Obsessive Compulsive Disorder
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is an anxiety state marked by recurrent, unwanted thoughts or images (obsessions) and unwanted repetitive behaviors (compulsions). Common obsessions include fear of contamination from germs, thoughts of aggressive behavior, and fear of harming oneself; common compulsions include rechecking locked doors, repetitive hand washing, and excessive neatness.
People who suffer from OCD recognize that their obsessions and compulsions are unreasonable but they cannot resist the intruding thoughts or ritualistic behavior. Symptoms, which usually first appear in the teens or 20s, are often severe enough to interfere with daily functioning. People with OCD do not necessarily have both obsessions and compulsions; either one is sufficient for a diagnosis. Though previously considered rare, OCD is now estimated to affect 2 to 3% of the population.
Who Gets Obsessive-Compulsive Disorder?
The National Institute for Mental Health reports that about 3% of people in the United States have OCD. Typical age of onset for boys is 6 to 15, while for women it is often later, between 20 and 30. Risk factors like genetic predisposition and environmental stress contribute to OCD. Also, OCD is more common among people of higher education, IQ, and socioeconomic status. Men and women, however, are affected equally. Though its course is chronic and usually lasts a lifetime, it is treatable with medication, behavioral therapy, and, in extreme cases, brain surgery.
- Obsessions, which refer to recurring and persistent thoughts, ideas, or impulses that invade a person’s thoughts. Common obsessions are fear of contamination from germs, fear of making a mistake or of inadvertently harming oneself or others, and a constant need for reassurance.
- Compulsions, which are defined as repetitive behaviors that are performed according to certain rules. Common compulsions are rechecking to be sure doors are locked, windows are closed, or an appliance is turned off; excessive neatness and organization; and repetitive hand washing that accompanies an obsession with dirt and germs.
- Anxiety that is associated with obsessions or compulsions.
- Those with mild OCD often manage to function with only minimal interference in their daily lives. But in people with more pronounced OCD, obsessive thoughts or compulsive behaviors may be frequent or distressing enough to become incapacitating.
- Probably the most common OCD complication is depression; another is marked interference with social and work behaviors.
- OCD may be related to an imbalance in certain neurotransmitters (brain chemicals).
- There appears to be a relationship between OCD and certain neurological or psychological disorders; these include Tourette’s syndrome, trichotillomania, body dysmorphic disorder, and hypochondriasis.
- Risk factors for obsessive-compulsive disorder include the following:
- Genetics. OCD tends to run in families.
- Postpartum periods. Women with OCD may experience a worsening of symptoms during pregnancy and postpartum.
- Environmental stressors. These include changes in living situation, occupational changes or problems, and school-related problems.
A diagnosis is often made based on a personal history of the disorder.
A psychiatric evaluation assists in identifying the disorder.
A physical examination may rule out physical causes of symptoms that mimic anxiety states, such as asthma or overactive thyroid.
There are four essential factors in the diagnosis of OCD that distinguish OCD from ordinary, mildly intrusive worries or brooding. They are the following:
- Symptoms cause significant distress.
- Symptoms take up more than 1 hour a day.
- Symptoms significantly interfere with work, relationships, or daily functioning.
- The person recognizes that his or her obsessions and compulsions are unreasonable or excessive.
Selective serotonin reuptake inhibitors (SSRIs)—a common class of antidepressants—are effective in treating OCD. However, improvements are more likely for compulsions than for obsessions. These drugs include fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac), and setraline (Zoloft).
The antianxiety drug buspirone (BuSpar) may be prescribed to diminish anxiety.
A combination of medication and psychotherapy (particularly behavior therapy) is usually recommended.
Goals of behavior therapy include desensitization and relearning. The method with the most certainty is exposure and response prevention therapy. This method exposes the patient to the objects or situations that trigger obsessions, fear, and anxiety, but then prohibits him or her from engaging in the usual compulsive response. The aim is to teach people to control their anxiety without relying on ritualized behavior.
In 2009, the FDA approved a deep brain stimulator device for severe cases of OCD for which medications and psychotherapy have not worked
Occasionally, surgical treatment of the cingulum (a bundle of nerve fibers in each hemisphere of the brain) may be beneficial to people who have severe symptoms and who do not respond to treatment. A cut is made between certain nerve fibers that trigger emotional arousal (cingulate gyrus) and the limbic system, which is involved in mood and intense emotion. About 30% of cingulotomies result in improvement.
Although some people with OCD experience spontaneous remission, in most the illness has an episodic course with periods of partial remission. In about 10% of sufferers, the course of OCD is chronic and unchanged.
OCD is not preventable.
When To Call Your Doctor
Call a doctor if obsessive thoughts interfere with daily functioning or if compulsive behaviors consume an excessive amount of time.
Reviewed by Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network.