Definition

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

Frontal Lobe

Frontal lobe
This part of the brain is believed to be the area of impulse control.
© 2009 Nucleus Medical Art, Inc.

Causes

The cause is unknown. OCD might be due to neurobiological, environmental, genetic, and psychological factors. An imbalance of serotonin (a brain chemical) may play a major role.

OCD is linked to other neurological disorders, including:

Risk Factors

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

Symptoms

Symptoms:

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

People with OCD may know that their thoughts and behaviors do not make sense. And they would like to avoid or stop them. But they are often unable to block their obsessive thoughts or compulsions.

Common obsessions:

  • 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
  • Persistent worries about a tragic event

Common compulsions:

  • 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 rereading and rewriting
  • Mentally repeating phrases
  • Repeatedly washing hands

Diagnosis

OCD is usually diagnosed through a psychiatric assessment. OCD is diagnosed when obsessions and/or compulsions either:

  • Cause a person significant distress
  • Interfere with a person’s ability to properly perform at work, school, or in relationships

Treatment

Treatment reduces OCD thoughts and behaviors. But treatment does not completely eliminate them. Most commonly, treatment is a combination of medication and cognitive behavioral therapy.

Treatments include:

Medications

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

***Please note FDA Public Health Advisory for Antidepressants:

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose. Although the warning is for all antidepressants, of most concern are the SSRI class such as:

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

Other medications used include clomipramine (Anafranil) and clonazepam (Klonopin) . Clomipramine is a tricyclic antidepressant drug that alters serotonin levels. Clonzepam is a benzodiazepine that relieves anxiety.

Therapy

Behavioral therapy addresses the actions associated with OCD; cognitive behavioral therapy (CBT) addresses both the thought processes and the actions associated with OCD.

Examples of therapies used to treat OCD include:

  • Exposure and response prevention—helps you gradually confront the feared object or obsession without giving in to the compulsive ritual linked to it
    • In patients who are also taking SSRIs, this form of therapy may be more effective than stress management training.
  • Aversion therapy—use of painful stimulus to prevent OCD behavior
  • Thought switching—patient learns to replace negative thoughts with positive thoughts
  • Flooding—intense exposure to object that causes OCD behavior
  • Implosion therapy—repeated exposure to object that causes fear
  • Thought stopping—patient learns to stop negative thoughts

Future Treatment

An implantable brain device has received limited FDA approval to treat severe cases of OCD. Often called a brain pacemaker, the device delivers mild electrical impulses to the brain to interrupt OCD symptoms.

Prevention

There are no guidelines for preventing OCD because the cause is not known. But early intervention may help before it becomes worse.