Obsessive-compulsive disorder

An obsessive-compulsive disorder, like simple phobia, panic disorder, PTSD and generalized anxiety disorder, falls under the diagnosis of anxiety disorder. This is a psychological disorder in which severe anxiety is experienced. This fear is not based on any real grounds, which is why it is called a disorder. Common examples of OCD include washing hands frequently and repeatedly checking whether the door is closed.


  • There are obsessions and compulsions;
  • These compulsive symptoms are considered nonsensical or excessive, although this does not alter the fact that they are felt, experienced and used;
  • The complaints cause a lot of tension. A patient functions less. This must be restrictive for the patient for more than one hour per day to be diagnosed with OCD;
  • No limitation to Axis I disorder diagnosis (e.g. not just preoccupations with food, as with an eating disorder. In that case, the diagnosis of an eating disorder is made if other criteria also apply).

Obsessions or obsessive thoughts are recurring, persistent ideas, thoughts, images or impulses that cause a lot of tension (involuntary). Compulsions or compulsive actions are repeated overt activities that are performed according to certain rules in a stereotypical manner, to neutralize/prevent tension (unrealistic or realistic but excessive). Obsessions are the thoughts that come in unwantedly, compulsions are the actions that someone ,chooses, to perform to go against the thoughts.

Obsessions and compulsions can occur together, develop suddenly and gradually, and one often anticipates that they may experience them again, leading to anticipatory anxiety. Obsessions can also trigger neutralizing thoughts instead of carrying out compulsions.


The chance that you will develop OCD in your entire life is 2.5%, but this is lower in the Netherlands.

Scientifically found causes

Learning theory : Mowrer’s two-factor theory. This involves the combination of classical and operant conditioning as the ,cause, for the disorder. However, there is no classical conditioning involved in the development of the disorder. This would mean, for example, that someone has developed a fear of dirt due to experiencing a trauma, which has led to dirt being connected to the trauma, causing someone to have to keep washing their hands because they fear that the trauma will happen again. However, often there is no such thing as trauma and the disorder has arisen ,just like that,. There is operant conditioning in which the disorder is maintained because someone ,rewards, himself. A person feels fear when he comes into contact with something ,contagious, or when he comes near a vagabond, or when he has been in a public toilet, and then washes his hands several times. This leads to reassurance, which reduces anxiety. The link between washing and anxiety reduction is made. So washing is like a kind of reward. This makes it more likely that hands will be washed again next time, sometimes increasing in frequency.

Cognitive: Unpleasant intrusive thoughts receive significantly more attention. A person pays particular attention to negative thoughts (e.g. the danger of dirty hands, bacteria, or what could happen if he forgets to turn off the gas).

Neuroanatomical: Prefrontal cortex, caudate nucleus, thalamus and striatum are indicated as areas and parts of the brain that can be related to having an obsessive-compulsive disorder.

Genetically: Nothing is certain yet, although a higher incidence is found in identical twins as opposed to fraternal twins. So there could be a genetic, innate explanation for the disorder.


Until the 1970s, OCD was seen as barely controllable. So someone could not avoid it if he or she had the disorder.

Later, exposure and response prevention was applied. Afterwards one is not completely free of complaints, but the result is favorable. Exposure mainly leads to fear reduction, while response prevention is mainly aimed at reducing certain rituals (e.g. constantly checking the gas after the stove has already been turned off, or constantly washing hands for fear that they are dirty). Stability is also seen in the longer term.

Cognitive therapy is also widely used. This is just as effective as behavioral therapy, but adds little new. No data on long-term effects are available.

Medication is also used, such as SSRI and tricyclic antidepressants. There is a high risk of relapse after discontinuing medication use. This may possibly be prevented by prescribing a combination of SSRI and behavioral therapy.


When living with the complaints for more than a year, spontaneous recovery is rarely seen. Instead, an extension of the complaints is usually visible. However, prognosis after behavioral therapy is favorable.

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