Obsessive-Compulsive Disorder (OCD)

What is OCD?

Obsessive-compulsive disorder is a condition in which obsessions and compulsions consume a significant amount of time and cause distress and impairment. It is estimated to affect 1% to 3% of people during their lifetime.^{[1, 2]}

Common symptoms

Obsessions are intrusive, repetitive thoughts, urges or mental images that are hard to control and cause distress. Compulsions are repetitive actions or mental acts that a person feels driven to perform to ease that distress or to prevent a feared outcome.^[1]

Common patterns include the following.^[1]

• Fear of contamination leading to excessive cleaning
• Fear of harm leading to repeated checking
• Intrusive aggressive, sexual or taboo thoughts, often with mental rituals
• A focus on symmetry with ordering or counting
• Avoiding situations that trigger obsessions

Most adults find their obsessions distressing and know their rituals are excessive. Children often have difficulty describing their obsessions.^[1]

Causes and risk factors

OCD is a heterogeneous condition that arises from a complex mix of genetic and environmental risk factors.^[1] Research points to differences in brain circuits linking the cortex, striatum and thalamus, and to serotonin, dopamine and glutamate signaling.^[3] It is not caused by weak character or poor upbringing.

How it is diagnosed and treated conventionally

A clinician diagnoses OCD from an assessment against standard criteria. Obsessions or compulsions must be present, they must take at least one hour a day, and they must significantly disrupt daily life.^[1]

Effective treatments are serotonin reuptake inhibitor medicines and cognitive behavioral therapy.^[4] Cognitive behavioral therapy with exposure and response prevention is the psychological treatment of choice. A meta-analysis of 36 trials found a large effect, although the authors noted that three quarters of the studies had suspected researcher allegiance, few were at low risk of bias, and the studies without suspected allegiance did not show a benefit.^[5] A separate meta-analysis of 39 randomized trials also found a benefit, with small reductions in depression and anxiety.^[6] For OCD that does not respond, specialist options include add-on medicines and brain stimulation or surgery for severe cases.^{[2, 4]}

Why OCD calls for a whole-person approach

OCD sits at the meeting point of brain biology, learned anxiety-driven habits and other mental health conditions. Good care therefore looks beyond the rituals themselves, and it should always include a clinician who treats OCD directly.^{[4, 7]}

Supportive care can address some of the surrounding stress and physical tension. It does not treat the obsessions or compulsions, and it cannot substitute for therapy or medicine.

Brain circuits and chemistry

OCD has been linked to dysfunction in circuits connecting the cortex, striatum and thalamus, and to differences in cognitive flexibility and the ability to hold back responses.^[3] These findings are part of why OCD is understood as a brain-based condition and not simply a matter of willpower.

Co-occurring mood and anxiety

OCD rarely occurs alone. A meta-analysis of more than 15,000 people found that about 69% had another psychiatric diagnosis, most often depression or generalized anxiety.^[7] Those conditions deserve their own assessment and treatment.

Genes and environment

Genetic and environmental factors both contribute to OCD.^[1] This is relevant to families, since having OCD does not reflect anything a person did wrong.

Anxiety, avoidance and the ritual cycle

Compulsions and avoidance provide short-term relief from distress, which can keep the cycle going, and this is the target of exposure and response prevention.^{[1, 5]} Stress and tension can make this cycle harder to tolerate, so relaxation is a reasonable goal for supportive care.

Acupuncture as supportive care in OCD

What the research shows

Acupuncture has not been shown to treat OCD. A 2007 systematic review of acupuncture for anxiety disorders found no trials in OCD.^[8] A systematic review of complementary approaches for OCD found tentative support for electroacupuncture, but from methodologically weak studies that had not been replicated.^[9]

We found no randomized controlled trial of acupuncture for OCD that we could cite. For anxiety in general, the 2007 review of acupuncture for anxiety disorders found positive but poorly reported trials and called for better research.^[8] These findings do not tell us whether acupuncture changes OCD symptoms.

How acupuncture may work

How acupuncture might affect OCD has not been studied. In Chinese medicine, obsessive thinking is traditionally described in terms such as stagnation of liver qi or phlegm that clouds the mind, which guides point selection. These are traditional explanations, not proven biology.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at selected points, usually left in place for about 20 to 40 minutes. A course is several visits, with reassessment along the way. We keep the focus on stress, sleep and relaxation, not on the rituals themselves.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in OCD

The Ayurvedic view

Ayurveda has no classical disease that matches OCD exactly. Practitioners may describe repetitive, anxious thinking as a disturbance of the mind (manas) with aggravated Vata, the principle said to govern movement and the nervous system. This is a traditional framework, not a medical diagnosis.

Therapies that may be used

Care is chosen for the individual and is used alongside, never instead of, psychological and medical treatment.

• Regular meals, steady sleep and wake times, and a calming daily routine
• Gentle warm oil massage and breathing or relaxation practices
• Yoga and meditation practices, which come from the same Indian tradition
• Herbs traditionally used for the nervous system, such as ashwagandha (Withania somnifera), prescribed individually by a qualified practitioner

Panchakarma, the traditional cleansing program, is not appropriate during pregnancy, acute illness or frailty, and we do not use it as a way to treat OCD. Where an herbal preparation applied to the skin is relevant, transdermal medication therapy is available, but we make no efficacy claim for it in OCD.

What the research shows

The research on Ayurveda for OCD is very limited. We found no trials of an Ayurvedic treatment program in OCD. A systematic review of herbal medicines reported tentative, low-quality evidence for Withania somnifera in OCD.^[11] A broader review of ashwagandha reported modest benefit in OCD and in anxiety, and warned that few randomized trials exist.^[12]

Yoga has been tested in a small trial. In a trial of 50 patients on medication, 10 supervised yoga sessions improved obsession, compulsion, anxiety and depression scores compared with a waitlist after 4 weeks, with assessors blind to group.^[13] It was a short, small trial without a sham or active comparison. Yoga itself is not Ayurvedic medicine, and we do not treat it as evidence for Ayurvedic treatment.

Herbal medicine as supportive care in OCD

Herbs and formulas that have been studied

Reviews list several plants studied in OCD, including saffron (Crocus sativus), milk thistle (Silybum marianum), Echium amoenum (borage-family herb), St. John's wort (Hypericum perforatum), and ashwagandha.^{[11, 14]} Natural compounds such as curcumin are also being studied.^[11]

What the research shows

The evidence is limited. A systematic review of herbal medicines for OCD found tentative, low-quality evidence for several plants, and said more research is needed to confirm that they work.^[11] A review of complementary treatments found positive but unreplicated studies of some herbs, including borage, and found that controlled studies suggested St. John's wort was ineffective.^[9] A review of medicinal plants concluded that clinical research in this area is in its infancy.^[14] A clinical guideline on nutraceuticals and phytoceuticals recommended using these products alongside standard medical care.^[15]

Safety and herb-drug interactions

Many people with OCD take serotonin reuptake inhibitors, and herbs can interact with them. A literature review of herb-drug interactions reports that St. John's wort caused serotonin syndrome when combined with SSRI antidepressants and lowered the blood levels of many other medicines.^[16] Tell us about every antidepressant, anti-anxiety medicine, sleep medicine, blood thinner, thyroid medicine and supplement you take. Do not start herbs without your prescriber's review.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[17] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

The following links are interpretation, not equivalence. Chinese medicine's descriptions of stuck qi and phlegm clouding the mind, and Ayurveda's aggravated Vata with a restless mind, both describe tension, rumination and poor sleep. Researchers studying OCD look at cortico-striatal brain circuits and serotonin, dopamine and glutamate signaling.^[3]

No study has shown that a pattern or dosha corresponds to a specific biological process in OCD. These frameworks should not be used to decide on medicine or therapy.

How this care fits with your medical care

Supportive care for OCD is complementary. Keep your psychiatrist or physician and your therapist, and do not stop or change prescribed medicines without your prescriber. We do not diagnose or treat OCD. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Please bring your diagnosis, a full list of medicines and supplements, and a note of any therapy you are in. Exposure and response prevention and medicine have the strongest research support, and supportive care should not delay them.^{[4, 5]}

When to seek urgent medical care

OCD is often accompanied by depression and anxiety, and some symptoms need prompt help.^[7]

• Thoughts of suicide or of harming yourself. Call or text 988, the Suicide and Crisis Lifeline, at any time.
• Severe depression, hopelessness, or inability to eat, sleep or leave the house
• Rituals so severe that you cannot eat, drink, take your medicines or care for yourself
• Sudden onset of severe symptoms, confusion or unusual behavior
• Chest pain, fainting or severe shortness of breath

For an emergency, call 911 or go to the nearest emergency department.