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Signs and Symptoms Mental obsessions and behavioral compulsions, with four subtypes: Symmetry or order, things need to be just so Forbidden thoughts or images: an affected person will seek reassurance that they are a good person, ask forgiveness and pray Cleaning and fear of contamination Hoarding (listed as a separate mental illness in the latest Diagnostic and Statistical Manual of Mental Disorders [DSM-5]) Tics (sudden, brief movements or sounds) or evidence of excessive handwashing may be signs in some cases Causes and Risk Factors The causes of OCD are not yet fully understood, but several factors seem to be involved: There may be abnormal structure and activity of certain parts of the brain and of the neurotransmitters serotonin and dopamine in patients with OCD Lower estrogen levels in both men and women are associated with OCD symptoms Life events such as stress or trauma can modify the gene expression of serotonin and dopamine, which may lead to OCD Conventional and Emerging Therapies Conventional treatment for OCD includes both pharmacological and non-pharmacological therapy: Cognitive-behavioral therapy, which seems to be more effective than selective serotonin reuptake inhibitors (SSRIs) in patients with OCD SSRIs and the tricyclic antidepressant clomipramine (Anafranil) (a non-selective serotonin reuptake inhibitor, or SRI) are both considered first-line pharmacotherapy for OCD