Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent and intrusive obsessions and/or compulsions that are excessive or unreasonable, are time-consuming, and cause marked distress for the individual and/or significant impairment in global functioning. Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate. Compulsions are defined as repetitive behaviors or mental acts that are performed in response to an obsession or according to rigid rules in order to prevent or reduce distress.
Common obsessions seen in individuals suffering from OCD are fear of contamination from germs, dirt, and environmental toxins; doubts about safety—having harmed the self or others; the need for symmetry, exactness, and order—having things "just right"; fear of making mistakes and acting socially inappropriate; intrusive sexual thoughts or urges; excessive religious or moral doubts—having "forbidden thoughts"; and the need to tell, ask, or confess. Common compulsions include washing and cleaning, checking, ordering and arranging, hoarding and collecting, repeating, touching, praying, counting, reassurance seeking, making mental lists, and retracing past memories.
People with OCD are sometimes overwhelmed by their disturbing obsessions, which seem uncontrollable and cause intense anxiety. To reduce the discomfort generated by the obsessions, an OCD sufferer avoids the feared situation and/or engages in compulsions repeatedly and ritualistically, which may relieve the discomfort but only temporarily. This pattern eventually develops into a vicious cycle of obsessions and a complicated web of compulsions. However, not all people with obsessions perform compulsions.
About 2 to 3 percent of Americans, as many as seven million people, have OCD at some point in their lives. OCD can happen to anyone and usually begins in adolescence or early adulthood, but the disorder can also occur in children. Seventy-five percent of those who develop it show symptoms by age thirty. OCD starts earlier in boys than in girls. In adults, men and women are affected in equal numbers. In some cases, OCD begins after a trauma. Cases involving the interplay of OCD and post-traumatic stress disorder (PTSD) precipitated by trauma need to be treated by addressing both disorders. OCD may co-occur with conditions such as Tourette’s syndrome, attention deficit disorder, other obsessive-compulsive spectrum disorders, and other anxiety disorders. Depression is often a secondary symptom to OCD.
Like many psychiatric disorders, OCD appears to result from a combination of biological and psychological factors. Some people may have a biological predisposition to experience anxiety. Research suggests that abnormal levels of the neurotransmitter serotonin may play a role in OCD. Brain scans of OCD sufferers have revealed abnormalities in the activity level of the orbital cortex, cingulated cortex, and caudate nucleus. OCD tends to develop when these biological factors are combined with a psychological vulnerability to anxiety. Some individuals may have learned that the world is a potentially dangerous place over which one has little control. This learned belief of danger is then overvalued and misattributed to one’s lack of control over the environment.
OCD can have disabling effects on a sufferer’s life. Individuals with severe cases of OCD may need hospital-ization to treat their obsessions and compulsions. People with OCD must allow a great deal of extra time to complete seemingly routine tasks. Individuals may avoid going to certain places or engaging in certain activities due to their own embarrassment about their compulsive behavior. Furthermore, family members of individuals with OCD may feel anger, frustration, and/or guilt when the sufferer’s compulsive behaviors interfere with family functioning. OCD is a chronic illness that, like other psychiatric illnesses, has periods of exacerbation followed by periods of relative improvements, though a completely symptom-free interval is generally unusual. With appropriate treatment, most sufferers show considerable improvements.
Exposure and response prevention (ERP), a form of cognitive-behavioral therapy, is the most effective type of psychotherapy for OCD. Essentially, OCD sufferers are repeatedly exposed to those anxiety-provoking thoughts and situations that they fear, but are prevented from engaging in their compulsive rituals and avoidance behaviors. The basis for ERP allows an individual the opportunity to learn that simply tolerating the obsessions without avoidance or compulsions will gradually lead to reduction in anxiety and extinction of obsessive fears. In turn, the occurrence of obsessions is reduced, and the vicious cycle eventually dissipates. Intensive ERP alone is often effective enough for many individuals with OCD.
OCD treatment using certain medications may be beneficial, but generally is not as effective as intensive ERP. Medications considered for the treatment of OCD are usually antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which are often effective without severe side effects. These SSRIs, which include fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) increase the serotonin available in the brain. Clomipramine (Anafranil), a tri-cyclic antidepressant, is another Food and Drug Administration-approved OCD medication that is more effective than SSRIs but has unpleasant side effects. In more resistant cases of OCD, an SSRI and clomipramine may be combined. Finally, although psychotherapy using ERP is commonly integrated with the use of medication, this treatment combination has not been established as generally superior to intensive ERP alone.
