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Obsessive-compulsive disorder

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A constant battle rages on in people with obsessive-compulsive disorder: On the one hand, they suffer from their compulsions. On the other hand, it is difficult for them to suppress it. How does an anxiety disorder develop? What therapy options are there?

What is Obsessive Compulsive Disorder?
Obsessive-compulsive disorder is when a person repeatedly determined himself uncomfortable thoughts impose or he has the urge to certain Actions to execute. Although the person concerned considers these thoughts and actions as nonsensical feels, he feels fear and inner tension when he tries to suppress it. Compulsions occur repeatedly and persistently: for at least two weeks on most days.

Have I locked the front door? Is the stove still on? Everyone knows unpleasant thoughts and exaggerated fears that cannot be suppressed. Many have probably also experienced the urge to absolutely have to do something. Usually such thoughts or needs occur though only temporarily and isolated on.

On the other hand, those who have obsessive-compulsive disorder are plagued the same need or the same thoughts over and over again: For example, he not only washes his hands when they are actually dirty, but every ten minutes. He doesn't go back to the car every now and then to check that he's locked it, but basically after every trip.

Thus, obsessive-compulsive disorder can become a massive load become. Those affected constantly suffer from fears, limit themselves more and more, can no longer work as usual and / or get into conflicts with friends and family members.


In Germany have about 1 to 3 in 100 people in the population an obsessive-compulsive disorder. Even children can develop obsessive-compulsive disorder. Most of the time, however, the disorder occurs in or after completion of the Puberty first appeared. It's about as many men as women affected.

Obsessive-compulsive disorder often occurs along with other mental illnesses on - these include:

In addition, obsessive-compulsive disorder is common in diseases of the brain (e.g. Parkinson's, Huntington's disease).

Obsessive-compulsive disorder: causes

The causes of obsessive-compulsive disorder have not yet been fully and conclusively clarified. Doctors and psychologists currently assume that several influences were involved in the creation are. Play a role

  • the hereditary predisposition,
  • changed processes in the brain and
  • psychological factors (e.g. learning experiences that the person concerned had in his childhood).

Emotional stress as a trigger
At more than half of those affected The obsessive-compulsive disorder started with a distressing one life event such as the loss of a loved one or in an emotionally stressful phase (e.g. pregnancy, building a house).

Influence of genes

Certain hereditary factors seem to favor the development of obsessive-compulsive disorder. This is supported by the fact that Obsessive-compulsive disorders occur more frequently in families. Apparently, the more closely related someone is to someone with OCD, the more likely they are to develop the same disorder:

  • When a identicalGemini has Obsessive Compulsive Disorder shows his twin mostly also obsessive-compulsive symptoms.
  • At dizygoti Twin pairs, on the other hand, find this correspondence in less than half of all cases.

The genetic information underlying obsessive-compulsive disorder has not yet been adequately researched. What is certain, however, is that the many individual sections of the genetic information have an influence on the risk of the disease.

Influence of brain function

A person's behavior is controlled by different parts of the brain, which communicate with each other via certain paths:

  • A path sets Actions in progress and keeps this going.
  • Another Path inhibits behavior and or changes you.

There appears to be an imbalance between these two pathways in people with obsessive-compulsive disorder. The path which Behavior initiated and maintains, is excessively active. The inhibiting path is too weak to counter it. This could explain why it is so difficult for those affected to refrain from or stop compulsive acts.

In addition, the body's own messenger substance serotonin seems to play a role in the development of obsessive-compulsive disorder. Which one has not yet been clarified. What is certain is that certain drugs that increase the levels of serotonin in the brain can relieve obsessive-compulsive disorder.

Psychological explanations

There are many different theories about the development of obsessive-compulsive disorder in psychology.

Most of the wise the anxiety a special meaning to. Everyone develops strategies in the course of their development to cope with fear and other unpleasant feelings. However, people with obsessive-compulsive disorder find it particularly difficult to cope with or endure anxiety. Instead of healthy coping strategies, they develop obsessive-compulsive disorder. The ritualized acts convey them security and offer them at least temporary protection from the unbearable feeling of fear.

A recent theory suggests that having obsessive-compulsive disorder Peculiarities of perception and Information processing related. Accordingly, the thoughts that those affected describe as "obsessive-compulsive thoughts" are not pathological: Even healthy people sometimes impose inappropriate or absurd thoughts. However, you do not suffer from it. On the other hand, people with obsessive-compulsive disorder feel the intrusive thoughts as threatening and unacceptable.

The fear or tension that these thoughts trigger can be relieved for a short time by performing compulsive acts. Long term leads that Compulsive behavior however, that fear intensifies: Since those affected consistently carry out the compulsive acts, they cannot have any corrective experiences. In other words, they do not experience that nothing bad happens if they fail to act.

At the same time, those affected seem one excessively strong sense of responsibility to have. As a result, they experience themselves as a threat to others. In order not to be overwhelmed by the fear of harming others, they take excessive safety measures. These measures then become compulsive acts.

Obsessive-compulsive disorder: symptoms

There are three types of obsessive-compulsive symptoms:

Compulsive impulses or obsessive thoughts are usually the reason for compulsive behavior: those affected feel as if they are averting an impending danger through the compulsive actions. They are usually aware that their fears are exaggerated and difficult to understand for outsiders. Also are Compulsions can be uncomfortable or very time consuming. However, if those affected try to resist the coercion, they then have to struggle with severe fear.

Obsessive-compulsive disorder usually leads to one strong internal conflict: On the one hand, those affected feel you internal resistance to obsessive thoughts and actions. On the other hand, they have the feeling that they cannot prevent the thoughts and the actions.

It is also typical of obsessive-compulsive disorder that the person concerned becomes aware of their obsessive thoughts and actions be ashamed. Many try to resolve their disorder in front of their family members, friends, and co-workers to hide. Over time, this often leads to them moving out of their familiar social environment withdraw and become lonely.

Obsessive thoughts

Obsessive-compulsive thoughts are uncomfortable and fear-related thoughts that keep imposing themselves on the person concerned and which they can hardly control:

  • Thoughts of pollution: Most often (one in two OCDs) obsessive-compulsive thoughts revolve around contamination - such as the obsessive-compulsive (and often associated with fear and disgust) idea of ​​getting dirty or infected with pathogens through contact with objects or other people.
  • Pathological doubts: About four in ten people with OCD have persistent doubts about having done or not done certain things (and often fear the possible consequences) - such as whether they turned off the car lights or the stove.
  • Physical fears of compulsion: About a third of obsessive-compulsive disorder have fears of illness - for example, the compulsive fear that their own health or that of relatives could be endangered.
  • Exaggerated need for symmetry: Equally common is the excessive need for symmetry, so that those affected, for example, constantly organize all sorts of things according to their own ideas.

Even healthy people are sometimes disgusted with dirt or fear for the health of relatives. However, in people with obsessive-compulsive disorder, these thoughts are evident more intense. They force themselves on them again and again.


Compulsive acts usually serve a specific purpose: those affected carry them out to protect themselves from the threat around which their obsessive thoughts revolve or to satisfy the need that is hidden behind their obsessive thoughts. Examples:

  • People wash themselves out of fear of contamination Compulsory washing hands constantly.
  • Some people with Compulsion to control return to their apartment several times in a row to make sure that they have actually turned off the stove.
  • People with Order keep tidying up their desk or apartment to satisfy their need for symmetry and order. Also typical of the compulsory order are ritualizedActions: Those affected feel the need to repeat a certain pattern of action over and over again in the same way.

Compulsions can too physical symptoms cause: For example, those who constantly wash compulsively often develop enormous skin problems.

Compulsory impulses

As Compulsory impulses one designates an intrusive, involuntary one Drive to take a certain action. People with compulsive impulses live in the constant fear of actually carrying out this action - but what mostly not happens.

Like obsessive-compulsive thoughts, the obsessive-compulsive impulses can also be used in obsessive-compulsive disorder differently be. However, the symptoms are mostly sexual or aggressive nature: Typical is, for example, the impulse to carry out uncontrolled sexual acts or to injure or kill one's own beloved child. Aggressive compulsive impulses can also include self-directed aggression - for example, the impulse to jump off a bridge or a high-rise building.

Obsessive-compulsive disorder: diagnosis

Anyone who notices signs of Obsessive Compulsive Disorder should do so see a psychiatrist or psychotherapist for clarification. He can use specific questions to determine whether the person concerned actually has an obsessive-compulsive disorder.

However, that is mostly not easy: Obsessive-compulsive disorder can develop express like a Anxiety disorder. Obsessive-compulsive disorder can also be easily confused with other mental illnesses, such as an eating disorder. In addition, obsessive-compulsive disorder often coexists with other mental illnesses such as depression.

In order to be able to make a reliable diagnosis, the psychiatrist or therapist must therefore know very precisely how the disorder manifests itself. As a rule, he or she orientates himself during the survey standardized questionnairesBased on scientific evidence about obsessive-compulsive disorder.

The most important criteriafor diagnosis "Obsessive-Compulsive Disorder" are that compulsions ...

  • ... for at least two weeks occurred on most days and / or
  • ... the people concerned very much burden or disturb.
It is important that the psychiatrist or psychotherapist also for signs of nerve disease such as Huntington's disease and Parkinson's diseaserespectthat may be associated with obsessive-compulsive symptoms. In contrast to obsessive-compulsive disorder, these disorders cannot be relieved by antidepressants or psychotherapy, but each require specific therapy.

Obsessive Compulsive Disorder: Treatment

Either Medication as well as one psychotherapy can help manage OCD. Also the combination in the Treatment options sometimes makes sense.

What psychotherapy helps with obsessive-compulsive disorder?

There are different forms of psychotherapy. In the case of obsessive-compulsive disorder, the so-called cognitive behavioral therapy proven. "Cognitive" means "relating to knowledge". Because therapist and patient first talk about which situations and thought patterns trigger the compulsive behavior. The therapist then helps the patient to analyze, question and change these thought patterns.

Then follows the practical part of therapy: Accompanied by the therapist, the person concerned enters a situation that would normally move him to a compulsive act. However, he tries this To suppress action in a targeted manner. For example, the therapist can ask him to touch a door handle without disinfecting his hands immediately.

At first, of course, this will make the patient anxious and uneasy. In time, however, it will determine, that the unpleasant feelings subside by themselves - even without him performing the compulsive act. In the best case scenario, he will draw so much strength and confidence from this learning experience that he is ready to face more difficult situations.

Many of those affected find it difficult at first to suppress the compulsive acts in everyday life and without the help of the therapist. It is therefore often useful to use the Include family members or the partner of the person concerned. They can help the person affected to transfer the learning successes from the therapy into the familiar environment. It is important that the relatives do not support the compulsive behavior, but rather encourage the person concerned to cope with their fears.

What drugs are used for obsessive-compulsive disorder?

Certain drugs against depression (so-called antidepressants such as clomipramine and selective serotonin reuptake inhibitors, SSRIs for short) have also proven themselves in the treatment of obsessive-compulsive disorder. Why is not yet fully understood. What is certain is that this means the concentration of the messenger substance Serotonin increase in the brain.

Brain cells transmit information to other brain cells via serotonin. The messenger substance therefore plays an important role in the communication between different parts of the brain. This communication seems to be disrupted in people with obsessive-compulsive disorder.

Unfortunately help Antidepressants only some of those affected get better. They also have a number of Side effectswhich some people find so uncomfortable that they stop taking it. For example, SSRIs can cause indigestion, nausea, headaches and insomnia. Clomipramine can cause dry mouth, constipation, dizziness, and nasal congestion, among other things.

Psychotherapy or medication: which works better?

Research has shown that a cognitive Behavioral therapy helps people with OCD somewhat better than medication. Nonetheless, drug therapy can be useful because the waiting time for psychotherapy to begin often has to wait many weeks or months.

In addition, many sufferers are ashamed of their disorder and are reluctant to see a psychotherapist. In the best case scenario, medication can help them cope with their symptoms to such an extent that it is easier for them to begin therapy.

Obsessive-compulsive disorder: course

Obsessive-compulsive disorder often develops over the course of the Childhood or adolescence, most of time creeping: In the beginning, those affected often consider their compulsions to be normal peculiarities or rituals. But the more often the unpleasant thoughts and impulses occur and the more time the compulsive actions take, the more stressful they become.

For some people, the compulsions go away on their own.For some, they weaken or change. More often, however, it happens that Obsessive-compulsive disorder becomes chronicpersist or worsen.

Then it can happen that those affected withdraw more and more from their social environment and become lonely. There is also a risk that the disorder will damage your health: Compulsory washing for example leads often to skin problems

That is why it is important for people with obsessive-compulsive disorder seek help early on. With psychotherapy and / or medication, the course of an obsessive-compulsive disorder can be influenced very favorably. Most of the time the constraints decrease. At about 10 to 15 out of 100 people affected lets down the obsessive-compulsive disorder even heal.

ICD-10 Diagnostic Key:

You can find the appropriate ICD-10 code for "Obsessive-Compulsive Disorder" here:

Onmeda reading tips:

Depression: how do you recognize it? What helps?

Psychotherapy: Everything you need to know about the different methods and reimbursement

Link tips:

Self-help groups / advice centers:


Payk, T .: Checklist Psychiatry and Psychotherapy. Thieme, Stuttgart 2018

Obsessive-compulsive disorder. Online information from the Clinic and Polyclinic for Psychiatry and Psychotherapy at the University Hospital Bonn: www.psychiatrie.uni-bonn.de (accessed on: June 29, 2018)

Background discussion with Katharina Bey, psychologist at the Clinic for Psychiatry and Psychotherapy at the University Hospital Bonn

Obsessive-compulsive disorder. Online information from the medical reference work AMBOSS: www.amboss.miamed.de (as of April 10, 2018)

Obsessive-compulsive disorder. Online information from the Institute for Quality and Efficiency in Health Care (IQWiG): www.gesundheitsinformation.de (as of October 4, 2017)

Obsessive-compulsive disorder. Online information from the Pschyrembel: www.pschyrembel.de (as of April 2016)

Wirtz, M. A .: Dorsch - Lexicon of Psychology. Hogrefe, Bern 2014

Guideline of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN): Obsessive-compulsive disorder. AWMF guidelines register No. 038/017 (status: May 2013)

Last content check:29.06.2018
Last change: 29.06.2018