Compulsions occur so often, typically taking up at least one hour per day, that they impair ones quality of life.The cause of OCD is unknown. There appear to be some genetic components, and it is more likely for both identical twins to be affected than both fraternal twins. Risk factors include a history of child abuse or other stress-inducing events; some cases have occurred after streptococcal infections. Diagnosis is based on presented symptoms and requires ruling out other drug-related or medical causes; rating scales such as the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) assess severity. Other disorders with similar symptoms include generalized anxiety disorder, major depressive disorder, eating disorders, tic disorders, and obsessive–compulsive personality disorder. The condition is also associated with a general increase in suicidality.Treatment for OCD may involve psychotherapy such as cognitive behavioral therapy (CBT), pharmacotherapy such as antidepressants, or surgical procedures such as deep brain stimulation. CBT increases exposure to obsessions and prevents compulsions, while metacognitive therapy encourages ritual behaviors to alter the relationship to ones thoughts about them. Selective serotonin reuptake inhibitors (SSRIs) are a common antidepressant used to treat OCD. SSRIs are more effective when used in excess of the recommended depression dosage; however, higher doses can increase side effect intensity. Commonly used SSRIs include sertraline, fluoxetine, fluvoxamine, paroxetine, citalopram, and escitalopram. Some patients fail to improve after taking the maximum tolerated dose of multiple SSRIs for at least two months; these cases qualify as treatment-resistant and require second-line treatment such as clomipramine or atypical antipsychotic augmentation.
Nor are there any medical exams that can predict if one will fall victim to such illnesses.To be diagnosed with OCD, a person must have obsessions, compulsions, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM notes that there are multiple characteristics that can turn obsessions and compulsions from normalized behavior to "clinically significant". There has to be recurring and strong thoughts or impulsive that intrude on the day to day lives of the patients and cause noticeable levels of anxiousness.These thoughts, impulses, or images are of a degree or type that lies outside the normal range of worries about conventional problems. A person may attempt to ignore or suppress such obsessions, or to neutralize them with some other thought or action, and will tend to recognize the obsessions as idiosyncratic or irrational. Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress. Therefore, while many people who do not have OCD may perform actions often associated with OCD (such as ordering items in a pantry by height), the distinction with clinically significant OCD lies in the fact that the person with OCD must perform these actions to avoid significant psychological distress.