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Q and A: Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) suffer from recurrent, unwanted thoughts (obsessions) or repetitive behaviors (compulsions), which they feel they cannot control. Rituals such as hand-washing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.

People with these symptoms, may feel ashamed to talk about them, worry that they are crazy, or think that nothing could possibly help. Fortunately, effective treatments have been developed to help people with OCD.

How common is OCD?

It is estimated that 2.2 million American adults may be affected by OCD during the course of their lives, roughly equally split between men and women. Individuals with OCD often notice symptoms during childhood. Early onset OCD has been reported in children as young as 2 years old. Some evidence suggests OCD may run in families. 

How does the American Psychiatric Association define OCD?

As the name implies, OCD is characterized by obsessive thoughts and compulsive behaviors. That is, people with OCD have persistent thoughts about certain things and incessantly perform certain behaviors.

What are obsessions?

  • Recurrent and persistent, intrusive, inappropriate thoughts that cause stress or anxiety, which leads to efforts to dismiss those thoughts 

  • Thoughts that are not simply excessive worries about real-life problems

  • Recognition that the thoughts are a product of his or her own mind

What are compulsions?

  • Repetitive behaviors (for example, hand-washing) or mental behaviors (for example, counting and repeating words or phrases)

  • Behaviors that are aimed at preventing distress, but are not realistically connected with what they are intended to neutralize

Other qualifiers:

  • The person recognizes the obsessions or compulsions are excessive and unreasonable.

  • The obsessions or compulsions cause marked distress, are time-consuming, and interfere with the person’s life.

  • The particular obsession or compulsion is not a specific symptom of some other mental disorder.

  • The obsessions and compulsions are not due to a substance (alcohol, drugs, or medications).

What causes OCD?

There is growing evidence that the major basis of OCD is neurobiologic. Family problems or attitudes learned in childhood—for example, an inordinate emphasis on cleanliness or a belief that certain thoughts are dangerous or unacceptable—are no longer considered primary and may not be involved at all. Genetic predisposition is currently being studied to establish a family link in this disorder.

Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medications produce changes in the brain. This is graphic evidence that both psychotherapy and medications affect the brain.

What treatments are available for OCD?

Both medications and psychotherapy have proven to be effective in most cases of OCD, and a combination of both is even more effective.

Several medications are effective in helping people with OCD, including clomipramine (a tricyclic antidepressant), or the SSRI (selective serotonin reuptake inhibitors), antidepressants, including: fluoxetine, fluvoxamine, sertraline, citalopram, escitalopran, and paroxetine. If one drug is not effective, others should be tried.

A type of behavioral therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is voluntarily exposed to whatever triggers the obsessive thoughts and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety. Cognitive psychotherapy also can be effective.

Can people with OCD also have other physical or emotional illnesses?

OCD sometimes is accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. When a person also has other disorders, OCD often is more difficult to diagnose and treat. Symptoms of OCD also can coexist and may even be part of a spectrum of neurologic disorders, such as Tourette's syndrome. Appropriate diagnosis and treatment of other disorders is important to successful treatment of OCD. Thus, it is important that the OCD sufferer have an initial evaluation by a psychiatrist or other mental health specialist to ensure correct diagnosis.