Obsessive-compulsive disorder (OCD)
is characterized by anxious thoughts or rituals you feel you
can't control. People with OCD are plagued by persistent, unwelcome
thoughts or images, or by the urgent need to engage in certain
rituals. Symptoms of OCD include:
being obsessed with germs or dirt (washing hands over and
feeling the need to check things repeatedly
preoccupation with thoughts of violence
fear of harming people that are close to you
spending long periods of time touching things or counting
preoccupation with order or symmetry
persistent thoughts of performing sexual acts that are
repugnant to you
being troubled by thoughts that are against your religious
The disturbing thoughts or images are called
and the rituals that are performed to try to prevent or dispel them
. The person with OCD gets no pleasure
in carrying out the rituals they are drawn to, only temporary
relief from the discomfort caused by the obsession.
A lot of healthy people can identify with having some of the
symptoms of OCD, such as checking the stove several times before
leaving the house. But the disorder is diagnosed only when such
activities consume at least an hour a day, are very distressing,
and interfere with daily life. Most adults with this condition
recognize that what they're doing is senseless, but they can't stop
it. Some people, though, particularly children with OCD, may not
realize that their behavior is out of the ordinary.
If OCD grows severe enough, it can keep someone from holding
down a job or from carrying out normal responsibilities at home,
but more often it doesn't develop to those extremes. Left
untreated, obsessions and the need to perform rituals can take over
a person's life. OCD is often a chronic, relapsing illness.
Fortunately, effective treatments have been developed to help
people with OCD.
How common is OCD?
About 2% of the U.S. population has OCD in a given year. OCD
typically begins during adolescence or early childhood. At least
one-third of the cases of adult OCD began in childhood. Roughly 1
in 50 people develop OCD and it affects men and women in
approximately equal numbers. It can appear in childhood,
adolescence, or adulthood, but on the average it first shows up in
the teens or early adulthood. A third of adults with OCD
experienced their first symptoms as children.
The course of the disease is variable-symptoms may come and go,
they may ease over time, or they can grow progressively worse.
Evidence suggests that OCD might run in families.
or other anxiety disorders may accompany OCD. Some
people with OCD have
. In addition, they may avoid situations in
which they might have to confront their obsessions. Or they may try
unsuccessfully to use alcohol or drugs to calm themselves.
What causes OCD?
There is growing evidence that OCD has a
basis. It is no longer attributed to family problems or to
attitudes learned in childhood - for example, an inordinate
emphasis on cleanliness, or a belief that certain thoughts are
dangerous or unacceptable.
Instead, the search for causes now focuses on the interaction of
neurobiological factors and environmental influences. Brain imaging
studies using a technique called
positron emission tomography
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 medication produce changes in the caudate nucleus, a
part of the brain. This is graphic evidence that both psychotherapy
and medication affect the brain.
What treatments are available for OCD?
A combination of the two therapies is often an effective method
of treatment for most patients. Some individuals respond best to
one therapy, some to another.
Clinical trials in recent years have shown that drugs that affect
can significantly decrease
the symptoms of OCD. These drugs include
. All these
serotonin reuptake inhibitors
have proven effective in treatment of OCD. If a patient
does not respond well to one SRI, another SRI may give a better
response. For patients who are only partially responsive to these
medications, research is being conducted on the use of an SRI as
the primary medication and one of a variety of medications as an
additional drug (an augmenter). Medications are of great help in
controlling the symptoms of OCD, but often, if the medication is
discontinued, relapse will follow. Most patients can benefit from a
combination of medication and behavioral therapy.
Traditional psychotherapy, aimed at helping the patient develop
insight into his or her problem, is generally not helpful for OCD.
However, a specific behavior therapy approach called "
and response prevention
" is effective for many people with OCD.
In this approach, the patient is deliberately and voluntarily
exposed to the feared object or idea, either directly or by
imagination, and then is discouraged or prevented from carrying out
the usual compulsive response. For example, a compulsive hand
washer may be urged to touch an object believed to be contaminated,
and then may be denied the opportunity to wash for several hours.
When the treatment works well, the patient gradually experiences
less anxiety from the obsessive thoughts and becomes able to do
without the compulsive actions for extended periods of time.
Studies of behavior therapy for OCD have found it to produce
long-lasting benefits. To achieve the best results, a combination
of factors is necessary: The therapist should be well trained in
the specific method developed; the patient must be highly
motivated; and the patient's family must be cooperative. In
addition to visits to the therapist, the patient must be faithful
in fulfilling "homework assignments." For those patients who
complete the course of treatment, the improvements can be
significant. With a combination of pharmacotherapy and behavioral
therapy, the majority of OCD patients will be able to function well
in both their work and social lives. The ongoing search for causes,
together with research on treatment, promises to yield even more
hope for people with OCD and their families.
What other physical or emotional illnesses can accompany
OCD is sometimes accompanied by
, or other anxiety disorders. When a
person also has other disorders, OCD is often more difficult to
diagnose and treat. Symptoms of OCD can also coexist and may even
be part of a spectrum of neurological disorders, such as Tourette's
syndrome. Appropriate diagnosis and treatment of other disorders
are important to successful treatment of OCD.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a