Saturday, December 20, 2014

Obsessive Compulsive Disorder

Table of Contents

Description

In obsessive-compulsive disorder (OCD), a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. For example:

  • Troubled by repeated thoughts that she may have contaminated herself by touching doorknobs and other "dirty" objects, a teenage girl spends hours every day washing her hands. Her hands are red and raw, and she has little time for social activities, but the washing continues.
  • A middle-aged man is tormented by the notion that he may injure others through carelessness. He has difficulty leaving his home because he must first go through a lengthy ritual of checking and rechecking the gas jets and water faucets to make certain that they are turned off.
  • Several times a day, a young mother is seized by the fearful thought that she is going to harm her child. However hard she tries, she cannot get rid of this painful and worrisome idea. She even refuses to touch the kitchen knives and other sharp objects because she is afraid that she may use them as weapons.

If OCD becomes severe enough, it can destroy a person's capacity to function in the home, at work, or at school.

Diagnosis

The diagnosis of obsession is valid only if the four following features are present:

  • Recurrent ideas, impulses, or images considered to be intrusive and senseless. These thoughts are not excessive worries about actual problems.
  • Attempts to ignore, suppress, or neutralize these thoughts with other thoughts or with actions.
  • Recognition by the patient that the troublesome thoughts are a product of his or her own mind, not imposed from without.
  • Symptoms not accounted for by another mental disorder, such as guilty thoughts in major depression or a longing for drugs in psychoactive substance use disorder.

The diagnosis of compulsion is valid only if the three following features are present:

  • Repetitive, purposeful, and intentional behaviors performed in response to an obsession, according to certain rules, or in a stereotyped manner.
  • Behaviors aimed at preventing discomfort or some dreaded situation but designed in a way that is unrealistic or excessive.
  • Recognition by the patient that the behaviors are unreasonable.

The diagnosis of obsessive-compulsive disorder is valid only if an obsession and/or compulsion (as just defined) causes marked distress, is time-consuming (1 hr./day), or significantly interferes with normal routine, work, or relationships.

Questions

What type of treatment do you recommend?

What type of therapy do you recommend?

How successful is the therapy with this behavior?

How long does it take before some improvement is seen?

How long will therapy be needed?

Will this disorder return? Can some other form of behavior of OCD develop later?

Will you be prescribing any medications? What are the side effects?