Obsessive-Compulsive Disorder (OCD)

by Amy Scholten, MPH

Definition

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which an individual suffers from unwanted repetitive thoughts and behaviors. These obsessive thoughts and compulsive behaviors are extremely difficult to overcome. If severe and untreated, OCD can destroy the ability to function at work, at school, or at home.

Causes

The cause of OCD is not known. It is believed to develop from neurobiological, environmental and psychological factors. An imbalance of the brain chemical serotonin probably plays a significant role in the development of OCD.

OCD is associated with other neurological disorders, including:

  • Tourette syndrome
  • Trichotillomania – the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair
  • Body dysmorphic disorder – imaginary or exaggerated defects in appearance
  • Eating disorders, such as bulimia or anorexia nervosa
  • Hypochondriasis – unfounded fear of having a serious disease
  • Substance abuse

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for OCD include:

  • Age: Late adolescence, early adulthood
  • Family members with a history of OCD
  • Other anxiety disorders
  • Depression
  • Tourette syndrome
  • Personality disorder
  • Attention-deficit disorder

Symptoms

Symptoms of OCD are:

  • Obsessions – unwanted, repetitive and intrusive ideas, impulses or images
  • Compulsions – repetitive behaviors or mental acts usually performed to reduce the distress associated with obsessions

Although people with OCD know that their thoughts and behaviors are nonsensical and would like to avoid or stop them, they are frequently unable to block their obsessive thoughts or avoid acting on their compulsions.

Common obsessions include:

  • Persistent fears that harm may come to self or a loved one
  • Unreasonable concern with being contaminated
  • Unacceptable religious, violent, or sexual thoughts
  • Excessive need to do things correctly or perfectly

Common compulsions include:

  • Excessive checking of door locks, stoves, water faucets, light switches, etc.
  • Repeatedly making lists, counting, arranging, or aligning things
  • Collecting and hoarding useless objects
  • Repeating routine actions a certain number of times until it feels just right
  • Unnecessary re-reading and re-writing
  • Mentally repeating phrases
  • Repeatedly washing hands

Diagnosis

OCD is usually diagnosed through a psychiatric assessment. OCD is often diagnosed when obsessions and/or compulsions cause an individual significant distress or interfere with the individual’s ability to properly perform at work, school, or in relationships.

Treatment

Treatment reduces OCD thoughts and behaviors, but does not completely eliminate them.

Treatments include:

Medications

Selective serotonin reuptake inhibitors (SSRIs) reduce OCD symptoms by affecting the neurotransmitter serotonin. This function is independent of their antidepressant effects. Common SSRIs include:

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants

Another medication often used is clomipramine (Anafranil). This is a tricyclic antidepressant drug that alters serotonin levels.

Behavior Therapy (Exposure and Response Prevention)

This helps you gradually confront the feared object or obsession without succumbing to the compulsive ritual associated with it.

Prevention

There are no guidelines for preventing OCD because the cause is not known. However, early intervention may provide help before the disorder becomes severely disruptive.

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org

Obsessive-Compulsive Foundation
http://ocfoundation.org

References:

Fauci AS, Braunwald E, Isselbacher KJ, et al. Harrison's Principles of Internal Medicine, 14th ed. New York, NY: The McGraw-Hill Companies; 2000.

National Institute of Mental Health, National Institutes of Health website. Available at: http://www.nimh.nih.gov/. Accessed October 13, 2005.

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