Obsessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). It is possible to have only obsessions or only compulsions and still have OCD.

People with OCD may or may not realize that the obsessions are unreasonable. They feel driven to perform compulsive acts in an effort to ease the stressful feelings.

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror, so much so that they get “caught” in the mirror and cannot move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items. Healthy people also have rituals, but the difference is that people with OCD perform their rituals even though doing so interferes with daily life and the repetition is distressing.

Brain circuits may not work properly in people who have OCD, and the disorder tends to run in families. The symptoms often begin in childhood or adolescence. Treatments include therapy, medicines, or both. Cognitive behavioral therapy is often useful for treating OCD.

OCD symptoms usually include both obsessions and compulsions.

OCD obsessions are repeated, persistent, and unwanted urges or images that cause distress or anxiety. These obsessions typically intrude when you are trying to think of or do other things.

Obsessions often have themes, such as:

• fear of contamination or dirt
• having things orderly and symmetrical
• aggressive or horrific thoughts about harming yourself or others
• unwanted thoughts, including aggression or sexual or religious subjects

Examples of obsession signs and symptoms include:

• fear of being contaminated by shaking hands or by touching objects others have touched
• doubts that you have locked the door or turned off the stove
• intense stress when objects are not orderly or facing a certain way
• images of hurting yourself or someone else
• thoughts about shouting obscenities or acting inappropriately
• avoidance of situations that can trigger obsessions, such as shaking hands
• distress about unpleasant sexual images repeating in your mind

OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors are meant to prevent or reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety.

Compulsions may also include rules or rituals to follow to control anxiety when you are having obsessive thoughts. These compulsions are often not rationally connected to preventing the feared event.

As with obsessions, compulsions typically have themes, such as:

• washing and cleaning
• counting
• checking
• demanding reassurances
• following a strict routine
• orderliness

Examples of compulsion signs and symptoms include:

• hand-washing until your skin becomes raw
• checking doors repeatedly to make sure they are locked
• checking the stove repeatedly to make sure it is off
• counting in certain patterns
• silently repeating a prayer, word, or phrase
• arranging your canned goods to face the same way

Symptoms of OCD usually begin gradually and tend to vary in severity throughout your life. Symptoms generally worsen when you are experiencing stress. OCD, considered a lifelong disorder, can be so severe and time-consuming that it becomes disabling. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. OCD can be accompanied by eating disorders, other anxiety disorders, or depression.

Most adults recognize that their obsessions and compulsions do not make sense, but that is not always the case. Children may not understand what is wrong with their feelings and behaviors.

The cause of OCD is not fully understood. Main theories include:

• biology. OCD may be a result of changes in your body's own natural chemistry or brain functions. OCD may also have a genetic component, but specific genes have yet to be identified. OCD sometimes runs in families, but no one knows for sure why some people have it while others do not.
• environment. Some environmental factors, including infections, may trigger OCD, but more research is needed to be sure.

Several parts of the brain are involved in fear and anxiety. By learning more about fear and anxiety in the brain, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role in OCD and other anxiety disorders.

OCD can be difficult to diagnose because the course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. To diagnose OCD, your doctor will probably perform a physical exam, laboratory tests, and a psychological evaluation. These could indicate if another problem or medical condition is causing your symptoms and reveal any complications related to the disorder.

There are several general criteria required for a diagnosis of OCD:

• You must have either obsessions or compulsions or both.
• You may or may not realize that your obsessions and compulsions are excessive or unreasonable.
• Obsessions and compulsions are significantly time-consuming and interfere with your daily routine and social or work functioning.

Obsessions must meet the followingcriteria:

• Recurrent, persistent, and unwelcome thoughts, impulses, or images are intrusive and cause distress.
• You try to ignore these thoughts, images, or impulses or to suppress them with compulsive behaviors.

Compulsions must meet the following criteria:

• Repetitive behavior that you feel driven to perform, such as hand-washing, or repetitive mental acts, such as counting silently.
• You try to neutralize obsessions with another thought or action.
• These behaviors or mental acts are meant to prevent or reduce distress, but they are excessive or not realistically related to the problem they're intended to fix.

OCD is a chronic condition, which means it may always be part of your life. You cannot treat OCD on your own, but you can do some things for yourself that will help your treatment plan.

Take your medications as directed. Even if you are feeling well, resist any temptation to skip your medications. If you stop taking your medications, OCD symptoms are likely to return.

Pay attention to warning signs. You and your doctors may have identified issues that can trigger your OCD symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.

Check with your doctor or pharmacists before taking other medications. Contact the doctor who is treating you for OCD or talk to your pharmacist before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, minerals, or herbal supplements. These may interact with your OCD medications.

OCD is generally treated with psychotherapy, medication, or both. The goal of treatment is not a cure, but control of symptoms so that they no longer interfere with your daily life.

Psychotherapy. A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively. One type of therapy called exposure and response prevention is especially helpful in reducing compulsive behaviors in OCD. Therapy may take place in individual, family or group sessions.

Medication. Doctors also may prescribe medication to help treat OCD. Antidepressants that have been approved by the Food and Drug Administration (FDA) to treat OCD include:

• clomipramine (Anafranil)
• fluvoxamine (Luvox CR)
• fluoxetine (Prozac)
• paroxetine (Paxil, Pexeva)
• sertraline (Zoloft)