“I’ve already washed my hands, but I feel like I need to wash them again.” “I keep checking whether I locked the door, over and over.” “I can’t get these unwanted thoughts out of my head.” — If you recognize that these thoughts and behaviors are excessive, yet still cannot stop them, these may be signs of obsessive-compulsive disorder (OCD).
Obsessive-compulsive disorder is a condition in which intrusive thoughts that won’t go away (obsessions) and repetitive behaviors performed to relieve the resulting anxiety (compulsions) significantly interfere with daily life. It is not a matter of willpower or personality — with appropriate treatment, improvement can be expected.
Keldsen Family Clinic is a family-oriented clinic offering both Psychosomatic Medicine and Internal Medicine, a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station. We are open on weekends and holidays and also offer telemedicine. “Going to a clinic feels a little scary” — we’d love to help you take that first step.
About Obsessive-Compulsive and Related Disorders
Obsessive-compulsive disorder was once classified as a type of anxiety disorder, but in recent diagnostic systems (ICD-11), it has been placed in its own independent category called “Obsessive-Compulsive and Related Disorders.” The common thread is that intrusive thoughts that won’t go away and behaviors that can’t be stopped cause distress and impairment in daily life.
OCD is known to frequently co-occur with panic disorder, social anxiety disorder, depression, bipolar disorder, tic disorders, and ASD (autism spectrum disorder). For this reason, it is important to assess overall mental and physical health — not just obsessive-compulsive symptoms — when determining a treatment plan.
OCD is a condition where both the person affected and those around them often wonder, “Why can’t I just stop?” The brain’s anxiety-processing circuits have become overly sensitive, and this is not a matter of willpower or character. The tendency for symptoms to intensify the harder you try to resist is, from a neuroscience perspective, a natural response — and there is no reason to blame yourself for it.
At Keldsen Family Clinic, we listen carefully to your concerns and conduct a comprehensive assessment that includes other conditions that commonly co-occur with OCD.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD: Obsessive-Compulsive Disorder) is a condition characterized by two main symptoms: obsessions and compulsions.
Obsessions are unwanted thoughts, images, or urges that intrude into the mind repeatedly, despite being unwelcome. Even when the person recognizes these thoughts as excessive or irrational, they cannot push them away.
Compulsions are repetitive behaviors performed to neutralize the anxiety caused by obsessions. These may include hand washing, checking, counting, rearranging, or mentally repeating specific phrases, all carried out according to the person’s own internal rules.
Many people spend significant amounts of time on compulsive behaviors, leading to major difficulties with going out, working, and maintaining relationships. The distress of “knowing it doesn’t make sense yet being unable to stop” is something only those who experience it can truly understand.
OCD most commonly develops in the late teens to twenties, with a lifetime prevalence estimated at 1–2%. It is also not uncommon for symptoms to begin in childhood.
One characteristic of OCD is that many people take a long time before seeking help. Feelings such as “It would be embarrassing if someone found out” or “I can’t talk about what’s going on in my mind” often lead people to struggle alone for years, with symptoms gradually worsening before they finally reach out. No matter what the content of your obsessions or compulsions may be, your doctor has heard from many people in similar situations. Please feel comfortable sharing your experience.
Symptoms and Characteristics of OCD
The symptoms of OCD can manifest across three dimensions: obsessions, compulsions, and effects on daily life.
Specific Symptom Examples
Examples of Obsessions
- Excessive fear of contamination or germs
- Aggressive thoughts such as “What if I hurt someone?”
- Anxiety about having left locks, stoves, or gas appliances unsecured
- Preoccupation with symmetry and orderliness
- Religious or moral guilt
- Intrusive sexual thoughts
Examples of Compulsions
- Washing hands repeatedly or taking multiple showers
- Checking locks, windows, and gas valves over and over
- Rearranging objects in a specific order
- Mentally repeating certain words or numbers
- Repeatedly asking family members for reassurance that “everything is okay”
- Following self-imposed rules for carrying out daily activities
Effects on Daily Life
- Taking excessive time to leave the house, commute, or attend school
- Inability to complete work or household tasks
- Skin irritation (from excessive hand washing, for example)
- Guilt about involving family members in rituals
- Reluctance to see other people
- Severe fatigue and depressive symptoms
When obsessions and compulsions occupy one hour or more per day and are causing impairment in daily life, this is generally considered a threshold for diagnosis.
Treatment and Approaches for OCD
Treatment for OCD typically involves a combination of SSRI-based medication therapy and cognitive behavioral therapy that includes exposure and response prevention (ERP). Starting treatment early and maintaining consistent engagement are key to improvement.
1. Medication Therapy
The first-line treatment is SSRIs (selective serotonin reuptake inhibitors). For OCD, higher doses than those typically used for depression are often necessary, and it may take 8 to 12 weeks before the effects become apparent. It is important to continue treatment patiently without rushing.
If SSRIs alone do not produce sufficient results, the tricyclic antidepressant clomipramine or low-dose augmentation with an antipsychotic medication may be considered.
Stopping medication on your own can lead to symptom relapse, so always discuss any changes with your doctor.
2. Psychosocial Support (Exposure and Response Prevention)
Exposure and response prevention (ERP: Exposure and Response Prevention) is the psychological therapy considered most effective for OCD.
- Exposure: Deliberately placing yourself in situations that trigger anxiety
- Response prevention: Refraining from performing compulsive behaviors and allowing the anxiety to subside naturally
By repeating this process gradually, you accumulate the experience that “anxiety decreases even without performing compulsions,” which helps reshape the brain’s response patterns over time. Because some stages can be challenging, it is important to proceed with a structured plan guided by a doctor or psychologist.
Cognitive behavioral therapy also involves re-examining how you relate to the obsessive thoughts themselves.
3. Workplace and School Strategies
- If checking behaviors require extra time, share the situation with someone you trust
- Set rules such as “check only once” for specific tasks
- Discuss the possibility of a leave of absence or workload adjustment when needed
A medical certificate can be a valuable tool for communicating your situation to your workplace or school.
4. Strategies at Home
- Do not forcibly stop compulsive behaviors or blame the person for them
- If repeatedly asked for reassurance, gradually reduce the number of times you respond (in line with the treatment plan)
- Avoid shouldering the burden alone as a family — work together with the treatment team
- Family members should also take time for themselves and seek support when needed
The way family members are involved can significantly influence treatment outcomes. Work with your doctor and psychologist to find the most appropriate ways to offer support.
5. General Self-Care
- Sleep: Maintain a regular routine to prevent mental and physical fatigue from accumulating
- Exercise: Aerobic exercise can be effective for reducing anxiety
- Mindfulness: Practicing “not trying to push thoughts away” can help change how you relate to obsessions
- Limit caffeine: It may intensify feelings of anxiety and tension
- Be kind to yourself: Recovery is a step-by-step process — focus on the progress you have made
OCD is a condition where appropriate treatment can significantly reduce the difficulties it causes in daily life. Rather than struggling alone, please feel free to reach out to Keldsen Family Clinic. We are a 1-minute walk from ‘Oizumi Yubinkyoku’ bus stop, accessible by Seibu Bus from Oizumi-Gakuen Station, open on weekends and holidays, and also offer telemedicine.