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Obsessive-Compulsive Disorder (OCD)

Dr. Oded Ben Harush, Medical psychologist
15 June 2025

Obsessive-Compulsive Disorder, or OCD, is a complicated mental illness that affects about 9.1% of people. The disorder is caused by problems in the communication between neurons in the brain. It causes unwanted thoughts, compulsive behaviors, checking things over and over again after doing them, and trouble making decisions. Without treatment, OCD can make it hard to do normal things in every part of life.

The behavioral addiction model is one of the ideas being put forward to explain the disorder. In this model, the behavior that happens over and over again is seen as a real addiction. To stop the behavior, the impulse must be treated.

OCD is a complicated disorder that affects many people in various ways, ranging from the need to be organized to health concerns, from checking things over and over again after doing something to having obsessive thoughts over and over again.

For a better understanding of the disorder, it is important to know how the different symptoms work and how they affect every part of life.

Repetitive behavior: a real addiction

In the past, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. However, in the fifth edition of the American Psychiatric Association's diagnostic manual, the DSM, published in 2013, OCD was redefined.

One of the models currently proposed to understand the disorder is the Behavioral Addiction Model. According to this model, the repetitive behavior is viewed as a genuine addiction for several reasons:

Tolerance

OCD intensifies over time due to increasing dependence on the behaviors—in other words, they are characterized by the development of tolerance, habituation, and diminished sensitivity as a result of the behavior, hence the need to increase the frequency and intensity of the behavior.

Reward

The repetitive behavior is driven by an uncontrollable impulse to perform various actions, despite their negative consequences. This dependence is because of the rewarding effect, which is when someone feels good after doing the compulsive behavior because they got approval for it.

Withdrawal

Withdrawal symptoms show up when you try to treat the disorder and stop the compulsive behavior. That is, the urge must be treated in order to stop the compulsive behavior (rituals).

Symptoms

  • Repeatedly checking to ensure that an action was actually performed, for example, locking a door or confirming that I said the right word during a conversation, or that it was done according to certain rules.

  • An impulse to organize items.

  • Repeated washing of hands and body, as well as cleaning various items.

  • Difficulty making decisions, accompanied by questions aimed at obtaining approval from others to perform actions and adhering to rigid rules.

Other, less familiar manifestations of OCD include:

  • Pulling out hair (trichotillomania).

  • Obsessive skin picking (dermatillomania).

  • Nail biting.

  • Hoarding (of objects, animals, or media, such as photos on phones, emails, and more).

  • An obsessive focus on physical health.

How OCD comes about

It is standard to refer to OCD not as a single disorder but as a spectrum of obsessive-compulsive disorders, characterized by inefficient behavior and inflexible thinking that disrupt daily life.

These disorders are attributed to problems in interneuronal communication within specific neural circuits. These circuits are responsible, among other things, for evaluating the results of an action and providing feedback about it. Under normal circumstances, when the correct feedback is given, these circuits prompt a rejection and delay of that action, causing it to stop. In a person with OCD, this process is dysfunctional, resulting in actions being repeated ineffectively—a situation commonly referred to as "ritual."

To illustrate this phenomenon, consider the example of an elevator door equipped with a motion sensor that detects movement to prevent the door from closing or, conversely, detects a lack of movement to confirm its closing. If the sensor malfunctions, the door will not receive a signal that "confirms" its closure, resulting in it either remaining open or continuously opening and closing until it is repaired—meaning the event does not conclude. Similarly, a person with OCD fails to "receive" confirmation that an action has been completed (for example, that the door is locked or the hands are clean), causing them to repeat the action until the confirmation is received (the ritual).

Incidence of OCD

After a shift in how we look at OCD—from seeing it as just one disorder to recognizing it as more of a spectrum—research suggests that about 9.1% of the population deals with it, with men and women affected pretty equally. A lot of folks say their OCD kicked in around puberty, but it’s worth noting that many symptoms can show up even earlier. Usually, people only seek help when it starts to really interfere with their daily lives.

Recent studies point to biological and genetic factors that contribute to the onset of the disorder. At the same time, it is important to remember that it is possible to prevent or reduce the severity of OCD with appropriate treatment early on.

The effects and consequences

If someone with OCD does not get help, it can affect every part of their life:

For example, a student with OCD may feel a frequent urge to wash his hands and therefore may frequently ask to leave the classroom, resulting in his missing significant parts of the lesson. Over a reasonable period of time, the student will find it difficult to complete the academic gaps that will accumulate. A student with intrusive thoughts about odd numbers may get a low grade on the exam because he only answered the even questions.

A student who suffers from the disorder can be focused on a thought ritual, also called a mental ritual—for example, during some routine action, the student tries to think of a positive event to avoid negative thoughts and subsequently easily and frequently loses focus. A student who asks many confirming questions will be considered a struggling student who does not understand the material being taught, while the purpose of his questions is not related to knowledge but rather a manifestation of compulsive behavior, meaning. a "ritual.".

OCD can manifest itself as intrusive thoughts pertaining to social or marital relationships and also those that are not directly related to the social arena. For example, a patient with compulsive thoughts regarding the harm she allegedly caused to her friend may apologize in a compulsive, inappropriate, and disturbing manner, ultimately resulting in the end of the relationship that she longs to maintain. Another example involves intrusive thoughts related to the doubt that arises regarding the compatibility of the relationship and that are accompanied by obsessive deliberation with the spouse on continuing the relationship—such repeated deliberation can actually lead to the termination of the relationship.

OCD may manifest as the need to finish tasks "perfectly." The obsessive preoccupation with marginal details may come at the expense of a broader view of the entire task. The general efficacy of the employee is therefore impacted, creating a delay in completing tasks and behavior that will ultimately result in termination.

On the one hand, OCD may cause patients to avoid medical examinations due to an obsession with a medical issue (hypochondria), resulting in a deterioration and complication of an existing medical problem. On the other hand, the disorder may cause harm as a result of repeated and unnecessary tests with the potential for cumulative damage (such as high-frequency exposure to X-rays).

Another common manifestation is washing rituals, which are apparently intended to maintain cleanliness and health but actually, due to the frequency of washing, may cause secondary medical problems. For example, prolonged and frequent hand washing can damage the skin, compulsive washing of the vagina results in recurring urinary tract infections, and more. Another way OCD harms health is in its manifestation with regards to appearance or body dysmorphic disorder. A patient who is dealing with the phenomenon can try to resort to cosmetic surgery to change the "damaged" body part, but the result will largely not satisfy them since the problem is in the way the brain perceives the body part and not with the body part itself. Problems may worsen with surgeries or irreversible medical procedures.

Untreated OCD tends to negatively affect other areas. For example, in the case of compulsive hoarding, which is the result of difficulty making a decision regarding an object, the objects remain where they are and "wait" for a decision to be made regarding their future. The result is that entire areas of the house eventually become filled with such objects, affecting the ability to use them properly (for example, a bed, bathroom, or kitchen that are not suitable for use due to the accumulation of objects or dirt).

Compulsive hoarding usually affects the family that is close to the patient, causes social isolation, and impairs daily functions involving body hygiene, eating hygiene, and sleep hygiene.

Impaired patterns of thinking

Obsessive-compulsive disorders manifest not only in the specific areas we mentioned but also as dysfunctional patterns of thinking. The most prominent of which are:

Problems making choices and the mental stiffness that comes from that

The process of making a decision needs "confirmation" of the choice. People with OCD have a lot of trouble with this process because their nerves don't send signals as well in the important neuronal circuits. When making choices is hard, a lot of patients would rather not do them and instead stick to rigid, but comfortable, patterns of behavior. So, the choices are already made, and there is none of the confusion that comes with having to make new choices.

Difficulty tolerating uncertainty

In our brains and in the brains of animals (yes, animals can also suffer from OCD), there are areas that are supposed to manage feelings of uncertainty. The normal dealing with everyday uncertainty involves behavior aimed at reducing the uncertainty at the cost of taking action to alleviate it. For example, if I leave the house and feel uncertain about whether I have locked the door, I can resolve the uncertainty by checking the door. Sometimes the price of the inspection is marginal - for example, returning from the elevator to the door that is a few meters away from it. Sometimes the price of the inspection is high, because it requires stopping the workday, returning home and checking the door. In such a case the role of the specific areas in the relevant neuronal circuits is to inhibit the "expensive" response and prevent the check. In people suffering from OCD, this mechanism is damaged, and despite the high price of the check, they will perform it again and again. Hence the frustration. On the one hand, the person knows that the action is unnecessary and irrational, on the other hand the urge to do it is overwhelming.

In conclusion, OCD is a spectrum of extremely varying disorders in terms of their visibility in each person and in terms of the content and the resulting behavior that characterizes every manifestation. Despite the difference, they have some common elements, including difficulty tolerating uncertainty, difficulty making decisions, use of confirming questions, and avoidance. If you or someone close to you is coping with irrational, compulsive, and obsessive thoughts, we recommend that you seek a professional assessment and diagnosis and, if necessary, begin treatment.

Dr. Oded Ben Harush, medical psychologist, founder and director of the Israeli Center for Treatment of OCD, expert member and instructor in the Israeli Association for Behavioral-Cognitive Therapy