Managing the Co-Occurring Disorders Associated With OCD

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects an estimated 1.2% of Americans annually. Anxiety disorders are known to co-occur with other mental health disorders and substance use disorders (SUD). When one condition exists with another in tandem, it is known as a co-occurring disorder. Learning how to manage the co-occurring disorders of OCD is challenging; however, many treatment options are available. Becoming familiar with these co-occurring disorders and available treatment options can be instrumental for lasting healing and recovery. 

What Is OCD?

The National Insitute of Mental Health (NIMH) defines OCD as “a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (‘obsessions’) and/or behaviors (‘compulsions’) that he or she feels the urge to repeat over and over.” Symptoms surface in two definable categories: obsessions and compulsions. 


First, obsessions are repeated – and often intrusive – thoughts and urges that enable an individual to carry out compulsive behaviors. These obsessions are often distressing and contribute to a great deal of anxiety in those with OCD. Some common examples of obsessions include:

  • Fear of contamination or germs
  • Aggressive thoughts toward self or others
  • Needing things to be organized perfectly
  • Worries about appliances being left on after use
  • Fear of acting in humiliating ways
  • Extreme concerns regarding specific superstitions, such as unlucky numbers 


Following obsessions, compulsive behavior occurs. Compulsive behavior is repeated behaviors that a person engages in to eliminate or quiet obsessions. Examples of compulsions linked to the aforementioned obsessions include:

  • Fear of germs: Excessive cleaning or handwashing
  • Aggression toward self or others: Potentially self-harming behaviors
  • Needing perfect organization: Ordering and arranging things in a particular or precise way
  • Worries about appliances being left on: Repeatedly checking if appliances are turned off 
  • Fear of acting in humiliating ways: Engaging in isolationist tendencies
  • Extreme concerns about specific superstitions: Tailoring behavior to avoid unlucky numbers or praying in an effort to reduce the potential harm of said superstition 

Additional Indications of OCD

It is important to understand that not all rituals or habits are necessarily compulsions. Similarly, those who engage in repeated habits do not necessarily have OCD. Some warning signs that may indicate the presence of OCD include:

  • The inability to control thoughts or behaviors, even when thoughts are excessive and interfere with daily functioning
  • Spends at least one hour a day experiencing obsessions and engaging in compulsions
  • No experience of pleasure results from performing compulsive behaviors, rather an individual may feel temporary relief from the anxiety caused by obsessive thoughts
  • Symptoms interfere with the individual’s ability to function normally in daily life

Similar to other mental health disorders, there is no one cause of OCD. Research confirms that both genetic and environmental risk factors can contribute to the development of OCD. 

Additionally, it is important to understand that symptoms of OCD may range in severity and intensity. Co-occurring disorders often develop when an individual turns to destructive coping mechanisms, such as substance abuse or self-harm. 

Common Co-Occurring Disorders of OCD

There are a variety of conditions that are known to co-occur with OCD. The following are some of the most common.

Anxiety and Mood Disorders

According to Dialogues in Clinical Neuroscience, OCD commonly co-occurs in the context of other neuropsychiatric disorders, including other anxiety disorders and mood disorders. The journal explains that many studies have confirmed high anxiety rates in individuals with untreated OCD. Continuing, “The levels of these anxiety ratings were as high or even higher than those reported in similar studies of panic disorder, generalized anxiety disorder, social phobia, and specific phobias.” 

Mood disorders are also common for those with OCD. The journal highlights that depressive features tend to surface in OCD, stating, “[M]ajor depressive disorder is the single most frequently comorbid disorder in OCD probands. Cumulatively, mood disorders occur in 50% to 90% of OCD probands.” The high prevalence of depression with OCD is caused by unwanted, upsetting obsessions. For many with OCD, the nature of obsessive thoughts is enough to trigger lasting depressive symptoms.  

Substance Use Disorders

A publication by the Substance Abuse and Mental Health Services Administration (SAMHSA) addresses the high prevalence of SUD in those with OCD. Often, SUD develops when an individual with OCD uses alcohol and other drugs to self-medicate their symptoms. Not only does self-medicating worsen the symptoms of OCD, but it also leads to increased tolerance and withdrawal. SAMHSA explains, “[I]t has been reported that fewer than half of individuals with co-occurring OCD and SUDs seek treatment for their OCD. 

Treatment for the Co-Occurring Disorders of OCD

It is vital for those struggling with OCD to recognize that effective treatments are available. Often, the first line of treatment for anxiety disorders is medication, followed by participation in therapy. Depending on the co-occurring disorder present, the treatment will likely be similar. 


Prescription medication is a great option for those with diagnosed anxiety disorders, such as OCD. While some symptoms of anxiety surface from intrusive thought patterns, others result from neurological dysfunction and chemical imbalances. Medication can help to balance these chemicals in the brain, leading to reduced symptoms of anxiety. 

Psychotherapy: Cognitive-Behavioral Therapy (CBT)

There are many effective therapies that may be used during treatment for OCD and co-occurring disorders. Cognitive-behavioral therapy (CBT) is one of the most well-researched and effective approaches for those with anxiety. CBT helps individuals to identify and overcome challenging patterns of thought and behavior. By challenging negative self-talk and other intrusive thought patterns, individuals can find relief from their OCD symptoms. 

For those with OCD and co-occurring SUD, treatment may also include detox and relapse prevention therapy. Those with co-occurring disorders can benefit greatly from individualized treatment, as treatment will be tailored to their unique needs and recovery goals.

Anxiety disorders such as OCD can bring about a wide range of debilitating symptoms. Leaving OCD untreated can increase your risk of developing co-occurring disorders, including mood, anxiety, and substance use disorders (SUDs). Luckily, effective treatment is available. At Alter Behavioral Health, we understand the complexities tied to treating anxiety disorders and co-occurring disorders. This is why we offer medication in addition to psychotherapeutic approaches. We can create a customized treatment plan to fit your unique needs and recovery goals. Let us help you overcome your obsessions and compulsions and help you gain control over your life today. To learn more about our facility and programs, call us at (866) 691-4386.