obsessive rituals. nine0003

In domestic psychiatry, obsessive states were understood as psychopathological phenomena, characterized by the fact that phenomena of a certain content repeatedly appear in the mind of the patient, accompanied by a painful feeling of coercion [Zinoviev PM, 193I]. For N.s. characteristic involuntary, even against the will, the emergence of obsessions with clear consciousness. Although the obsessions are alien, extraneous in relation to the patient's psyche, the patient is not able to get rid of them. They are closely related to the emotional sphere, accompanied by depressive reactions, anxiety. Being symptomatic, according to S.L. Sukhanov [1912], "parasitic", they do not affect the course of intellectual activity in general, remain alien to thinking, do not lead to a decrease in its level, although they worsen the efficiency and productivity of the patient's mental activity. Throughout the course of the disease, a critical attitude is maintained towards obsessions. N.s. conditionally divided into obsessions in the intellectual-affective (phobia) and motor (compulsions) spheres, but most often several of their types are combined in the structure of the disease of obsessions. The isolation of obsessions that are abstract, affectively indifferent, indifferent in their content, for example, arrhythmomania, is rarely justified; An analysis of the psychogenesis of a neurosis often makes it possible to see a pronounced affective (depressive) background at the basis of the obsessive account. Along with elementary obsessions, the connection of which with psychogeny is obvious, there are “cryptogenic” ones, when the cause of painful experiences is hidden [Svyadoshch L.M., 1959]. N.s. are observed mainly in individuals with a psychasthenic character. This is where apprehensions are especially characteristic. In addition, N.S. occur within the framework of neurosis-like states with sluggish schizophrenia, endogenous depressions, epilepsy, the consequences of a traumatic brain injury, somatic diseases, mainly hypochondria-phobic or nosophobic syndrome. Some researchers distinguish the so-called. "Neurosis of obsessive states", which is characterized by the predominance of obsessive states in the clinical picture - memories that reproduce a psychogenic traumatic situation, thoughts, fears, actions. In genesis play a role: mental trauma; conditioned reflex stimuli that have become pathogenic due to their coincidence with others that previously caused a feeling of fear; situations that have become psychogenic due to the confrontation of opposing tendencies [Svyadoshch A.M., 1982]. It should be noted that these same authors emphasize that N.s.c. occurs with various character traits, but most often in psychasthenic personalities.

Currently, almost all obsessive-compulsive disorders are united in the International Classification of Diseases under the concept of "obsessive-compulsive disorder".

OKR concepts have undergone a fundamental reassessment over the past 15 years. During this time, the clinical and epidemiological significance of OCD has been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and causes a high percentage of morbidity, which requires the urgent attention of psychiatrists around the world. Parallel to this, our understanding of the etiology of OCD has broadened: the vaguely formulated psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm that explores the neurotransmitter disorders that underlie OCD. And most importantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the prospects for recovery for millions of OCD patients worldwide. nine0003

The discovery that intense serotonin reuptake inhibition (SSRI) was the key to effective treatment for OCD was the first step in a revolution and spurred clinical research that showed the efficacy of such selective inhibitors.

As described in ICD-10, the main features of OCD are repetitive intrusive (obsessive) thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is the syndrome of obsession, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise in addition to the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessional impulses or ideas are recognized as alien to the personality, but as if coming from within. Obsessions can be the performance of rituals designed to alleviate anxiety, such as washing hands to combat "pollution" and to prevent "infection". Attempts to drive away unwelcome thoughts or urges can lead to severe internal struggle, accompanied by intense anxiety. nine0003

Obsessions in the ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by an indicator of 1. 5% (meaning "fresh" cases of diseases) or 2-3%, if episodes of exacerbations observed throughout life are taken into account. Those suffering from obsessive-compulsive disorder make up 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally. nine0003


The problem of obsessive-compulsive disorders attracted the attention of clinicians already at the beginning of the 17th century. They were first described by Platter in 1617. In 1621 E. Barton described an obsessive fear of death. Mentions of obsessions are found in the writings of F. Pinel (1829). I. Balinsky proposed the term "obsessive ideas", which took root in Russian psychiatric literature. In 1871, Westphal coined the term "agoraphobia" to refer to the fear of being in public places. M. Legrand de Sol [1875], analyzing the features of the dynamics of OCD in the form of "insanity of doubt with delusions of touch, points to a gradually becoming more complicated clinical picture - obsessive doubts are replaced by ridiculous fears of" touch "to surrounding objects, motor rituals join, the fulfillment of which is subject to the whole life sick. However, only at the turn of the XIX-XX centuries. researchers were able to more or less clearly describe the clinical picture and give syndromic characteristics of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and adolescence. The maximum of clinically defined manifestations of obsessive-compulsive disorder is observed in the age range of 10-25 years. nine0003

Main clinical manifestations of OCD:

Obsessional thoughts - painful, arising against the will, but recognized by the patient as their own, ideas, beliefs, images, which in a stereotyped form forcibly invade the patient's consciousness and which he tries to resist in some way. It is this combination of an inner sense of compulsive urge and efforts to resist it that characterizes obsessional symptoms, but of the two, the degree of effort exerted is the more variable. Obsessional thoughts may take the form of single words, phrases, or lines of poetry; they are usually unpleasant to the patient and may be obscene, blasphemous, or even shocking. nine0003

Obsessional imagery is vivid scenes, often violent or disgusting, including, for example, sexual perversion.

Obsessional impulses are urges to do things that are usually destructive, dangerous or shameful; for example, jumping into the road in front of a moving car, injuring a child, or shouting obscene words while in society.

Obsessional rituals include both mental activities (eg, counting repeatedly in a particular way, or repeating certain words) and repetitive but meaningless acts (eg, washing hands twenty or more times a day). Some of them have an understandable connection with the obsessive thoughts that preceded them, for example, repeated washing of hands - with thoughts of infection. Other rituals (for example, regularly laying out clothes in some complex system before putting them on) do not have such a connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if that fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of the onset of insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities. nine0003

Obsessive rumination (“mental chewing gum”) is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some obsessive doubts relate to actions that may have been incorrectly performed or not completed, such as turning off the gas stove faucet or locking the door; others concern actions that could harm other people (for example, the possibility of driving past a cyclist in a car, knocking him down). Sometimes doubts are associated with a possible violation of religious prescriptions and rituals - “remorse of conscience”. nine0003

Compulsive actions - repetitive stereotypical actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his relatives.

In addition to the above, in a number of obsessive-compulsive disorders, a number of well-defined symptom complexes stand out, and among them are obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek. phobos).

nine0002 Obsessive thoughts and compulsive rituals may intensify in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are kept. Since patients often avoid such situations, there may be a superficial resemblance to the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while after others it increases. Obsessions often develop as part of depression. In some patients, this appears to be a psychologically understandable reaction to obsessive-compulsive symptoms, but in other patients, recurrent episodes of depressive mood occur independently. nine0003

Obsessions (obsessions) are divided into figurative or sensual, accompanied by the development of affect (often painful) and obsessions of affectively neutral content.

Sensual obsessions include obsessive doubts, memories, ideas, drives, actions, fears, an obsessive feeling of antipathy, an obsessive fear of habitual actions.

Obsessive doubts - intrusively arising contrary to logic and reason, uncertainty about the correctness of committed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether windows or water taps are closed tightly enough, whether gas and electricity are turned off), doubts related to official activities (whether this or that document is written correctly, whether the addresses on business papers are mixed up , whether inaccurate figures are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the committed action, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this kind of obsession. nine0003

Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a sense of shame, repentance. They dominate the mind of the patient, despite the efforts and efforts not to think about them.

Obsessive impulses - urges to commit one or another tough or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to get rid of it. The patient is seized, for example, by the desire to throw himself under a passing train or push a loved one under it, to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented. nine0003

Manifestations of obsessive ideas can be different. In some cases, this is a vivid "vision" of the results of obsessive drives, when patients imagine the result of a cruel act committed. In other cases, obsessive ideas, often referred to as mastering, appear in the form of implausible, sometimes absurd situations that patients take for real. An example of obsessive ideas is the patient's conviction that the buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity, implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delusions. nine0003

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified, driven away by the patient from himself antipathy towards a certain, often close person, cynical, unworthy thoughts and ideas in relation to respected people, in religious persons - in relation to saints or ministers churches.

Obsessive acts are acts done against the wishes of the sick, despite efforts made to restrain them. Some of the obsessive actions burden the patients until they are realized, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in those cases when they become the object of attention of others. nine0003

Obsessive fears, or phobias, include an obsessive and senseless fear of heights, large streets, open or confined spaces, large crowds of people, the fear of sudden death, the fear of falling ill with one or another incurable disease. Some patients may develop a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of the emergence of fears (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) - an obsessive fear of some serious illness. Most often, cardio-, stroke-, syphilo- and AIDS phobias are observed, as well as the fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude to their condition - they turn to doctors of the appropriate profile, require examination and treatment. The implementation of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (general non-mental illnesses) provocations, and spontaneously. As a rule, hypochondriacal neurosis develops as a result, accompanied by frequent visits to doctors and unreasonable medication. nine0003

Specific (isolated) phobias - obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, treatment at the dentist, etc. Since contact with situations that cause fear is accompanied by intense anxiety, the patients tend to avoid them.

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of "magic" spells that are performed, despite the critical attitude of the patient to obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some that specific action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody to the patient or repeating certain phrases, etc. In these cases, even relatives are not aware of the existence of such disorders. Rituals, combined with obsessions, are a fairly stable system that usually exists for many years and even decades. nine0003

Obsessions of affectively neutral content - obsessive sophistication, obsessive counting, recalling neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient, interfere with his intellectual activity.

Contrasting obsessions ("aggressive obsessions") - blasphemous, blasphemous thoughts, fear of harming oneself and others. Psychopathological formations of this group refer mainly to figurative obsessions with pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, the absolute lack of motivation of the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add endings to the replicas they have just heard, giving an unpleasant or threatening meaning to what has been said, to repeat after those around them, but with a touch of irony or malice, phrases of religious content, to shout out cynical words that contradict their own attitudes and generally accepted morality. , they may experience fear of losing control of themselves and possibly committing dangerous or ridiculous actions, injuring themselves or their loved ones. In the latter cases, obsessions are often combined with object phobias (fear of sharp objects - knives, forks, axes, etc.). The contrasting group also partially includes obsessions of sexual content (obsessions of the type of forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals). nine0003

Obsessions of pollution (mysophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other impurities), as well as the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (glass fragments, needles, specific types of dust), microorganisms. In some cases, the fear of contamination can be limited, remain at the preclinical level for many years, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated washing of hands) or in housekeeping (thorough handling of food, daily washing of floors). , "taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually becoming more complex protective rituals come to the fore: avoiding sources of pollution and touching "unclean" objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain "sterility" in the bathroom. Stay outside the apartment is also furnished with a series of protective measures: going out into the street in special clothing that covers the body as much as possible, special processing of wearable items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go out, but do not even leave their own room. In order to avoid contacts and contacts that are dangerous in terms of contamination, patients do not allow even their closest relatives to come near them. Mysophobia is also related to the fear of contracting a disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by fears that a person suffering from OCD has a particular disease. In the foreground is the fear of a threat from the outside: the fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions. nine0003

A special place in the series of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, unlike organically conditioned involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics can shake their heads (as if checking whether the hat fits well), make hand movements (as if discarding interfering hair), blink their eyes (as if getting rid of a mote). Along with obsessive tics, pathological habitual actions (lip biting, gnashing of teeth, spitting, etc.) are often observed, which differ from obsessive actions proper in the absence of a subjectively painful sense of persistence and experience them as alien, painful. Neurotic states characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and primary school age, tics usually subside by the end of puberty. However, such disorders can also be more persistent, persist for many years and only partially change in manifestations. nine0003

The course of obsessive-compulsive disorder.

Unfortunately, chronization must be indicated as the most characteristic trend in the OCD dynamics. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and preservation of one type of manifestation (agoraphobia, obsessive counting, ritual handwashing, etc. ), a long-term stabilization of the condition is possible. In these cases, there is a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation. For example, patients who experienced fear of traveling on certain types of transport, or public speaking, cease to feel flawed and work along with healthy people. In mild forms of OCD, the disease usually proceeds favorably (on an outpatient basis). The reverse development of symptoms occurs after 1 year - 5 years from the moment of manifestation. nine0003

More severe and complex OCDs such as phobias of infection, pollution, sharp objects, contrasting performances, multiple rituals, on the other hand, may become persistent, resistant to treatment, or show a tendency to recur with disorders that persist despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.


It is important to distinguish OCD from other disorders that involve compulsions and rituals. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (eg, mixed sexual and blasphemous themes) or the rituals are exceptionally eccentric. The development of a sluggish schizophrenic process cannot be ruled out with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), and the uniformity of emotional manifestations. Prolonged obsessional states of a complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. Unlike neurotic obsessive states, they are usually accompanied by a sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations, which acquire the character of obsessions of "special significance": previously indifferent objects, events, random remarks of others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view a special, menacing significance. In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. It can also be difficult to differentiate between OCD and conditions with a predominance of generalized disorders, known as Gilles de la Tourette's syndrome. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, sticking out the tongue, and intense gesticulation. In these cases, this syndrome can be excluded by the coarseness of movement disorders characteristic of it and more complex in structure and more severe mental disorders. nine0003

Genetic factors

Speaking about hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in approximately 5-7% of parents of patients with such disorders. Although this figure is low, it is higher than in the general population. While the evidence for a hereditary predisposition to OCD is still uncertain, psychasthenic personality traits can be largely explained by genetic factors.


Approximately two-thirds of OCD patients improve within a year, more often by the end of this period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptom-free 13 to 20 years later. nine0003


Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of other diseases. In this regard, we must warn patients and their relatives against self-treatment. If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent adequate treatment. At the same time, it should be remembered that at present a visit to a psychiatrist does not threaten with any negative consequences - the infamous "accounting" was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and dispensary observation. nine0003

When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement). The apparent suffering of the patient often seems to call for vigorous effective treatment, but the natural course of the condition must be kept in mind in order to avoid the typical error of over-intensive therapy. It is also important to consider that OCD is often accompanied by depression, the effective treatment of which often leads to an alleviation of obsessional symptoms. nine0003

The treatment of OCD begins with an explanation of the symptoms to the patient and, if necessary, with reassurance that they are the initial manifestation of insanity (a common concern for patients with obsessions). Those suffering from certain obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly, but sympathetically, mitigating the symptoms as much as possible, and not aggravating it by excessive indulgence in the sick fantasies of patients. nine0003

Drug therapy

The following therapeutic approaches exist for the currently identified types of OCD. Of the pharmacological drugs for OCD, serotonergic antidepressants, anxiolytics (mainly benzodiazepine), beta-blockers (to stop autonomic manifestations), MAO inhibitors (reversible) and triazole benzodiazepines (alprazolam) are most often used. Anxiolytic drugs provide some short-term relief of symptoms, but should not be given for more than a few weeks at a time. If anxiolytic treatment is required for more than one to two months, small doses of tricyclic antidepressants or small antipsychotics sometimes help. The main link in the treatment regimen for OCD, overlapping with negative symptoms or ritualized obsessions, are atypical antipsychotics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants or other antidepressants - moclobemide, tianeptine, or with high-potency benzodiazepine derivatives ( alprazolam, clonazepam, bromazepam). nine0003

Any comorbid depressive disorder is treated with antidepressants at an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is insignificant and occurs only in patients with distinct depressive symptoms.

In cases where obsessive-phobic symptoms are observed within the framework of schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to connect traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanxol) and parenteral administration of benzodiazepine derivatives. nine0003


Behavioral psychotherapy

One of the main tasks of the specialist in the treatment of OCD is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the "harm" caused by psychotropic drugs, to convey his conviction in the effectiveness of treatment, subject to the systematic observance of the prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the OCD sufferer. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of the method of preventing a reaction with placing the patient in conditions that aggravate these rituals. Significant but not complete improvement can be expected in about two-thirds of patients with moderately heavy rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede. In panphobia, predominantly behavioral techniques are used to reduce sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Thought-stopping has been used by some experts for many years, but its specific effect has not been convincingly proven. nine0003

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient's condition may improve regardless of which particular methods of treatment were used. Until recovery, patients can benefit from supportive conversations that provide continued hope for recovery. Psychotherapy in the complex of treatment and rehabilitation measures for patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy to correct behavioral disorders and improve family relationships. If marital problems exacerbate symptoms, joint interviews with the spouse are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, need both medical and social and labor rehabilitation. In this regard, it is important to determine adequate terms of treatment - long-term (at least 2 months) therapy in a hospital with subsequent continuation of the course on an outpatient basis, as well as taking measures to restore social ties, professional skills, family relationships. Social rehabilitation is a set of programs for teaching OCD patients how to behave rationally both at home and in a hospital setting. Rehabilitation is aimed at teaching social skills to properly interact with other people, vocational training, as well as skills necessary in everyday life. Psychotherapy helps patients, especially those who experience a sense of their own inferiority, treat themselves better and correctly, master ways to solve everyday problems, and gain confidence in their strength. nine0003

All of these methods, when used judiciously, can increase the effectiveness of drug therapy, but are not capable of completely replacing drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even worsen because such procedures encourage them to think painfully and unproductively about the subjects discussed in the course of treatment. Unfortunately, science still does not know how to cure mental illness once and for all. OCD often has a tendency to recur, which requires long-term prophylactic medication. nine0003

Obsessive-Compulsive Disorder (OCD) - key facts in English


See our disclaimer that applies to all translations available on this site.

What is obsessive-compulsive disorder?

At times we can all get hung up on things, but if:

Terrible thoughts come compulsively into your head, even if you try to get rid of them,

You have to count or touch things over and over again , or repeating some actions, for example, washing hands,

You may have obsessive-compulsive disorder (OCD).

Who gets OCD?

About 1 in 50 people will experience OCD at some point in their life. Equally, it can be men and women. In the UK, their number is about 1 million people. OCD usually begins in adolescence or early adulthood. Symptoms of OCD may get worse or worse over time, but often people don't seek help for many years.

What are the signs and symptoms of obsessive-compulsive disorder?

  • Recurring thoughts that make you feel anxious - "obsessions" or "obsessions". It can be unpleasant words or phrases, mental pictures or doubts.
  • The things you do over and over again that help you feel less anxious are 'compulsions'. You can try to correct or "neutralize" thoughts by counting over and over again, saying a special word, or performing certain rituals. nine0165

What are the causes of OCD?

Many factors can play a role in the occurrence of OCD. One or more of the following could explain why you or someone you know has OCD.

  • In some cases, OCD is inherited, so sometimes the disorder can run in the family.
  • Stressful life events cause OCD in about a third of cases.
  • Life changes in which you have to take on more responsibility, such as puberty, the birth of a child, or a new job. nine0165
  • If you have OCD and it lasts for some time, you may develop an imbalance of serotonin (also known as 5HT), a brain neurotransmitter.
  • You are a neat, pedantic, methodical person - but you go too far in this.
  • If you have extremely high standards of morality and responsibility, you may feel especially bad about having unpleasant thoughts. To the point where you start to be wary and keep a close eye on them, which makes them even more likely to appear. nine0165

How to help yourself

  • If you regularly force yourself to think the thoughts that are bothering you, you will be able to control them better. You can write them down - on a recorder or on paper, and then listen to or reread. You should do this regularly, for about half an hour every day. At the same time, try to resist compulsive behavior.
  • Do not use alcohol to control your anxiety.
  • If your intrusive thoughts are about your faith or religion, discuss them with your religious leader to help you understand if OCD is a problem. nine0165
  • Try using a self-help book.

Professional help Various types of psychotherapy

Exposure and response prevention

Helps stop the mutual reinforcing of compulsive behavior and anxiety.

We know that if you stay in a stressful situation long enough, you will gradually get used to it and the anxiety will go away. In this way, you gradually face the situation that you fear (exposure), but stop yourself from doing your usual compulsive rituals of checking or clearing (avoiding a response) and wait for your anxiety to go away. nine0003

Cognitive therapy

Instead of getting rid of your thoughts, cognitive therapy helps you change how you react to them. It specifically targets unrealistic self-critical thoughts. Useful if you have intrusive thoughts but are not performing any rituals or activities to reduce your anxiety. Can be used with Exposure and Response Prevention.

Antidepressant treatment

Even if you are not depressed, SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants can help. They may be used alone or with cognitive behavioral therapy for moderate to severe OCD. If the medicine doesn't help at all after three months of taking it, you can change it to another SSRI antidepressant or a medicine called Clomipramine (Anafranil). nine0003

How effective is the treatment?

Exposure and Response Prevention

About three out of four people who completed this therapy did well, but one in four will return symptoms and require further treatment. Approximately one in four people refuse to try this type of cognitive-behavioral therapy or do not complete it - they find it too hard for them.


About six out of 10 people feel better with medication and their symptoms lessen by about half. Medications do help prevent OCD from returning for as long as they are taken, even years later. Unfortunately, about half of those who stop taking the drug return symptoms within a few months afterward. This is less likely when drug treatment is combined with cognitive behavioral therapy. nine0003

Which approach is best for me?

Mild OCD

Exposure and response prevention can be done without professional help. This method is effective and has no side effects, but you will feel more anxious for a while. You must be motivated and ready for hard work. Cognitive therapy and drug treatment are equally effective.

Moderate or severe OCD
  • Initially, you can choose either CBT (up to 10 hours in contact with a therapist) or medication (within 12 weeks). If you do not get better, you should try both treatments together. nine0165
  • If you have severe OCD, it is best to use medication and CBT together from the start.
  • Medication alone will help you if you don't feel able to face the anxiety that Exposure and response prevention will cause, but the chances of OCD coming back are higher - about one in two compared to one in four with psychotherapy treatment. The medicine must be taken for about a year and is obviously not ideal during pregnancy or breastfeeding. nine0165

The original page produced by the RCPsych Public Education Editorial Board. Series Editor: Dr Philip Timms.

Information about treatments can change rapidly and the College updates its mental health information pages regularly.

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