Millions of individuals contend with obsessive-compulsive disorder (or OCD), with many more thought to face the disorder’s specific symptoms. 2.3% of US adults, in addition to 1-2.3% of US children and adolescents face this condition. The destabilizing symptoms of OCD can severely harm one’s quality of life and negatively impact their ability to function. Its effects have resulted in a growing number of patients asking—is OCD curable? Read on to find out.
Obsessive-compulsive disorder is mainly composed of obsessive thoughts and compulsive behavior (and sometimes thoughts). While the following chapter lists the many aspects of this disorder over which there are still disputes, the above definition of OCD is universally agreed upon as its two main features.
So, what are obsessive thoughts, specifically in regard to OCD? According to the World Health Organization (WHO) and the American Psychiatric Association (APA), these are defined as intrusive, unwanted, and adverse thought content that forces the individual experiencing them to focus their attention on a certain topic they find extremely unpleasant. The four most common OCD themes are:
Worrying about such topics within an OCD context causes individuals a great deal of anguish, frustration, eventually wearing them down and depleting their energy levels and emotional and mental reserves.
The other side of this disorder is made up of compulsive behavior/thinking, collectively referred to as compulsive or compulsive acts. Initially, these acts are carried out in an attempt to rid themselves of their obsessive thinking: an individual drawn to obsessively imagine their family being attacked by a pack of dogs might develop the habit of snapping their fingers to ward off these thoughts. A compulsive thought could be to imagine the word “SAFETY,” thereby replacing the violent image they had previously held with a (momentarily) calming one.
Yet over time, though, such compulsive acts cease to have a calming effect, and instead are incorporated into the very disorder they were meant to alleviate. As a result, the same individual would eventually feel compelled to snap their fingers each time they thought of their family being attacked, without receiving any calming benefit from their action.
Despite receiving a great deal of focus over the past several years, much about OCD remains a mystery—including its root cause.
The APA, for example, currently defines OCD as an anxiety-centered disorder, and positions OCD in close proximity to the anxiety disorders chapter it grew out of. According to the APA, OCD is caused by an intense, persistent fear that is normally experienced when faced with immediate danger. With OCD, it is assumed the survival mechanism of fear, which typically acts to keep one from harm’s way, is kicked into overdrive: as a result, an individual with OCD might find themselves intensely concerned with matters of contamination (in the case of cleanliness OCD), the thought of finding themselves in the midst of a gruesome car crash (in case of catastrophizing OCD), and more.
More recently, though, research on OCD has pointed to distress as a possible cause for OCD. Studies looking into this hypothesis claim OCD is not so much experienced as a variant of fear or anxiety, but as nagging and extremely unpleasant thought content. Those with cleanliness OCD, for example, are not necessarily afraid of catching an illness, as they are exhausted from the bombarding concerns over the possibility of contracting an illness, regardless of whether they believe this is likely to occur.
Even beyond the root of this condition, OCD continues to pose questions about the mechanism behind it. Specific OCD-related neurological pathways and genetic pathways have been identified, further distinguishing it from the anxiety-centric disorders it used to be grouped with. Moreover, many patients with OCD show a significant response to two particular types of treatment—selective serotonin reuptake inhibitors (SSRIs), and cognitive behavioral therapy (CBT). And so, while OCD continues to be officially seen as an anxiety disorder, a diverse array of evidence has been highlighting the unique path that leads to this condition, be it biologically, cognitively, or emotionally.
When left untreated, OCD typically becomes a chronic condition, with symptoms often disappearing and reappearing over time, as well as changing in their severity.
Without treatment, remission rates among adults with OCD are low, with the APA settling full remission rates at 20% for those who have been re-evaluated over 40 years. Additional sources have found that between 10-20% of patients reach full recovery from this condition.
For many patients, OCD can be a continuous factor in their lives, and depending on their approach to it, can become an aspect they work to live with and minimize. Indeed, when dealing with such a persistent disorder, it is important to remain realistic when discussing a treatment’s outcome. For this reason, many OCD researchers study the more modest treatment response, in addition to full treatment recovery.
The goal-oriented CBT and serotonin-focused SSRIs, for instance, have each shown impressive rates of OCD treatment response. Recent years have noted a 25% CBT treatment response, finding that many patients with OCD exhibit less severe or less frequent OCD symptoms following this treatment. Due to their proven safety and relatively high efficacy, both SSRIs and CBT have been FDA-approved to treat OCD.
Exposure-response therapy (ERP), an offshoot of the cognitive psychotherapy revolution, has also been recognized as a particularly effective OCD treatment. The OCD Foundation lists it as a top form of treatment, stating that seven out of ten patients with OCD experience a 40-60% symptom reduction following this form of therapy.
More recently, transcranial magnetic stimulation (TMS) has been FDA-cleared to treat OCD due to its safety and efficacy. The medical device treatment has shown impressive results among patients, with studies noting an initial 38% response rate among patients with OCD, a significantly higher percentage than patients in the sham group, who did not receive this treatment. One month after the TMS treatment, the response rate was even higher and greater than the sham group’s at 45%.
Empirically tested and reproduced treatments such as the ones mentioned above offer patients with OCD greater agency over their condition, while protecting their health and safety. Many have also found benefit in combining different treatment types—under the supervision of a licensed and experienced healthcare provider. As with all types of medical care, it is important to consult with a physician or mental health professional when considering what treatment may be right for you.
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