Prevention

There is no way to prevent OCD.

Treatment

OCD usually is treated with a combination of psychotherapy and medications.

Medications The most common medications used to treat OCD are antidepressants, particularly those called selective serotonin reuptake inhibitors (SSRIs). This class of medications includes fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). To treat OCD, the dose of medication usually has to be higher than when treating depression.

Tricyclic antidepressants also may be effective. The one most used for OCD is clomipramine (Anafranil). Although this drug may be slightly more effective than the SSRIs for treating OCD, it also tends to have more troublesome side effects, including drowsiness, constipation and dry mouth.

Psychotherapy A number of psychotherapy techniques may be helpful, depending on the person's preference, the events that may have contributed to the problem, and availability of family and other social support. It's important to get education about OCD and to get support from friends, family or support groups. Cognitive behavioral therapy is designed to help you recognize the unreasonableness of the thoughts and teach you techniques for controlling your compulsions. Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore the history behind the symptoms, though insight itself is not likely to have an impact on severe symptoms.

In behavior therapy, treatments are aimed at eliminating the patient's compulsive actions by examining and evaluating the distorted, fearful thinking and considering alternative ways of dealing with anxiety. Some specialized approaches for the treatment of OCD are:

• Exposure and response prevention (ERP) - In this therapy, a person is exposed to situations that provoke obsessive thoughts but is prevented from performing the usual compulsive ritual. For example, a person may be asked to touch a "dirty" shoe, then be told to wait before washing his or her hands. The person will practice this behavior daily, gradually increasing the waiting time and keeping a diary of his or her efforts. Therapy sessions usually are scheduled weekly for a period of three to 12 months.

• Habit reversal - In this therapy, the person is asked to substitute a different response, such as deep breathing or fist clenching, for the usual compulsive ritual.

• Thought stopping - This technique involves some form of distraction whenever an obsessive thought occurs. One common method is to instruct the person to say the word, "Stop," and snap a rubber band at the wrist.

• Saturation - This approach asks the patient to concentrate intensely on the obsessive thought until the thought loses its impact and becomes meaningless.

Family therapy and group therapy also have been used successfully to treat some people with OCD. Because this disorder can be very disruptive to family life, family therapy often is recommended. In addition, therapy can identify ways that family members unwittingly perpetuate or promote symptoms.